The healthcare landscape changed dramatically in recent years. Telehealth went from a niche service to a mainstream care delivery method almost overnight. While video visits gained much of the attention, telephone-based care remained an essential option for many patients.
Enter Modifier 93.
This billing code, introduced by the American Medical Association (AMA) in 2022, officially recognizes audio-only telehealth services in the Current Procedural Terminology (CPT) coding system -5. Before its creation, providers faced confusion about how to properly bill for telephone visits that provided meaningful medical care.
Today, Modifier 93 plays a crucial role in medical billing. It helps practices get paid for legitimate audio-only services while maintaining clear documentation about how care was delivered. This guide explains everything you need to know about this important modifier.
What Exactly Is Modifier 93?
Modifier 93 is a two-character code appended to CPT procedure codes. It indicates that a service was delivered through audio-only telecommunications.
The official descriptor from the AMA states:
“Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system” -5.
Let’s break down what this means in plain language:
Synchronous means real-time. The provider and patient communicate simultaneously, just like a regular phone call. This differs from asynchronous services like store-and-forward where information is recorded and reviewed later.
Audio-only means exactly what it sounds like. No video component exists. The interaction happens through voice communication alone.
Telecommunications system covers various technologies. While a standard telephone works, this also includes secure smartphone apps, VoIP systems, and other audio-only platforms.
The key point is that Modifier 93 describes real-time voice communication between a provider and patient who are in different locations.
The Effective Date
Modifier 93 became effective on January 1, 2022 -5-12. However, due to its late addition to the CPT code set, many providers didn’t learn about it until later in the year. The AMA created Appendix T in the CPT manual to list codes appropriate for use with Modifier 93 -5.
Why Was Modifier 93 Created?
Before Modifier 93 existed, providers faced an awkward situation. They could bill for phone calls using CPT codes 99441-99443 (telephone evaluation and management services). However, these codes had limitations. They couldn’t be used for established patients already being managed for ongoing conditions, and they had strict time requirements.
The pandemic highlighted the need for more flexible audio-only options. Many patients couldn’t or wouldn’t use video technology. Others lived in areas with poor internet connectivity. Some simply preferred the simplicity of a phone call.
The AMA recognized this reality and created Modifier 93 to provide a better solution -5. This allowed providers to bill audio-only services using standard evaluation and management (E/M) codes, just like they would for in-person or video visits.
The Official Definition: What the AMA Says
Let’s look at the official language directly from the AMA’s CPT manual:
“Synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located away at a distant site from the physician or other qualified health care professional” -5.
This definition contains three essential elements:
- Real-time interaction – The exchange happens live, not stored and forwarded
- Physician or qualified professional – The service must be provided by an eligible healthcare provider
- Distant site – The patient is in a different location from the provider
The definition continues with an important requirement about the service quality:
“The totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that is sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction” -5.
This sentence is crucial. It means you can’t just provide a quick, superficial phone call and bill it the same as an in-person visit. The audio-only service must be comprehensive enough to meet all the requirements of the service as if it were done face-to-face.
When to Use Modifier 93
Modifier 93 applies specifically to audio-only telehealth encounters. Here are the primary situations where its use is appropriate:
1. Patient Lacks Video Capability
Some patients simply don’t have the technology for video visits. This includes:
- No smartphone or computer
- Insufficient internet bandwidth for video
- Older adults who struggle with technology
- Individuals in rural areas with poor connectivity
When the patient cannot participate in a video visit, Modifier 93 lets you provide care by phone and get properly reimbursed -1.
2. Patient Declines Video
Some patients prefer not to use video for various reasons:
- Privacy concerns about their home environment
- Feeling uncomfortable being on camera
- Disability that makes video participation difficult
Medicare explicitly allows audio-only visits when the patient does not consent to two-way audio/video technology -1.
3. Technical Difficulties
Sometimes technology fails. The provider’s video system might be down, or the patient’s camera might not work. In these situations, converting to an audio-only visit and using Modifier 93 can save the appointment.
4. Clinical Appropriateness
Some services are well-suited for audio-only delivery. Many behavioral health services, medication management visits, and follow-ups for stable chronic conditions can be effectively handled by phone.
However, not every service is appropriate for audio-only delivery. Physical examinations require visual observation. Wound checks need visual assessment. The provider must determine if the service can be safely and effectively delivered without video.
When NOT to Use Modifier 93
Understanding when not to use this modifier is just as important as knowing when it applies.
Avoid Modifier 93 When:
- Video was used – If the visit included any video component, use Modifier 95 instead.
- The service wasn’t synchronous – For asynchronous (store-and-forward) services, different modifiers apply.
- The patient was in the same location – Modifier 93 is only for services provided at a distant site.
- The service isn’t on the approved list – Not all CPT codes are eligible for telehealth delivery, even by phone.
- The visit lacked adequate clinical content – A brief, superficial phone call doesn’t qualify as a comprehensive service.
Critical Warning
Important: Modifier 93 does not transform an inappropriate service into an appropriate one. You must document that the service met all clinical requirements for the CPT code you’re billing, just as if the patient were in your office.
Modifier 93 vs. Modifier 95: Understanding the Difference
This comparison is essential for proper billing. Many providers confuse these two telehealth modifiers, but they serve distinct purposes.
| Feature | Modifier 93 | Modifier 95 |
|---|---|---|
| Service Type | Audio-only | Audio and video |
| Technology Used | Telephone, voice-only apps | Video conferencing, two-way camera |
| Real-time Interaction | Yes | Yes |
| Patient Visibility | Not required | Required |
| Typical Use Case | Patients without video capability | Standard telehealth visits |
| Medicare Acceptance | Yes, with conditions | Yes |
The choice between these modifiers is straightforward: if the patient could see the provider and the provider could see the patient (even briefly), use Modifier 95. If the interaction was voice-only from start to finish, use Modifier 93.
Modifier 93 vs. Telehealth Service Codes
Here’s where things get interesting.
In 2025, the AMA introduced new stand-alone telemedicine codes (98000-98016) specifically designed for telehealth services, including audio-only visits -15. These new codes describe the telehealth service itself, eliminating the need for modifiers in many cases.
However, the Centers for Medicare & Medicaid Services (CMS) declined to recognize 16 of these 17 new codes -15. Medicare continues to require providers to use standard E/M codes with Modifier 93 or 95 appended.
This creates a two-track system:
For Medicare patients:
- Use standard E/M codes (e.g., 99202, 99213, 99214)
- Append Modifier 93 for audio-only
- Append Modifier 95 for audio-video
- Document the service as required
For many commercial payers:
- May accept new telehealth-specific codes
- May accept standard E/M codes with modifiers
- Policies vary widely by insurer
Important: Always check each payer’s policy. Some commercial insurers have adopted the new telehealth codes, while others continue to require traditional coding with modifiers -13.
Modifier 93 vs. Modifier FQ
If you work in certain settings, you’ll encounter Modifier FQ as well. This can cause confusion since both indicate audio-only services.
| Feature | Modifier 93 | Modifier FQ |
|---|---|---|
| Used For | Non-behavioral health services | Behavioral health services |
| Setting | All settings | Primarily FQHCs and RHCs |
| Coding System | CPT/professional coding | Institutional/UB billing |
| Payer Acceptance | Most payers | Specific to certain payers |
Modifier FQ specifically indicates a behavioral health service delivered via audio-only technology -9. It’s commonly used in Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs).
In some cases, FQHCs and RHCs can use either Modifier 93 or FQ for audio-only services -1. The choice may depend on payer requirements or the specific service being provided.
CPT Codes That Work with Modifier 93
Not every CPT code can be used with Modifier 93. The AMA created Appendix T specifically to list codes appropriate for audio-only reporting -5. Codes in this appendix are also marked with a speaker symbol in the CPT manual.
Common Codes Used with Modifier 93
The following types of services frequently use Modifier 93:
Evaluation and Management (E/M) Codes:
- 99202-99205 (new patient office/outpatient visits)
- 99211-99215 (established patient office/outpatient visits)
- 99221-99223 (initial hospital care)
- 99231-99233 (subsequent hospital care)
Behavioral Health Services:
- Psychiatric diagnostic evaluations
- Psychotherapy sessions
- Medication management visits
Other Services:
- Some preventive medicine services
- Certain counseling services
- Chronic care management
Services Generally NOT Appropriate
Some services are inherently unsuitable for audio-only delivery:
- Procedures requiring physical manipulation
- Services requiring visual examination of skin or wounds
- Certain diagnostic tests
- Services requiring auscultation or palpation
The provider must exercise clinical judgment about whether a specific service can be safely delivered by phone.
Billing for Medicare with Modifier 93
Medicare has specific rules for audio-only telehealth visits that you must follow for proper reimbursement.
Medicare’s Position on Audio-Only
Medicare generally expects audio-visual technology for telehealth services. However, exceptions exist for patients in their homes who:
- Lack the technical capacity for video, or
- Do not consent to two-way audio/video technology -1
In these situations, audio-only visits are permitted with proper documentation.
Place of Service (POS) Codes
A key consideration is which POS code to use. Under current Medicare rules:
Medicare indicates they will continue to reimburse encounters at the POS it would have been furnished in-person at least until the end of 2023 -11.
For example, if a telehealth visit would have occurred in the office had it been in-person, POS 11 (Office) would be appropriate.
Documentation Requirements
Medicare requires thorough documentation for audio-only visits:
- Patient’s lack of video capability or declined consent must be documented
- The clinical content must justify the level of service billed
- Medical necessity must be clearly established
Recent Changes
The landscape continues to evolve. As of 2025, many COVID-era telehealth flexibilities have been extended temporarily, but the long-term future remains uncertain -13. Providers should stay informed about pending legislation and regulatory changes.
Important: Some Medicare contractors have announced payment reductions for audio-only telehealth. For example, one payer announced a 15% reduction on audio-only telehealth effective July 2024 -4. Review your local Medicare contractor’s policies.
Commercial Payer Policies
Commercial insurance companies often have different rules than Medicare. This creates complexity for billing teams.
Payer Variations
Each commercial payer establishes its own telehealth policies:
- Some follow Medicare’s rules closely
- Others have developed their own requirements
- Some accept Modifier 93, while others still prefer other modifiers
Pre-authorization Requirements
Some commercial payers require pre-authorization for telehealth services. This is particularly true for:
- Mental health services
- Specialty consultations
- Frequent visits
Checking Payer Policies
Given the variation, checking each payer’s policy is essential. Resources to consult include:
- Payer websites and provider portals
- Provider manuals
- Contractual agreements
- Direct contact with payer representatives
Tip: Create a payer reference guide for your practice. Document each payer’s preferences for telehealth modifiers, POS codes, and documentation requirements.
Documentation Requirements
Proper documentation is essential for Modifier 93 billing. Without adequate documentation, claims can be denied, and practices risk compliance issues.
What to Document
For every audio-only visit billed with Modifier 93, ensure your documentation includes:
- Patient’s agreement to audio-only service
- Include consent for telephone visit
- Note if patient declined video or lacked capability
- Technology used
- Indicate telephone, secure app, or other audio-only system
- Clinical content of the visit
- Document history, assessment, and plan
- Show the service met all requirements of the CPT code
- Medical necessity
- Explain why the visit needed to occur via telehealth
- Demonstrate why audio-only was appropriate
How to Document
The documentation should mirror what you’d provide for an in-person visit while adding telehealth-specific elements:
“Patient called for scheduled visit via telephone. Patient lacks smartphone with video capability. Discussed current symptoms of depression, medication side effects, and coping strategies. PHQ-9 administered verbally. Patient reports improved mood and energy. Will continue current medication regimen. Follow-up scheduled in 4 weeks. Patient informed to call sooner if symptoms worsen.”
Common Documentation Mistakes
Avoid these errors:
- Failing to document why video wasn’t used
- Insufficient clinical content for the level of service billed
- Missing the consent to audio-only service
- Not documenting medical necessity
Warning: Claims for audio-only telehealth services face increased scrutiny. Some auditors specifically target Modifier 93 for potential abuse. Thorough documentation provides protection in case of audit -12.
Reimbursement and Payment
Understanding reimbursement is essential for practice financial health. Here’s what you need to know.
Payment Rates
Under current Medicare rules, audio-only telehealth visits generally receive the same payment rate as in-person services for the same CPT code, provided the clinical content is equivalent.
However, some payers have implemented payment reductions:
- One Medicaid plan announced a 15% reduction on all audio-only telehealth effective July 2024 -4
- Some commercial plans have similar reductions
Parity Laws
Many states have telehealth parity laws requiring insurers to reimburse telehealth services at the same rate as in-person services. However, these laws may have exceptions:
- Some apply only to video telehealth
- Some have specific requirements for audio-only coverage
- Private self-funded plans may be exempt
Factors Affecting Payment
Several factors influence reimbursement:
- Payer policy – Each insurer sets its own rates
- Patient’s coverage – Benefit design affects what’s covered
- Provider contracts – Negotiated rates vary
- State regulations – State law may mandate coverage
Modifier 93 for FQHCs and RHCs
Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) have special rules for audio-only telehealth.
FQHC-Specific Rules
FQHCs can use either Modifier 93 or Modifier FQ when billing for audio-only services -1. The choice depends on:
- The type of service provided
- Payer requirements
- The specific billing system
Behavioral Health Services
For behavioral health services in FQHCs, Modifier FQ is often preferred because it specifically identifies these services -9. This helps ensure proper tracking of behavioral health encounters.
Documentation Considerations
FQHCs should maintain documentation that demonstrates:
- The clinical need for the service
- The patient’s inability or refusal to participate in video
- The service met all requirements of the CPT code
Reimbursement Model
FQHCs and RHCs have unique reimbursement models based on encounter rates rather than individual CPT code payments. However, proper modifier use remains essential for encounter tracking and payment accuracy.
New CPT Codes for Telehealth in 2025
The AMA introduced significant changes to telehealth coding in 2025, creating new codes specifically for telemedicine services -15.
The New Codes
The 2025 CPT manual includes 17 new codes for audio-visual and audio-only telemedicine visits:
- 98008-98011: New patient visits
- 98012-98015: Established patient visits
- Additional codes for other telehealth services
CMS Response
CMS declined to recognize 16 of these 17 codes -15. Medicare continues to require traditional E/M codes with modifiers 93 and 95.
Commercial Payer Response
Commercial payers vary in their adoption of these new codes:
- Some have embraced the new codes
- Others continue to prefer traditional coding
- Many are transitioning gradually
The Transition Period
This creates a transitional period where providers need to understand two different coding systems. The choice depends primarily on:
- The patient’s insurance type
- Payer-specific billing requirements
Important: Many new telehealth codes may not require Modifier 93 or 95 since the code descriptor itself indicates how the service was performed. However, for Medicare, you must continue using traditional codes with modifiers -15.
State-Specific Variations
Telehealth regulation remains primarily a state responsibility, creating variation in Modifier 93 application.
State Telehealth Laws
Most states have laws governing telehealth practice and reimbursement:
- Some mandate coverage of audio-only services
- Others require video for certain services
- Some have specific documentation requirements
Medicaid Programs
Each state’s Medicaid program establishes its own telehealth policies. While many follow Medicare guidance, significant variations exist.
Example: California’s Medi-Cal program allows Modifier 93 for audio-only synchronous services across many benefit categories -14.
Professional Licensure
State licensure requirements can also affect telehealth delivery. Providers must be licensed in the state where the patient is located, regardless of the technology used.
Fraud and Abuse Considerations
As with any billing code, Modifier 93 carries compliance risks. Understanding these risks helps you avoid problems.
Common Compliance Issues
Modifier Overuse
Billing Modifier 93 excessively relative to peers can trigger audits. A provider who uses Modifier 93 significantly more than comparable providers may face scrutiny -12.
Inadequate Documentation
Lack of proper documentation for audio-only visits is a common deficiency. If audited, the provider must demonstrate that the service met all requirements of the CPT code.
Inappropriate Service
Some services simply cannot be delivered effectively by phone. Billing for a service that required visual assessment as audio-only constitutes improper billing.
Avoiding Fraud Issues
To minimize compliance risk:
- Document thoroughly – Every audio-only visit should have detailed notes
- Use Modifier 93 only when appropriate – Don’t use it simply to increase reimbursement
- Train staff – Ensure everyone involved in billing understands proper use
- Monitor usage – Track your Modifier 93 usage and compare to peers
- Follow payer rules – Each payer may have specific requirements
Audit Triggers
Be aware of factors that may increase audit risk:
- High volume of Modifier 93 claims
- Claims for services that seem clinically inappropriate for audio-only
- Pattern of billing high-level E/M codes with Modifier 93
- Documentation that lacks required elements
Best Practices for Using Modifier 93
Follow these best practices to ensure proper billing and minimize compliance risk.
Before the Visit
- Determine appropriateness – Is this service suitable for audio-only delivery?
- Verify patient consent – Document agreement for telephone visit
- Confirm patient identity – Verify you’re speaking with the correct patient
- Check payer coverage – Understand whether the service is covered
During the Visit
- Provide quality care – Deliver the same standard of care as in person
- Document in real-time – Take notes during the call
- Gather complete history – Ask all relevant questions
- Review systems verbally – Complete the ROS verbally
After the Visit
- Complete documentation – Include all required elements
- Apply correct coding – Use appropriate CPT code with Modifier 93
- Include POS code – Use correct place of service code
- Bill promptly – Submit claims in a timely manner
Practice Management Tips
- Create a template – Develop documentation templates for audio-only visits
- Train providers – Ensure all clinicians understand documentation requirements
- Regular audit – Periodically review Modifier 93 claims for compliance
- Stay updated – Monitor policy changes affecting audio-only telehealth
Frequently Asked Questions
Is Modifier 93 Only for Telephone Calls?
No. While telephone is the most common audio-only technology, Modifier 93 also applies to any other real-time interactive audio-only telecommunications system, including secure smartphone apps and VoIP systems -5-7.
Can I Use Modifier 93 for a Patient Who Has Video Capability But Prefers Phone?
Yes, but document the patient’s preference. Medicare allows audio-only when the patient does not consent to two-way audio/video technology -1. However, if the patient routinely declines video without reason, the payer may question this.
What Is the Difference Between Modifier 93 and CPT 99441-99443?
The 99441-99443 codes (telephone E/M services) are distinct from using E/M codes with Modifier 93. The telephone codes have specific time requirements and are more limited in scope. Many payers are phasing out the telephone codes in favor of Modifier 93 -15.
Does Medicare Accept Modifier 93?
Yes, under certain conditions. Medicare permits audio-only telehealth when the patient lacks technical capacity for video or declines consent to video -1-13. Providers must document the exception for telephone-only visits.
Will Modifier 93 Affect Reimbursement?
Possibly. Some payers reimburse audio-only services at a lower rate than video visits. For example, one Medicaid plan announced a 15% reduction for audio-only telehealth -4. Check each payer’s reimbursement policies.
Is Modifier 93 Going Away?
Not in the near term. While the AMA created new telehealth-specific codes for 2025, Medicare declined to adopt most of them, continuing to rely on Modifier 93 for audio-only services -15. Providers should expect Modifier 93 to remain relevant for the foreseeable future.
Can FQHCs Use Modifier 93?
Yes. FQHCs can use Modifier 93 for non-behavioral health audio-only services and either Modifier 93 or FQ for behavioral health services -1-9.
Do I Need Prior Authorization for Modifier 93 Services?
It depends on the payer and the service. Some payers require pre-authorization for telehealth services, especially for behavioral health. Check each payer’s requirements.
Conclusion
Modifier 93 is a vital tool for accurately coding and billing audio-only telehealth services. Created in 2022, this modifier officially recognizes telephone-based care as a legitimate telehealth modality when properly documented -5.
The key takeaways are:
- Use Modifier 93 only when service is delivered via real-time audio-only technology with no video component
- Document why video wasn’t used—patient lacks capability, declines consent, or technical issues
- Know payer variations—Medicare accepts Modifier 93 with conditions, while commercial plans vary widely
- Stay current with changes—the telehealth landscape evolves rapidly, with new codes introduced in 2025 while Medicare continues to use traditional coding with modifiers -15
- Document thoroughly—audio-only visits require documentation meeting all requirements of the CPT code, just like in-person visits
- Check payer policies regularly—reimbursement rates, coverage rules, and requirements change frequently
When used correctly, Modifier 93 enables providers to serve patients effectively through telephone visits while ensuring appropriate reimbursement.
Additional Resources
American Medical Association
Visit the AMA website for CPT updates, coding guidance, and telehealth policies.
https://www.ama-assn.org/
Centers for Medicare & Medicaid Services
Access Medicare telehealth policies, coverage determinations, and billing guidance.
https://www.cms.gov/
AAPC
Find coding resources, training, and certification information.
https://www.aapc.com/
Disclaimer: This article provides general information about Modifier 93 in medical billing. Coding and reimbursement rules change frequently, and payer policies vary significantly. Always verify current requirements with each payer and consult with qualified billing professionals before submitting claims. The information in this article does not constitute legal or compliance advice.
