Does Medicare require modifier 95 for telemedicine?
The utilization of telemedicine has surged in recent years, particularly amidst the global pandemic. As a result, healthcare providers have been seeking clarity on billing and coding requirements for telemedicine services. One of the most common questions revolves around the use of modifier 95 in Medicare billing. In this article, we will delve into whether Medicare necessitates the use of modifier 95 for telemedicine services.
Understanding Modifier 95
Modifier 95, also known as the “Significant, separately identifiable evaluation and management (E/M) service by the same physician on the same day of the procedure or other service,” is used to indicate that a physician has provided a significant, separately identifiable E/M service on the same day as another service. This modifier is crucial in certain scenarios where a patient requires additional medical attention that is distinct from the primary service being performed.
Medicare’s Position on Modifier 95 for Telemedicine
Medicare does not explicitly require modifier 95 for telemedicine services. However, the use of this modifier can be beneficial in certain situations. According to the Centers for Medicare & Medicaid Services (CMS), the use of modifier 95 is appropriate when the telemedicine service is significant and separately identifiable from the other service provided on the same day.
When to Use Modifier 95 for Telemedicine
1. Separate Evaluation: If a physician provides a telemedicine service that is distinct from the primary service being performed, such as a separate evaluation or consultation, modifier 95 can be used.
2. Significant Service: The telemedicine service must be significant and separately identifiable from the primary service. This means that the service should be substantial enough to justify billing it separately.
3. Documentation: Proper documentation is essential to support the use of modifier 95. The documentation should clearly state the nature of the telemedicine service and its significance in relation to the primary service.
Alternatives to Modifier 95
If modifier 95 is not applicable or deemed unnecessary, there are alternative coding options for telemedicine services. For instance, CMS provides specific codes for telemedicine visits, such as G2061 (Telehealth visit for evaluation and management of an established patient, 5-10 minutes) and G2062 (Telehealth visit for evaluation and management of a new patient, 5-10 minutes).
Conclusion
In conclusion, Medicare does not require modifier 95 for telemedicine services; however, its use can be beneficial in certain scenarios. Healthcare providers should assess the significance and distinctiveness of the telemedicine service in relation to the primary service and document the service accordingly. By understanding the appropriate use of modifier 95 and alternative coding options, providers can ensure accurate billing and compliance with Medicare regulations.
