Updated Telehealth Modifier Use

Beginning July 1, 2025, Healthfirst is issuing updated billing requirements for telehealth services delivered through New York State Office of Mental Health (OMH) licensed and/or designated outpatient programs.

Providers must adhere to a revised Telehealth Modifier Grid, including the use of a new modifier for audio-only services. These changes affect Healthfirst’s Medicaid, Personal Wellness Plans (HARP), and Medicaid Advantage Plans (MAP) and are aimed at supporting smoother, more consistent claims processing.

Key Updates

Revised Telehealth Modifier Use Grid:

OMH has revised its Telehealth Grid to reflect recent rate code changes and updates to modifiers, including:

• Modifier FQ: Audio-only modifier FQ is no longer represented in OMH’s revised telehealth grid. Providers must discontinue use of this modifier only when billing outpatient services delivered through audio-only methods.
• Modifier 93: OMH providers are required to use modifier 93 for eligible telehealth and audio-only mental health services beginning July 1, 2025.

Although modifier FQ is no longer applicable for OMH outpatient services, providers may still use modifier FQ for other non-OMH scenarios where it may still be appropriate.

This change aligns with CMS billing standards and is intended to streamline crossover claims processing between Medicare and Medicaid.

What Do Providers Need to Do?

Ensure your billing systems are updated to accept modifier 93 for OMH-eligible audio-only services rendered on or after July 1, 2025.

Continue to follow OMH Telehealth Guidance and the New York State Medicaid Telehealth Policy Manual for additional context and billing policies

More Information

For more information on OMH’s telehealth billing guidance, visit:

• Telehealth Services Guidance for OMH Providers
• Medicaid Telehealth Policy Manual

Questions?

If you have any questions, please contact your Network Account Manager, or call Provider Services at 1-888-801-1660, Monday to Friday, 8:30am-5:30pm.

Coverage is provided by Healthfirst Health Plan, Inc., Healthfirst PHSP, Inc., and/or Healthfirst Insurance Company, Inc. (together, “Healthfirst”).
R25-30
July 2025