Should We Begin Using the New CPT Modifier -93

Question:

Should we begin using the new CPT® modifier -93?

Answer:

I recommend a wait and see approach.  Here’s the definition from the AMA, released in December, 2021 with an effective date of 1-1-2022. It will be included in the 2023 book.

Modifier -93 Synchronous Telemedicine Service Rendered Via Telephone or Other Real-Time Interactive Audio-Only Telecommunications System: Synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located away at a distant site from the physician or other qualified health care professional. The totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that is sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction.

• Let’s start with Medicare. I have not seen any CMS guidance about using modifier -93 for office visit codes done via audio-only, without real-time, audio/visual equipment. Let’s see what they say. Perhaps CMS or your MAC will want modifier -93 on services that can be performed audio only, from the CMS list. So far, I haven’t see anything.
• Don’t confuse this with the new FQ modifier. FQ is for audio only for behavioral health services performed via telehealth, effective 1-1-2022.
• Other payers? Every payer is different. They may or may not have added this modifier to their library of modifiers, and they may not have had time to develop a policy for this modifier, and whether to use it in place of modifier 95. Unfortunately, it is another instance in which you’ll have to check payer by payer.