Viewpoint: Modifier Code Allows Researchers to Evaluate Audio-Only Telehealth

A viewpoint article published in Health Affairs described the creation and benefits of the CPT Modifier 93 code for audio-only telehealth use among Medicaid beneficiaries.

Before the COVID-19 pandemic, telehealth coverage for Medicaid beneficiaries was not widespread. Further, barriers such as lack of access to the needed technology and the absence of needed digital skills resulted in Medicaid patients being less likely to participate in telehealth visits.

When the public health emergency struck, Medicaid agencies across the country revised their policies to expand access to telehealth services, including audio-only. An October report from the Center for Connected Health Policy detailed how there have been various changes in telehealth policies, including several states adding Medicaid reimbursement for audio-only telehealth.

Research from the Department of Health and Human Services (HHS) found that following these policy changes, Medicaid beneficiaries (45.5 percent) were more likely to participate in audio-only care compared to those who were privately insured (35.1 percent). 

They also found that among Medicaid beneficiaries who used telehealth, 38.1 percent of White patients used audio-only services for their visits. Meanwhile, Latino, Black, and Asian patients had audio-only telehealth use rates of 49.3 percent, 46.4 percent, and 48.7 percent, respectively.

Due to this increase in the use of audio-only telehealth among Medicaid beneficiaries, state Medicaid leaders needed a tool to measure results like clinical outcomes, healthcare costs, and patient experience, the authors wrote. This led various Medicaid medical directors to send an application to the American Medical Association (AMA) that urged the creation of a Current Procedural Terminology (CPT) modifier.

The AMA CPT Editorial Panel accepted the addition of the CPT Modifier 93 code in September 2021, leading to its activation on Jan. 1, 2022.

The CPT Modifier 93 code allows for differentiation between audio-only, audiovisual, and in-person care services. This helps researchers in evaluating the success of the audio-only care method.

The code can also help policymakers adjust regulations as needed to support the use of audio-only telehealth, the authors wrote. It further enables claims-based research to review health disparities across different care types and ensure that audio-only services are sustainable and equitable.

Another way in which the CPT 93 modifier can help bolster audio-only telehealth is by helping to mitigate concerns about fraud, waste, and abuse, according to the authors. 

Thus, the authors state that this modifier should be widely adopted.

"…to make the most of this opportunity, regulators, payers, providers, and researchers must take steps to increase adoption and evaluation of the audio-only modifier," they wrote. "To catalyze this work, large health systems should consider leading the adoption of the CPT 93 modifier while also encouraging local private providers to do the same."

The authors include clinicians from various hospitals and Medicaid organizations, including Massachusetts General Hospital, the Virginia Department of Medical Assistance Services, and the Texas Health and Human Services Commission.

Another study published in the American Journal of the Medical Sciences in August found that audio-only telehealth was not inferior to video-based telehealth. Researchers reached this conclusion after analyzing a diverse set of participants assigned to a phone or video-based telehealth appointment.

Using a visit satisfaction rate scale as the main unit of measurement, researchers concluded that audio-only telehealth was non-inferior to video-based telehealth, with satisfaction levels of the two groups being similar.