Date: March 21, 2022
To: All Medical Assistance Program Providers
Re: Modifier 93 and Place of Service Code 10 Implementation April 1, 2022
This notice informs providers of billing updates effective with dates of service beginning April 1, 2022. These changes apply to claims paid under the Medicaid fee-for-service program and the HealthChoice Illinois managed care plans.
- New Modifier 93 - Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system
Modifier 93 is a new modifier used to identify services that are provided via telephone or other real-time interactive audio-only telecommunication systems. It does not replace modifier GT, which should continue to be used to identify telehealth interactions using both audio and video telecommunications systems. When using modifier 93, the communication during the audio-only service must be of an amount or nature that meets the same key components and/or requirements of a face-to-face interaction. Modifier 93 is effective with dates of service beginning April 1, 2022.
- New Place of Service Code (POS) 10 – Telehealth Provided in Patient's Home
POS 10 is a new place of service code that specifies a distant site telehealth service rendered to a patient who is located in their home. It does not replace POS 02. The description for POS 02 has been changed to, "Telehealth Provided Other than in Patient's Home" and it is still a valid distant site telehealth service POS code. POS 10, when applicable, should be submitted for claims with dates of service beginning April 1, 2022.
The Centers for Medicare and Medicaid Services (CMS) POS definitions can be found at https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set.
Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565.
Kelly Cunningham, Administrator
Division of Medical Programs