decisionhealth Newsletters, Part B News - 2026 Issue 5 (May)
Denials for modifiers 93, 95 flag errors you should check
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Article Overview
This article examines Medicare Part B claims data for telehealth services and compares denial patterns associated with audio-only and audio/video reporting. It is relevant to billing, coding, compliance, and revenue cycle teams that work with telemedicine claims, office/outpatient E/M services, psychotherapy, and place-of-service reporting. The article also discusses the role of Medicare administrative contractors and CMS telehealth policy updates affecting 2024 reporting.
Why This Topic Matters
Understanding how telehealth claims are denied can help practices identify documentation and reporting risks, monitor claim quality, and reduce avoidable payment issues. The article highlights where claim and place-of-service mismatches may appear without automatic denial, making review important for compliance and reimbursement accuracy.
What You Will Learn
- How Medicare Part B telehealth claim denials are discussed in relation to modifier-based reporting
- How denial patterns vary across common telehealth service types and locations
- How telehealth place-of-service reporting is addressed in current Medicare claims analysis
- What role contractors and CMS policy updates play in telehealth claim processing
Who Should Read This
- Medical coders
- Billing staff
- Compliance professionals
- Revenue cycle managers
- Telehealth program administrators
- Practice managers
Codes Discussed
Modifiers Discussed
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