Wiki Telehealth visits and modifier for 2025

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kkiger123

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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?​

 
kkiger123 said:

​

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?​

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Looks like Medicare will not be covering the new Telehealth code. This what I found
"The bad news is that Medicare does not plan to recognize the other 16 new telehealth codes (98000-98016) that CPT 2025 added. CMS plans to assign payment status code “I” (Not valid for Medicare purposes) to these codes. Therefore, for evaluation and management (E/M) visits performed over telehealth, you’ll continue to use the existing E/M codes, such as 99202-99215 for Medicare payers. It’s unclear which private payers – if any – do plan to recognize 98000-98016 in 2025. Most insurers will be issuing their 2025 coverage guidelines in the coming weeks." https://www.medcentral.com/coding-r...dule-targets-telehealth-advanced-primary-care
 
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?
 
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?
 
rsinoben said:
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?
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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
 
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.
 
mbanerjee said:
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.
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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.
 
TThivierge said:
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
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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.
 
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.
 
forehandl said:
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.
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Forehandl
I heard will keep all telehealth CPT codes till Mar 2025. But also heard telehealth works best for mental health support. We use modifiers 93 and 95 with all Evt Mgnt codes but in the southern part of US. I hope this helps you. Also told to use modifier AI, AH and AJ when certain professionals do the session related to telelhealth.
Lady T
 
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rsinoben said:
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?
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I'm wondering the same thing. First Coast doesn't have modifier 93 on their website, Novitas does, but it says:
This modifier should only be used by Opioid Treatment Programs (OTPs) and Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs):
Opioid Treatment Programs (OTPs) report on claims for counseling and therapy provided using audio-only technology.
Reference Opioid Treatment Programs Claims
RHCs and FQHCs report modifier on claims for mental health visits for audio-only technology.

UHC Medicare usually follows Medicare guidelines but they are not approving modifier 93 for use with codes not found in appendix t. So is audio only no longer covered in 2025?
 
TThivierge said:
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
Click to expand...
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!
 
forehandl said:
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.
Click to expand...
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)?
 
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.
 
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