HCA publishing audio-only telemedicine billing codes to be effective July 1, 2022
New audio-only telemedicine policies are being implemented on July 1, 2022.
To support this, the Health Care Authority (HCA) has published a list of billing codes that are payable when services are provided by audio-only telemedicine (over the phone). This shift in billing practice comes as a result of 2021 legislation (HB1196), which requires coverage of audio-only telemedicine that can be safely and effectively provided according to generally accepted health care practices and standards.
HCA is expanding telemedicine to include audio-only services
Before the COVID-19 public health emergency (PHE), HCA offered an expansive traditional telemedicine program, complete with a suite of HIPAA-compliant audio/visual telemedicine codes.
During the PHE, HCA added flexibilities to telehealth coverage to support access to care while maintaining physical distancing to limit the spread of COVID-19. This included modification to existing telehealth billing codes if they were being used for audio-only interactions.
As we emerge from the PHE, HCA is implementing access to audio-only services as directed by HB1196. Effective July 1, 2022, HCA will pay for audio-only services for specific billing codes when provided and billed as directed in HCA's provider billing guides.
How are you doing this?
This new list of audio-only codes is published on the HCA website, so billers and providers may familiarize themselves before the new requirement is implemented.
Apple Health (Medicaid) policies require the appropriate audio-only modifiers (93 or FQ). Information related to specific service areas and billing guidelines includes the following:
- For SERI and Part II of the Mental Health Billing Guide, providers will use modifier FQ
- For Part 1 of the Mental Health Billing Guide, providers will use modifier 93
- All other programs will use modifier 93
| Modifier |
Modifier description |
| 93 |
Synchronous Telemedicine Service Rendered Via Telephone or Other Real-Time Interactive Audio-Only Telecommunications System: 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. 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. |
| FQ |
The service was furnished using audio-only communication technology |
Who can I contact if I have questions?
Contact HCA at HCAAppleHealthClinicalPolicy@hca.wa.gov if you have any questions.
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