12/15/2022

Correct Billing for Audio Only Telehealth Visit

can you tell me why some insurance companies are not acknowledging the 93 audio only telehealth modifier

The coding is incorrect for an audio only telehealth visit. Modifier -93 should not be used for these services. Based on the amount of time spent with the patient, one of the following E&M codes should be billed to WellCare:

99441: Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment.

99442:  11-20 minutes of medical discussion

99443: 21-30 minutes of medical discussion

Established patient E&M codes should only be used with commercial insurance payers, depending on their reimbursement guidelines for telemedicine services.