Audio-only telehealth services, primarily utilized for behavioral healthcare, underwent analysis in Washington state. Researchers studied the utilization trends of modifiers 93 and FQ, crucial in identifying audio-only telemedicine services. Notably, behavioral health conditions like anxiety and depression were the focal point of these services. The study observed a surge in modifier-marked claims, emphasizing their role in capturing previously unrecorded telehealth interactions. Challenges like limited guidance hindered their widespread adoption. Despite this, with increasing interest from payers, these modifiers are anticipated to evolve as essential tools in reliably identifying and shaping audio-only telehealth policies.
Audio-only telehealth services have emerged as a pivotal resource for addressing behavioral healthcare needs, as indicated by a study analyzing their utilization patterns in Washington state. This investigation focuses on modifiers 93 and FQ, instrumental in identifying and categorizing audio-only telemedicine services. Behavioral health conditions, including anxiety, depression, schizophrenia, and bipolar disorders, constitute the primary areas of application for these services. The study’s objective is to underscore the importance of these modifiers in accurately documenting audio-only telehealth usage amid ongoing debates surrounding reimbursement and policy formulation.
A recent study, featured in JAMA Network Open, delved into the early patterns of utilizing new audio-only telehealth claims modifiers—93 and FQ—in Washington state. Amidst the onset of the COVID-19 pandemic, these services were categorized through Current Procedural Terminology (CPT) codes such as 99441 to 99443 and 98966 to 98968, primarily focusing on physician-conducted evaluation and management telephone visits and those conducted by non-physician healthcare professionals. However, as the pandemic persisted, a wider range of services became accessible through audio-only telehealth, leading to complexities in capturing these services due to the absence of clear modifiers.
Accurate documentation of audio-only telehealth usage stands as a critical aspect, given the novelty of financial reimbursement for such services and the ongoing discussions regarding their continued reimbursement. Consequently, in 2022, CPT code modifiers 93 and FQ were introduced.
The study scrutinized claims data obtained from the Washington All-Payer Claims Database spanning January to November 2022, encompassing 4.3 million insured children and adults from public and private insurance plans in 2021.
In 2022, there were 917,589 instances of audio-only telehealth services compared to 3.3 million claims for audiovisual telehealth services.
Among the total audio-only services, 345,941 (38 percent) were marked with modifier FQ, while 55,352 (6 percent) were designated with modifier 93. Notably, telehealth claims bearing these modifiers were prominently utilized for prevalent behavioral health conditions like anxiety, depression, schizophrenia, and bipolar disorders.
Moreover, the commonly associated CPT codes for modifiers FQ and 93 comprised psychotherapy codes, behavioral health counseling and therapy, and family training and counseling for child development.
Researchers underscored the significance of audio-only telemedicine in enabling frequent and intimate follow-ups often essential for managing behavioral health issues.
The distribution of claims with modifiers provides insights into their trajectory: in January 2022, FQ modifier-tagged claims accounted for 24 percent (22,375 services) of all audio-only telehealth claims, which surged to 53 percent (47,865 claims) by June 2022 before descending to 30 percent (22,475 claims) by November 2022. On the other hand, 93 modifier-related claims escalated from 0.4 percent (362) in January 2022 to 11 percent (8,356) in November 2022.
Concurrently, claims for audiovisual telehealth services exhibited a gradual decline from 400,669 in January 2022 to 260,244 in November 2022.
The study highlighted that 309,020 audio-only service claims were only captured through modifiers 93 and FQ, underscoring their critical role in identification beyond the limitations of CPT codes.
However, the relatively low adoption of these modifiers stemmed from factors like insufficient familiarity and specific guidance from Medicare and commercial payers regarding their application.
Nevertheless, with mounting interest from payers, including Medicare’s inclination from January 1, 2023, to mandate clinicians to use these modifiers, it is anticipated that modifiers 93 and FQ will evolve further, serving as vital tools for reliably identifying audio-only telemedicine claims to support research on quality, outcomes, and equity, thus informing policies effectively.
Continual research on the quality of audio-only telehealth remains pivotal, especially considering studies indicating its heightened usage among underserved populations. A 2021 study illustrated that older patients, Black individuals, residents of rural areas, and those covered by Medicaid were more inclined towards phone visits compared to video visits, based on data analysis spanning April 1, 2020, through June 30, 2020, at Michigan Medicine.
The study highlights the significance of audio-only telehealth services, particularly in catering to prevalent behavioral health conditions. Despite challenges like limited guidance hindering their widespread adoption, modifiers 93 and FQ have proven crucial in identifying previously unrecorded telehealth interactions. The escalating interest from payers, including Medicare, foresees these modifiers evolving into essential tools for reliably identifying and shaping audio-only telehealth policies. Continued research into the quality and accessibility of audio-only telehealth remains pivotal, particularly in serving underserved populations and informing equitable healthcare policies.
