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Telehealth service modifiers

Telehealth modifiers should be submitted with distant site telehealth services. Generally, interactive audio and video communications must be used to permit real-time communication between distant site physician or practitioner and patient. Patient must be present and participating in telehealth visit.

A list of telehealth services is available on the CMS website.

Modifier Description Additional notes
93 Telehealth modifier defined as "synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system."

Modifier 93 is used for audio only communication:

  • Permitted for patients in their home if patient does not have:
    • Technical capacity
    • Availability of real-time audio and visual interactive technology
  • Permitted for patients in their home if patient does not:
    • Consent to the use of two-way, audio/video technology

Opioid Treatment Programs (OTPs) report on claims for intake activities, periodic assessments, counseling and therapy provided for audio-only technology:

RHCs and FQHCs can report either modifier 93 or FQ for services provided by audio-only technology.
95 Telehealth modifier defined as synchronous telemedicine service rendered via real-time Interactive audio and video telecommunications system.

For institutional billing, use modifier 95 for dates of service on and after January 1, 2024, through September 30, 2025, when:

  • The clinician is in the hospital and the patient is in their home.
  • Outpatient therapy provided via telehealth by PTs, OTs or SLPs employed by hospitals.

OTPs report on claims for intake activities, periodic assessments, counseling and therapy provided for audio-only technology:
FQ The service was furnished using audio-only communication technology. This modifier is only used by RHCs and FQHCs
G0 (zero) Telehealth services furnished for purposes of diagnosis, evaluation, or treatment of symptoms of an acute stroke. 

Valid for:

  • Telehealth distant site codes billed with place of service (POS) code 02; or
  • CAH method II (revenue codes 096X, 097X, or 098X); or

Telehealth originating site facility fee, billed with HCPCS code Q3014.
GQ Telehealth service rendered via asynchronous telecommunications system. Certifying the collection and transmission of the asynchronous medical file at the distant site from a federal telemedicine demonstration conducted in Alaska or Hawaii.
GT

Telehealth service via interactive audio and video telecommunication systems. *

 

 *Only allowed on institutional claims billed by CAH method II providers.

 

References