Health Plans Not All Recognizing New Telehealth Code
By Joey Berlin

A new telehealth code and a series of coding modifier descriptors have already taken effect in 2022 or will take effect soon. But not all health plans are recognizing the new coding elements, according to Texas Medical Association staff monitoring their status.

TMA staff recommend you check with health plans directly to find out if they recognize the following:

  • POS 10, a new Centers for Medicare & Medicaid Services code that corresponds to telehealth provided to patients at home, set to take effect on April 4.
  • Modifier 93, an American Medical Association CPT code modifier now in effect that corresponds with a real-time medical service delivered by telephone or another audio-only technology.

Also not yet recognized by all health plans are the following Healthcare Common Procedure Coding System modifiers:

  • Modifier FQ (furnished using audio-only communication technology);
  • Modifier FR (supervising practitioner was present through two-way communication technology with both audio and video); and
  • Modifier FT (unrelated evaluation and management during a postoperative period, or on the same day as a procedure or another evaluation and management visit).

TMA reimbursement specialists are keeping watch on insurers’ recognition of codes and modifiers. TMA’s Health Plan News page will post new developments as they emerge; for example, as noted on the Health Plan News page, Humana is recognizing modifier FQ.

Continue to read Texas Medicine Today for updates.

CPT copyright American Medical Association. All rights reserved.

Last Updated On

April 05, 2022

Originally Published On

January 19, 2022

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