Modifier – 95 for Telemedicine Services

Following is the AMA definition of mod 95:

“Modifier 95 – Synchronous telemedicine service defined as a real-time interaction between a physician or qualified healthcare professional and a patient who is located at a distant site from the provider. The totality of the communication of information exchanged between provider and the patient during the course of the service must be of an amount and nature that would be sufficient to meet the key components of the same service when rendered via a face-to-face interaction.”

 

This is the real-time interaction between a physician or qualified professional and a patient.  The services are to be documented just like an office visit or a hospital consultation.  We would append this modifier to any of the applicable evaluation and management (E&M) codes.  What the modifier tells the carriers is that the service was rendered in the same format that you would render an office visit or hospital consultation, but it was done through real-time interaction via something like Skype and the   provider documented all the services just like they would any other E&M service.

 

This 95 modifier can be applied to any new patient visits, established patient visit, inpatient consultation, an inpatient visit, or any office consultation.  There are additional CPT codes for which you may use a telemedicine modifier, but Apache Health specializes in:

In these medical billing specialties, the provider is rendering services either in their office or an external facility and it’s professional services rendered by a specialist, therefore, these are the codes that are applicable to the services.  So when it’s done in a telemedicine environment we would append the modifier to the same CPT code as if you saw the patient face-to-face and it would notify the insurance carriers that the same E&M service was rendered in a telemedicine capacity.

 

Modifier – 95 for Telemedicine Services

Mod 95 Can be used with the following E&M CPT codes:

  • CPT 99201-99205

New Patient Visits

  • CPT 99212-99215

Established Patient Visits

  • CPT 99231-99233

Inpatient Visits

  • CPT 99241-99245

Consultations

  • CPT 99251-99255

Inpatient Consultations

 

About Apache Health

Apache Health is a revenue cycle management (RCM) analytics, benchmarking, and auditing company. The founders of Apache formerly ran a large RCM company that was acquired by a private equity group in a rollup. Apache’s predictive analytics will benchmark billing performance and project exactly how much more revenue you should earn from your existing volume of patients.  Using many factors and a blend of artificial intelligence and specialty specific benchmarks, the model projects whether changing the billing process would improve collections for your particular mix of procedures and payers. Apache Health can help you evaluate whether to outsource the billing, determine which billing company to select to maximize performance, or track in-house billing performance improvement over time. For more information contact:

Sean McSweeney

Apache Health

www.apachehealth.com

888-422-5514