Modifier 95 | Telemedicine Service Via Audio & Video Explained

Modifier 95 indicates a synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system.

1. What is modifier 95?

Modifier 95 is a telehealth modifier that identifies services provided through a synchronous or real-time audiovisual conference between a patient and a provider.

In this scenario, the provider at a distant site provides healthcare services for a patient at a different location. The patient must be an active participant in the telehealth visit.

2. When to use modifier 95?

Modifier 95 is appropriate when a healthcare provider delivers services to a patient through a synchronous telemedicine system. This system must provide two-way, real-time audiovisual conferencing between the patient and the provider.

3. Description

The official description of modifier 95 is “synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system.”

4. Examples

Procedures requiring modifier 95 include psychiatric evaluations, consultations, and follow-up visits. Modifier 95 is also used to remotely monitor chronic conditions, such as diabetes or heart disease.

5. Documentation

To use modifier 95, the healthcare provider must document the telehealth visit in the patient’s medical record. The documentation should include the date and time of the visit, the patient’s location, and the provider’s location. The provider must also document the services provided during the telehealth visit.

6. Billing

The healthcare provider must append modifier 95 to the appropriate CPT code to bill for services provided through a synchronous telemedicine system. The provider must also use the place of service code that corresponds to the patient’s location.

7. Common mistakes

One common mistake medical coders make when using modifier 95 is failing to document the telehealth visit in the patient’s medical record. Another mistake is using modifier 95 for services that do not meet the criteria for synchronous telemedicine. To avoid these mistakes, review the guidelines for using modifier 95 and ensure all documentation requirements are met.

8. Other modifiers related to modifier 95

Other modifiers related to modifier 95 include modifier GT, used for services provided through an interactive audio and video telecommunications system, and modifier GQ, used for asynchronous telemedicine services.

9. Tips

When using modifier 95, check with the individual payer for their policies, guidelines, and codes for which modifier 95 assignment applies. Some payers may require a specific place of service code or a different modifier.