Looks like Medicare will not be covering the new Telehealth code. This what I found
Hello all, for the new CPT codes for audio only telehealth visits using POS 10, do we need to use modifier 93? Do we also use modifier 93 for straight Medicare telehealth visits as well?
Add the modifier 93 if phone call to Evt mgt CPT codes. Ensure provider list mode of treatment (phone call vs face to face).Naturally if face to face do not add modifier 93I am now being told that Medicare will cover telehealth until March 2025. However the audio only codes are being discontinued and the new codes aren't recognized, so how will we bill Medicare for audio only?
There was Congressional action. However, at the present time it simply extends coverage until 03/31/2025. I expect it will be extended past that (hopefully on a permanent basis), but only Congress may do so.On the CMS website, they say "Absent Congressional action, beginning January 1, 2025, the statutory limitations thet were in place for Medicare telehealthservices prior to the Covid-19 PHEwill retake effectfor most telehealth services. These include geographic and location restrictions on where the services are provided, and limitations on the scope of practioners who can provide Medicare telehealth services."
Does that mean our doctors will not be able to do telemedicine E/M visits anymore since we are not in a rural area? We are a pulmonary practice and have a lot of elderly patients who prefer to do telemedicine visits. Any help will be much appreciated. Thank you.
The CPT book Appendix T for Audio Only codes does not list the E/M codes 99202-99205, 99211-99215, so I'm not sure if Medicare will accept the Modifier 93.Add the modifier 93 if phone call to Evt mgt CPT codes. Ensure provider list mode of treatment (phone call vs face to face).Naturally if face to face do not add modifier 93
ForehandlI work for a company that supports mental health members, and they are extending telehealth for Mental Health and I'm wondering why Medicare will not open up the new Telehealth codes for our members. The challenge we are coming across is that AHCCCS Medicaid is going to accept those new telehealth codes and Medicare is not, so that makes it difficult trying to communicate/train our providers to use two different types of codes.
I'm wondering the same thing. First Coast doesn't have modifier 93 on their website, Novitas does, but it says:I am now being told that Medicare will cover telehealth until March 2025. However the audio only codes are being discontinued and the new codes aren't recognized, so how will we bill Medicare for audio only?
Can you confirm if CMS is covering AUDIO only for ALL conditions, or just ESRD and Mental health? I cannot find clear documentation either way. I understand that we are not to use the new CPT codes (98008-98015) and we are to use modifier 93 with POS 10 when patient is at home, but am unclear about the conditions being treated. Appreciate any guidance!Add the modifier 93 if phone call to Evt mgt CPT codes. Ensure provider list mode of treatment (phone call vs face to face).Naturally if face to face do not add modifier
I also am not sure what to do in our cases for Mental health for our Psychiatry practice which use medication management and psychotherapy. In 2024 we would code 99214-95, 90833-95, but the new 98006 code doesn't work with 90833, so insteadIi think we need to code with the 25 modifier on the telemedicine code, but it doesn't seem right? (98006-25, 90833-95)?I work for a company that supports mental health members, and they are extending telehealth for Mental Health and I'm wondering why Medicare will not open up the new Telehealth codes for our members. The challenge we are coming across is that AHCCCS Medicaid is going to accept those new telehealth codes and Medicare is not, so that makes it difficult trying to communicate/train our providers to use two different types of codes.
I am also receiving rejections from UHC and BCBS with no change when POS codes changed.Has any one had success yet with the new telehealth code sets being accepted/paid? I am tracking all our claims going out the door with these codes, and so far NO ONE is paying. I have rejections from straight BCBS, UHC, Humana. I have tried the new codes utilizing POS 11, 10, 2. None of which have had any success. I had a feeling this was going to be a headache. When 99418 was introduced as the new prolonged visit code for inpatient visits, it took an entire month before all insurances had it implemented on their end and started paying. thank you in advance.
I had the same question appendix t is pretty limited.UHC's newest policy update states modifier 93 will only be paid when appended to codes in appendix t. So how do we bill for audio only?
BCBS ND gives clear direction on codes that do not require 95 modifiers, and the 98XXX codes are on that list. So they are not required. But the 9921X codes would need the modifier.Hi some one give suggestion wheather still we can use 95 modifier for cpt 98000-98007 still allowed to but portals and codify ? not showing any edits kindly navigate me how to use 95 modifer
Any thoughts on this? I'm wondering the same thing.Hello,
Thank you for the update on the new telehealth codes, I understand that Medicare might not recognize them, but
what would have been the benefit of the new tele-health codes when practitioners can still submit a e/m visit using telehealth with the codes: 99202-99205 and 99211-99215?
CPT codes are created by the AMA after their committees and research decided new codes were needed. AMA does not decide any payor policies.Any thoughts on this? I'm wondering the same thing.
I was wondering the same thing. I work for a psychiatry practice that regularly bills EM+psychotherapy add on codes. Have you confirmed that you can't bill the add on with the new codes? Any luck with the -25 mod?I also am not sure what to do in our cases for Mental health for our Psychiatry practice which use medication management and psychotherapy. In 2024 we would code 99214-95, 90833-95, but the new 98006 code doesn't work with 90833, so insteadIi think we need to code with the 25 modifier on the telemedicine code, but it doesn't seem right? (98006-25, 90833-95)?
I tried and Medicare deniedThe CPT book Appendix T for Audio Only codes does not list the E/M codes 99202-99205, 99211-99215, so I'm not sure if Medicare will accept the Modifier 93.