Medicare Modifiers Made Easy: Your Key to Billing Success

I know billing Medicare can seem confusing and there’s a lot of conflicting information out there, but billing correctly will save you A LOT of time and frustration! And using the correct modifiers is KEY to making sure you’re getting paid the correct amount and your claims aren’t getting denied. 

For telehealth, continue to use your normal place of service (11) and modifier 95 to indicate telehealth. If you use place of service 02 or 10, you may be reimbursed less. Continue to use 11/95 through the end of December 2024. (source)

For seeing clients in person, no modifier is needed. 

For audio only…this is a tough one. I have seen BOTH FQ or 93. You can read more here on page 10. Please check with your local MAC to determine the best billing practices for your state. 

If you are seeing a patient who is in hospice, you can use the GW modifier to continue seeing them, and make sure you coordinate with the hospice agency. The GW modifier indicates that the service rendered is unrelated to the patient's terminal condition. All providers must submit this modifier when the service(s) provided are unrelated to the patient's terminal condition. (source) 

You can purchase my Introduction to Billing Course here, where I go more in-depth into Medicare billing and everything you need to know. You have lifetime access and unlimited replays when you purchase the course, which includes being able to view any new updates I’ll add to it as things change! 

P.S. If you’re feeling overwhelmed and looking for a place to rest and restore, join me in Belize in January for the Beyond Burnout Retreat. I’ll be bathing you in sound and meditation in the Belizean jungle to soothe your soul. You’ll leave refreshed and energized with new friends and experiences! Read more here and schedule a call with me to talk through any questions you may have!