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Modifier 93 for Examinations Requiring Interpreter Services: A DaisyBill Guide

September 22, 2017 by Catherine Montgomery

Interpreters play a crucial role in workers’ comp treatment. By negating language barriers, interpreters remove a massive source of friction from an already friction-burdened field. When it comes to billing and payment, it’s important for providers to know how to obtain proper reimbursement when a visit requires an interpreter’s services.


Here’s what providers need to know in order properly apply m
odifier 93.

With the RBRVU-based physician fee schedule, modifier 93 is no longer used to report interpreters for physician services. Medical-legal evaluations continue to use modifier 93 to account for the extra time needed for interpretation during the evaluation.

For dates of service from January 1, 2014, modifier 93 is not reported on medical treatment bills since the regulations for the Physician Fee Schedule did not adopt the use of modifier 93. For medical-legal evaluations, modifier 93 is billed, but only in strictly defined circumstances, and subject to reporting requirements. The rules for modifier 93 are laid out in California Code of Regulations (CCR) code § 9795 (d):

“-93 Interpreter needed at time of examination, or other circumstances which impair communication between the physician and the injured worker and significantly increase the time needed to conduct the examination. Requires a description of the circumstance and the increased time required for the examination as a result. Where this modifier is applicable, the value for the procedure is modified by multiplying the normal value by 1.1. This modifier shall only be applicable to ML 102 and ML 103.”

As stated in the regulation, modifier 93 only applies to only two billing codes:

  1. ML 102 for a Basic Comprehensive Medical-Legal Evaluation
  2. ML 103 for Complex Comprehensive Medical-Legal Evaluations.

In both cases, to report modifier 93, communication between the patient and provider must be so impaired as to “significantly increase the time needed to conduct the examination.” The provider must provide a description of the impairment and the extra time needed.

Modifier 93 does not apply to other medical-legal evaluations or fees listed in CCR § 9795 Medical-Legal Fee Schedule. Since reimbursement for the other codes listed are calculated based on time spent by the provider, any additional time required due to interpreter's services should be included in the provider’s reported time, thereby negating the need to use modifier 93.

To ensure correct application of modifier 93, refer to this chart:

When to Apply Modifier 93 for Interpreter Services (Medical-Legal evaluations only)

Procedure Code

Procedure

Modifier 93 Applicable?

ML100

Missed Appointment for a Comprehensive or Follow-Up Medical-Legal Evaluation

NO

ML101

Follow-up Medical-Legal Evaluation

NO

ML102

Basic Comprehensive Medical-Legal Evaluation

YES

ML103

Complex Comprehensive Medical-Legal Evaluation

YES

ML104

Comprehensive Medical-legal Evaluation Involving Extraordinary Circumstances

NO

ML105

Fees for medical-legal testimony

NO

ML106

Fees for supplemental medical-legal evaluations

NO

As always, we’ll keep you posted on any updates to the rules for compliant use of modifier 93, as well as any other significant changes to workers’ comp billing and payment.


DaisyBill offers a full suite of cloud-based billing software to keep providers up to speed on every change to the Official Medical Fee Schedule (OMFS). Schedule a free demonstration today, and see how DaisyBill can improve your bottom line.

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