Use of New Audio-Only Telemedicine Claim Modifiers.

Morenz AM, Staloff J, Liao JM, Wong ES. Use of New Audio-Only Telemedicine Claim Modifiers. JAMA Network Open. 2023 Dec 1; 6(12):e2348224.

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Abstract:

IMPORTANCE: Policymakers at both the state and federal levels face decisions about coverage of audio-only telemedicine amid a dearth of reliable data due to changes and variation in billing practices. OBJECTIVE: To describe early trends in the use of new audio-only telemedicine claims modifiers 93 and FQ in Washington State, which were introduced to improve the designation and identification of audio-only telemedicine claims. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study analyzed claims data from the Washington All-Payer Claims Database from January to November 2022. Participants included 4.3 million children and adults insured for at least 6 months in 2021 through public or private insurance plans. EXPOSURES: Use of audio-only telemedicine was compared by age, race, ethnicity, insurance type, rurality, and Social Vulnerability Index. MAIN OUTCOMES AND MEASURES: Audio-only telemedicine services were identified by claims appended by Current Procedural Terminology (CPT) code modifiers 93 or FQ or that included telephone-only CPT codes. Modifiers 93 and FQ denote audio-only telemedicine services for any reason and for behavioral health concerns, respectively. RESULTS: In 2022, there were a total of 917?589 audio-only telemedicine services, of which 345?941 (38%) were appended with modifier FQ and 55?352 (6%) with modifier 93. Audio-only telemedicine services with these modifiers were most frequent for behavioral health diagnoses or routine prenatal and postpartum care. Individuals who used telemedicine exclusively via audio-only modality were more likely to be older (mean [SD] age, 46.0 [22.5] vs 42.0 [21.4] years) and insured by Medicare (41?758 of 196?225 [21%] vs 95?962 of 707?626 [14%]) than those who used at least 1 audiovisual service. CONCLUSIONS AND RELEVANCE: In this cohort study of a statewide all-payer claims database, modifiers 93 and FQ offered the important capability to identify audio-only telemedicine services beyond telephone-only CPT codes, but their uptake remained low. Audio-only telemedicine appears to offer an important means for access to behavioral health and perinatal care access, but further work is needed to study outcomes and quality of care.