Telehealth may have become more popular during the COVID-19 emergency. However, it also led to confusion in medical billing. Providers and billing teams must clearly distinguish between a phone-only visit and a full audio-video encounter.
This is exactly why medical billing teams use the modifier 93. The modifier was introduced by the American Medical Association (AMA) CPT Editorial Panel and became effective after January 1, 2022. It indicates a synchronous telemedicine service delivered using real-time audio-only communication for diagnosis and treatment.
Learning to bill this modifier, its applicable scenarios, billing guidelines, and the primary differences between 93 and modifier 95 is a must for successful processing of telehealth claims.
Modifier 93 – Description
Modifier 93 is defined as:
“Synchronous Telemedicine Service Provided Using Telephone/Other Real-Time Interactive Audio-Only Telecommunications System.”
According to the American Academy of Family Physicians (AAFP), the “synchronous telemedicine service” mentioned here refers to a real-time interaction between the patient and a qualified physician or a healthcare provider present at a remote site for treatment.
The AMA suggests that any information exchanged between the healthcare professional and the patient during the audio-only visit must be comprehensive and substantive, just like it would be in the case of a face-to-face encounter.
Modifier 93 and Appendix T
Appendix T (introduced in the CPT 2022 updates) identifies codes eligible for audio-only reporting when the modifier 93 is appended. Simply put, CPT codes like 90785, 97804, 90791, 99354, and 90792 may be reported with modifier 93 when the service is delivered via audio-only communication.
You can find an audio-speaker symbol on these codes within the CPT codebook. Additionally, the American College of Allergy, Asthma & Immunology (ACAAI) explains that the modifier was unpublished in the hardcopy of the CPT book until the 2023 edition.
Scenarios WhereModifier 93 is Applicable
Modifier 93 applies to telehealth services, but should be used in specific scenarios by billing professionals. The following are three applicable scenarios to remember for this modifier:
Follow-Up E/M Service via Telephone
Consider the case of a 72-year-old female Medicare beneficiary suffering from type 2 diabetes. The woman also suffers from hypertension and connects with her primary care physician via phone call for an evaluation and management (E/M) encounter.
In this case, the patient is present in a rural area with unreliable internet. Therefore, due to technical limitations for a video interaction, the provider and patient switch to a telephone call. During the evaluation, the specialist:
- Reviews the patient’s current medication.
- Documents moderate-complexity medical decision-making (MDM).
- Conducts a telephone visit (30 minutes duration).
- Adjusts her antihypertensive routine.
Since Medicare wants providers to report telehealth E/M services with standard office codes, the visit will be reported with CPT code 99214 and place of service (POS) code 10. Also, modifier 93 will be appended since Medicare specifically requires it for audio-only services.
Audio-Only Psychiatric Diagnostic Evaluation
Let us say a psychiatrist provides an initial psychiatric diagnostic evaluation for a patient with a major depressive episode. The patient is bound at home, thus does not have access to video call technology. However, he can participate in a real-time telephone call for the same purpose.
During the evaluation, the psychiatrist documents the complete diagnostic evaluation, which includes:
- Psychiatric history
- Pharmacologic treatment plan
- Mental status examination
After the services are complete, the billing team uses CPT code 90792, which may be reported with POS 10, and modifier 93 only if the payer policy allows audio-only delivery for this service.
Important Note: According to the AMA’s Appendix T, code 90792 is eligible for audio-only telehealth reporting using the 93 modifier.
Fertility Counseling (Audio-Only)
Imagine a case where a reproductive endocrinologist conducts a telephone consultation with a 30-year-old female patient. During the call, the endocrinologist discusses embryo transfer options, medication protocols, and addresses informed consent.
Moreover, according to the American Society for Reproductive Medicine (ASRM) Coding Committee, using modifier 93 is accurate if the CPT code is part of Appendix T, given the payer accepts audio-only delivery.
Modifier 93 – Billing Guidelines
The modifier has been widely reported since the COVID-19 emergency, but it can often lead to revenue cycle disruptions if billing teams are not well-versed in the guidelines. Therefore, here’s a quick, comprehensive look at the most crucial ones.
Verify the CPT Code Appears in Appendix T.
As stated earlier, AMA designates Appendix T codes as eligible for audio-only reporting. However, payer policies ultimately determine coverage and reimbursement. So, appending modifier 93 to a code not listed in Appendix T may result in a claim denial.
Use the Correct POS Code
The place of service is a vital piece of information for modifier 93 and can determine the claim’s outcome. Therefore, always report the place of service where the service was rendered. Generally, the following POS codes are used with the 93 modifier.
- POS 02 (services provided in a place other than the patient’s home).
- POS 10 (services rendered in the patient’s home).
These POS codes are typically used for telehealth services. However, modifier 93 should be appended only when required by the payer.
Document Clinical Appropriateness
Justifying clinical appropriateness for the audio-only service is a must for professionals. Therefore, medical billing teams should document the clinical appropriateness of audio-only delivery.
A couple of reasons for this may include:
- The patient lacks video-capable technology.
- Bandwidth issues.
- Patient preference.
- Clinical condition of the patient.
Additionally, the encounter must meet the documentation and medical-necessity standards equivalent to an in-person visit.
Avoid Reporting 93 and 95 Together
Modifier 93 is explicitly for audio-only telehealth services, whereas modifier 95 indicates a real-time audio and video encounter. Hence, they should not be reported together, as they represent different communication modalities and may lead to claim denials.
Confirm Payer-Specific Requirements
Billing guidelines for the modifier are subject to change. Therefore, medical billing teams should review each guideline and follow the latest requirements. They should verify each payer’s authorized coverage guidelines across Medicare, Medicaid, and commercial plans. This ensures the claim is compliant and fulfills requirements appropriately.
Modifier 93 vs 95: What’s the Difference?
Modifiers 95 and 93 both apply to synchronous telemedicine, but are they the same? No. They have their distinctions, which we have discussed in the table below.
| Modifier 93 | Modifier 95 | |
|---|---|---|
| Tech Utilized | Audio-only (real-time telephone or equivalent). | Audio and video (real-time). |
| Medicare Use | Applicable to telehealth claims (audio-only). | Medicare uses POS codes (02 or 10), so it does not need the modifier. |
| Applicable Since | January 1, 2022 | January 1, 2017 |
| Applicable Appendix List | Appendix T (audio-only eligible). | Appendix P (audio-video eligible). |
According to the information available at AMA’s overview of telehealth CPT code development, new telehealth E/M codes (98000-98016), introduced in 2025, include built-in distinctions for audio-only and audio-video services, potentially reducing the need for modifiers.
However, billers should verify whether the insurer follows the new codes or chooses traditional E/M codes for modifiers 95 and 93.
Partner with MediBillMD for Fewer Telehealth Denials
Modifier 93 is a simple and effective telehealth modifier that indicates to the payer the visit was explicitly audio-only. However, the guidelines applicable to the modifier may be relatively complex.
If your team struggles to focus on patient care due to excessive billing workload, we recommend considering professional medical billing services to ensure accurate telehealth coding, payer compliance, and fewer denials.
