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Telehealth Billing for Nutrition Therapy: Correct Modifier Usage Explained

elehealth has grown into an important way of delivering care, especially for nutrition therapy. In fact, more than 12% of Medicare patients used telehealth billing services in late 2023. Studies also show that almost half of patients receiving nutrition therapy used audio-only visits. This makes billing more complex because payers need to know exactly how the service was provided.

One of the most important parts of nutrition therapy billing is the correct use of modifiers. Modifiers explain to payers whether the visit was done by video, phone, or another method. Using the wrong modifier often leads to claim denials or delays.

In this guide, we explain step by step how to apply modifiers correctly when billing for nutrition therapy sessions.

Step 1: Identify the Service (Video or Audio-Only)

Video sessions: Use modifier 95 for real-time, two-way video visits.
Audio-only sessions: Use modifier 93, but only if the payer allows it. Some older payers may still ask for modifier GQ for asynchronous encounters.

Step 2: Match Modifier with the Right CPT/HCPCS Code

Correct pairing of a CPT/HCPCS code with a modifier is key in medical billing services:

CPT Codes:
- 97802 – Initial assessment97803 – Follow-up visit
- 97804 – Group session
Add modifier 95 for video-based visits, or modifier 93 if audio-only visits are allowed by the payer
HCPCS Codes:
G0270/G0271 – For additional hours after referral
FQHCs/RHCs may require modifier FQ for audio-only sessions.
Some payers still accept GT or GQ in special cases.

Step 3: Correct Place of Service (POS)

POS 02 – Telehealth outside patient’s home
POS 10 – Telehealth from patient’s home
POS 11, 12, 22 – In-person visits

Institutional claims may also require Revenue Code 942 with CPT/HCPCS codes and the correct modifier.

Step 4: Special Rules for FQHCs and RHCs

Medicare requires G2025 for distant site telehealth visits.
Apply modifier 95 for video sessions or modifier FQ/93 for audio-only visits.
Always check with your Medicare Administrative Contractor (MAC) for local requirements.

Step 5: Document Everything

Good documentation supports your billing and prevents denials:

Record patient consent (verbal or written).
Note the modality (video or audio-only).
Explain the reason if only audio was used.
Include start and stop times for CPT 97802/97803
Record provider and patient locations.
Keep detailed clinical notes.

Step 6: Avoid Common Mistakes

Don’t use modifier 95 for audio-only visits.
Always use modifier 93 when required for phone visits.
Make sure POS code matches the modifier.
Don’t assume payer rules are the same across all insurers.
Use older modifiers like GT/GQ only if specifically required.

Conclusion

Telehealth rules keep changing. Medicare has extended telehealth flexibilities, including audio-only visits, through March 2025. After that, audio-only will officially be considered part of telehealth when patients cannot use video. Commercial insurers and state Medicaid programs may update their rules even faster.

Because of this, many practices choose outsourcing telehealth billing and coding services to experts like 24/7 Medical Billing Services. Our team ensures the correct CPT/HCPCS code medical billing services are applied with the right modifiers, POS codes, and documentation. This reduces claim errors, prevents denials, and speeds up payments for nutrition therapy billing.

FAQ

Q1. How often can patients receive nutrition therapy through telehealth? Medicare allows a set number of hours per year, while private insurers may have different limits.

Q2. Are group nutrition therapy telehealth sessions reimbursable? Yes, but payer approval is usually required.

Q3. Can telehealth nutrition therapy be billed across state lines? Yes, but the provider must meet licensing requirements in the patient’s state.

Q4. Is pediatric nutrition therapy covered under telehealth? Most plans cover it, but the rules depend on the payer.

Read detailed blog:https://www.247medicalbillingservices.com/blog/telehealth-billing-for-nutrition-therapy-correct-modifier-usage-explained

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