Be on the lookout for guidance on modifier 93 from private payers and Medicare. The new modifier isn’t in your 2022 CPT manual but it will go into effect Jan. 1, 2022, the AMA announced in an
undated notice on its website.
Part B News has not been able to locate a Medicare or payer policy that requires the modifier, but practices should study the full descriptor so they’ll be prepared:
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.
The modifier may be appropriate for encounters that take place by computer, tablet or telephone. For example, a patient who usually receives telehealth services by real-time audio and visual connection may request an audio-only encounter because he hasn’t gotten dressed that day. The treating practitioner will need to indicate the nature of the connection – audio and visual or audio-only – for accurate coding.
In addition, the modifier asserts that an audio-only encounter was appropriate for the encounter.
The CPT editorial panel discussed a modifier to describe real-time, audio-only services during a CPT editorial panel meeting, which took place Sept. 30-Oct. 2, 2021. The panel gave no sign that it would roll out a modifier so quickly in the
Summary of Panel Actions, released Nov. 1, 2021.
The modifier will be included in the 2023 CPT manual.
The panel took similar action on a new appendix for augmented and artificial intelligence (AI) during the September meeting. It created
Appendix S: AI taxonomy for medical services & procedures to help stakeholders classify various clinical AI systems when they submit a code change application.