Healthcare Fraud Shield’s Latest Article: New Year, New Modifier?

11 Jan

You may asking yourselves, what Modifier? Well, in September 2021, the AMA CPT Editorial Panel agreed on the acceptance of a new modifier, Modifier -93.  The code was published to the AMA website December 31, 2021.  Due to the late addition of the code, many folks may not be aware of it because it will not be in the AMA code files or books until 2023 even though it is effective January 1, 2022. 

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.

What should I know about this Modifier?

Let’s carve out some of the key words/sections and their meanings:

  • Synchronous means real-time
  • Telephone/Audio-Only means no video communication
  • Must meet the key components and/or requirements of the same service when rendered via a face-to-face interaction means this must show the same service would/coud have been rendered in person. 

What to look for?

With any new code of any kind we want to look for potential abuse so we should pay close attention to: 

  • Providers billing it excessively
  • Frequency of billing per member
  • Services performed and billed with this code that could not possibly meet the requirements if it had been performed in a face-to-face interaction

Healthcare Fraud Shield is monitoring this new Modifier very closely with a new alert:

[2527-20] – OUTLIER, MODIFIER 93: This Alert identifies providers excessively billing modifier 93 when compared to their peers as they may not be meeting the key components and/or requirements of the same service when rendered via a face-to-face interaction. (PEER COMPARISON)

If you have any questions or comments, please reach out to SIU@hcfraudshield.com.


[1] https://www.ama-assn.org/system/files/cpt-appendix-a-modifier-93.pdf

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