Modifier 95: A Guide to Telehealth Billing

Modifier 95 is a medical billing code used to indicate that a service was provided via telehealth. This modifier is crucial for ensuring that healthcare providers receive appropriate reimbursement for remote services.

Key Points About Modifier 95:

• Purpose: Modifier 95 is appended to the CPT or HCPCS code for a service conducted through real-time audio and video communication between a healthcare provider and a patient.
• Usage: It's primarily used for services that mirror in-person visits, such as consultations, follow-up visits, and behavioral health services.
• Requirements: To use Modifier 95, the telehealth service must meet specific requirements, including using synchronous communication technology. Asynchronous or "store-and-forward" services generally don't qualify.
• Billing: When Modifier 95 is used correctly, it ensures the claim is processed as a telehealth service and eligible for reimbursement, often under the same rates as in-person care, depending on the payer.

Common Use Cases for Modifier 95:

• Telehealth Visits: Initial consultations, follow-up visits, established patient visits, and new patient visits.
• Telehealth Consultations: When a healthcare provider consults with another provider about a patient using telehealth.
• Telehealth Evaluations: When a healthcare provider evaluates a patient's condition using telehealth.

Important Considerations:

• Payer Requirements: Always check with the payer's specific guidelines to ensure compliance with their rules regarding telehealth services and the use of Modifier 95.
• State and Federal Regulations: Be aware of any state or federal regulations that may impact the use of telehealth services and the application of Modifier 95.
• Documentation: Maintain detailed documentation of telehealth visits, including the date, time, and type of service provided. This documentation can be crucial in supporting reimbursement claims.

Example of Modifier 95 Usage:

If a physician performs a telehealth follow-up visit with an established patient, the billing code would be the appropriate evaluation and management (E/M) code followed by Modifier 95. For instance, if the visit is a level 3 E/M, the billing code would be 99213-95.

Conclusion:

By understanding the appropriate use of Modifier 95 for telehealth services, healthcare providers can ensure accurate billing and reimbursement. This modifier is a vital tool in the world of telehealth, helping to streamline the billing process and ensure that providers receive fair compensation for their services.

Need Assistance with Telehealth Billing?

Allzon Management Services can provide comprehensive support to medical billing companies, helping them stay compliant, optimize revenue, and minimize claim denials. Our expert team can assist with:

• Regulatory Compliance
• Staff Training
• Eligibility Verification
• Documentation Management
• Claim Review and Appeals

Contact Allzon Management Services today to learn more about how we can help your medical billing company.

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