Which scenario applies to Modifier 95 usage?

Modifier 95 is specifically intended for use in situations where real-time interactive audio and video telecommunications are utilized in the provision of medical services. This modifier indicates that the service was delivered via telehealth, meaning that the interaction between the patient and healthcare provider occurred in a live, synchronous format.

In this context, it is important to understand what constitutes "real-time interactive" communication. Such communication allows for immediate feedback and two-way interaction, which are key features of telemedicine services. This is essential for maintaining the quality of care and ensuring effective diagnostic and therapeutic processes when traditional in-person visits are not possible.

By using Modifier 95, providers can signify that the services rendered may be reimbursable under telehealth guidelines, which differ from standard face-to-face services. This modifier has become particularly important as telehealth has grown in prevalence, especially in light of recent healthcare trends that promote remote patient care.

While the presence of the patient for a face-to-face evaluation pertains to in-person interactions, the nature of lab procedures and consultations through standard telephone calls do not align with the criteria for Modifier 95, as these do not meet the telehealth definition requiring real-time audio and video communication.