Resolved New Jersey Medicaid Telehealth resources

[SandraD_44941]

Hello,

I am auditing Psych visits and do not have any resources regarding Telehealth Services and the use of modifier 95. Can someone provide me a link or email me any resources?

 

[JenniferD_91853]

Hello,


When auditing psychiatric visits involving telehealth services, understanding the appropriate use of Modifier 95 is crucial. Here's an overview based on the latest CMS guidelines:

Modifier 95: Synchronous Telemedicine Service​

Modifier 95 is designated for services rendered via real-time, interactive audio and video telecommunications systems. According to the American Medical Association (AMA), this modifier applies to synchronous telemedicine services. CodingIntel+4Mend+4Medicare FCSO+4

CMS Guidelines on Modifier 95 Usage​

As of January 1, 2024, CMS has updated its policies regarding the use of Modifier 95:

• General Use: CMS no longer requires Modifier 95 for most telehealth services. Instead, providers should use the appropriate Place of Service (POS) codes:CodingIntel
  
  • POS 02: Telehealth provided other than in the patient's home.Centers for Medicare & Medicaid Services+1Medicare FCSO+1
  • POS 10: Telehealth provided in the patient's home. Centers for Medicare & Medicaid Services
• Exceptions: Modifier 95 is still required for:
  
  • Outpatient therapy services provided via telehealth by physical therapists (PTs), occupational therapists (OTs), or speech-language pathologists (SLPs) employed by hospitals.NGS Medicare+3Medicare+3Medicare FCSO+3
  • Services where the clinician is in the hospital and the patient is in their home. NGS Medicare+2Medicare+2Medicare FCSO+2

Behavioral Health Services​

For behavioral health services, including psychiatric evaluations and therapy sessions, telehealth provisions have been extended:

• CMS allows these services to be provided via telehealth through September 30, 2025. Medicare FCSO+1CodingIntel+1
• For audio-only telehealth services, Modifier 93 should be used. Mend+2CodingIntel+2Medicare FCSO+2

Additional Resources​

For comprehensive information, you can refer to the following resources:

• CMS Telehealth Services Fact Sheet
• CMS Evaluation and Management Services Guide
• Telehealth Coding and Billing Basics - AAFP

If you need further assistance or have specific scenarios you'd like to discuss, feel free to ask.