Modifier 93 marks a synchronous audio-only visit. Chart that the patient was at home (usually POS 10), that you used audio-only, and why video did not happen: no capable device, no broadband, declined video, or video failed after you started. A video template with a 93 on the claim is a mismatch.
CMS’s CY 2027 Physician Fee Schedule proposed rule (issued July 14, 2026) implements the Consolidated Appropriations Act, 2026 extension: in-person requirements for Medicare mental health telehealth would not apply through December 31, 2027. Audio-only in the home remains available under current law through that date. Starting January 1, 2028, the standing rule is tighter: you must be technically capable of video, and the patient must be unable to use video or must not consent to it. Write those facts now so the 2028 note is not a new invention.
The video header is in POS 10 vs 02. What belongs in a telehealth psychiatry note covers the extras that office notes skip.
State why video was not used
One sentence, specific.
- “Patient has a flip phone; no smartphone video.”
- “Broadband dropped after 4 minutes of video; remainder of visit audio-only.”
- “Patient declined video because they are in a car pickup line and cannot be on camera; agreed to audio-only.”
- “I offered video; patient is technically capable and I am capable; patient does not consent to video today.”
“Audio visit” without a why will not help you in 2028, and it already fails some commercial audits. If you never offered video, say that too, especially if you are a clinic that still runs a phone tree as default.
You must actually be able to do video if you are going to claim the patient declined it. A clinician without a working camera should not chart “patient declined video.”
Confirm home location, identity, and consent
Patient city, state, and that the originating site is their home. POS 10. If they are not at home, audio-only Medicare rules may not be the ones you think they are. Write the real place and talk to billing before you drop 93 plus POS 10 out of habit.
Identity without a camera: name, DOB, callback number, and a known voice or security question per your policy. Emergency address still matters. You cannot see them. You need a place EMS could go.
Consent: audio-only this visit, limits of a visit without video (no visual MSE for tremor, gait, bruises, intoxication signs you would have seen). They agreed to proceed.
RHC and FQHC may use FQ in addition to or instead of 93 depending on the service. OTPs have separate audio-only reporting. Do not copy a group-practice 93 header into an FQHC claim without your biller.
Write modifier 93 language where billing can find it
Header line: “Synchronous audio-only; modifier 93. Video not used because [reason]. Patient at home, [city, state]; POS 10. Clinician at [city, state].”
If the visit started as 95 and became 93, write the minute the modality changed and which portion was which. Payers differ on mixed visits. The chart should not pretend it was video the whole hour.
Do not use 95 on a phone call. Do not use GT unless that is still the modifier your MAC or FQHC workflow requires. GT is not a substitute for documenting audio-only.
Chart clinical content that still supports the code
You still need medical necessity for 99213-99215, 90833-90838, 90834/90837, or 90791/90792. Time and MDM rules do not relax because you could not see the patient.
MSE: what you heard (speech rate, volume, crying, intoxication, thought process as evidenced in language) and what you could not see. Do not paste a full visual MSE from last month’s office visit.
Risk: ask the questions. Audio-only is a bad setting for a first-time high-risk disclosure if you have no address; if that happens, write the disposition.
Sample audio-only header
Modality: telephone, real-time, modifier 93.
Video offered on clinic Zoom. Patient declined: no private room with
camera; calling from home kitchen after children left for school.
Patient location: home, Tulsa, OK. POS 10.
Clinician location: Tulsa, OK office.
Identity: name, DOB, known voice. Callback [phone]. Address for EMS:
[street], Tulsa, OK.
Consent: agreed to audio-only; advised I cannot see tremor or gait.
Duration: 32 minutes. CPT 99214 (MDM) without psychotherapy add-on.Questions people ask
The patient lives in a car. Is that home? If the car is where they reside, document that as home and the city/state, plus a callback that actually works. If they are in a shelter common room, say so; POS and privacy both change.
Can I use 93 for a voicemail? No. 93 is interactive, real-time. A voicemail is outreach. See no-show documentation.