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As telemedicine continues to transform the healthcare industry, correct billing practices are essential for accurate reimbursement. Modifier 95 is an important element in telehealth billing, as it indicates that a healthcare service was conducted using real-time audio and video communication. Introduced in 2017 by the American Medical Association (AMA), Modifier 95 differentiates telehealth visits from in-person appointments, ensuring proper documentation and compliance with payer requirements.
In this guide, we’ll cover:
Modifier 95 is used in medical billing to indicate that a service was provided via synchronous telemedicine, which is a live interaction between the patient and provider through video and audio communication. It allows insurers to easily identify telehealth services and appropriately process claims based on the interaction’s remote nature.
As telemedicine continues to grow, using the correct billing codes is critical for accurate reimbursement. Modifier 95 has become an essential tool for telehealth billing, as it helps clearly identify and document remote services. Here’s why Modifier 95 is so important:
Using Modifier 95 effectively enhances billing accuracy, helping providers navigate the unique requirements of telehealth services and ensure appropriate reimbursement.
Modifier 95 is added to specific Current Procedural Terminology (CPT) codes to indicate that the service was conducted via telehealth. Common CPT codes associated with telehealth include:
On the CMS 1500 form, Modifier 95 should be included in field 24d alongside the corresponding CPT code, ensuring accurate telehealth billing.