Medical Billing ServicesRevenue Cycle Management (RCM)

Physicians ought to know about telemedicine modifier

Telemedicine permit health care professionals to evaluate, diagnose, and treat patients at a distance using telecommunications technology. It is viewed as a cost-effective alternative to the more traditional face-to-face way of providing medical care that states can choose to cover under Medicaid.

Telemedicine allows improving a patient’s health by permitting two-way:

  • Interactive communication between the patients in real-time
  • The physician or practitioner located at the distant site

Telemedicine includes various technologies such as telephones, facsimile machines, electronic mail systems, and remote patient monitoring devices, which are used to collect and transmit patient data for monitoring and interpretation. Generally different terms used in telemedicine for which the physicians must be aware.

Common terms used in Telemedicine

Distant or Hub site: Site at which physician or other licensed practitioner is delivering the service via a telecommunications system

Originating or Spoke site: Location of the Medicaid patient at the time of the service being offered via a telecommunications system

Asynchronous or “Store and Forward”:-Data transfer from one site to another with the help of the recording devices an image that is sent (forwarded) via telecommunication to another site for consultation. For instance, a camera or similar device that records

Medical Codes: States may select from a variety of HCPCS codes (T1014 and Q3014), CPT codes, and modifiers (GT, U1-UD) to identify, track, and reimburse for telemedicine services.

After knowing various terminologies used in telehealth now, Lets’ look at different modifiers used for reimbursement for telemedicine services:

Telehealth modifier

Various modifiers of Telehealth must be submitted with distant site telehealth services. Generally, interactive audio and video communications are used to permit real-time communication between distant site physician/practitioner and patient. Patients must be present and participating in the telehealth visit.

G0 (zero) – modifier G0 is valid for

  • Telehealth distant site codes billed with a place of service (POS) code 02; or
  • Critical access hospitals, CAH method II (revenue codes 096X, 097X, or 098X); or
  • Telehealth originating site facility fee billed with HCPCS code Q3014

GQ

  • Telehealth service rendered via an asynchronous telecommunications system

GT

  • Interactive audio and video telecommunication systems
  • For professional claims, the use of modifier GT has been eliminated and the use of the telehealth POS code 02 certifies that the service meets the telehealth requirements.
  • The GT modifier is only allowed on institutional claims which are billed by CAH Method II providers

Medicare previously required providers to submit claims for telehealth services using the appropriate procedure code along with the telehealth GT or GQ modifier.

The claim line will be rejected if the GT modifier is billed by other provider types. However, the GQ modifier is still needed when applicable (e.g., for those providers participating in the Alaska or Hawaii federal telemedicine demonstration programs)

Telemedicine services in COVID-19

  • Under the Coronavirus Preparedness and Response Supplemental Appropriations Act and Section 1135 waiver authority, the Centers for Medicare & Medicaid Services (CMS) has expanded access to Medicare telehealth services so that beneficiaries can get a wider range of services from their doctors and other clinicians without traveling to a health care facility.
  • Under this Section 1135 waiver expansion, various providers, such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers can offer a specific set of telehealth services such as evaluation and management visits (common office visits), mental health counseling, and preventive health screenings.
  • Beneficiaries can get telehealth services irrespective of location including a physician’s office, hospital, nursing home or rural health clinic, and from their homes. This change enables telehealth flexibility without regard to the beneficiary’s diagnosis because at this critical point it is important to ensure beneficiaries follow CDC guidance including practicing social distancing to reduce the risk of COVID-19 transmission.
  • This change is helpful in the prevention of vulnerable beneficiaries from unnecessarily entering a health care facility.

The following table provides a summary of the POS and modifier requirements for Medicare Part B:

SERVICE PLACE OF SERVICE MODIFIER(S)
Office visit related to COVID-19 testing 11 – Office -CS
Telehealth visit related to COVID-19 testing 11 – Office -95, -CS
Office visit not related to COVID-19 11 – Office None
Telehealth visit not related to COVID-19 11 – Office -95
Virtual Check-In (HCPCS G2012, G2010) 11 – Office None
E-Visit (CPT 99421-99423) 11 – Office None
Telephone Evaluation and Management (CPT 99441-99443) 11 – Office None

Commercial payers are generally following Medicare’s lead in terms of coverage and policy. However, coding guidance varies from payer to payer. Moreover, appropriate diagnosis coding can help further distinguish services related to COVID-19.

Have more doubt regarding telemedicine billing questions? Feel free to contact us at info@medicalbillersandcoders.com and we will try best to help you out. We help providers to get paid for their telemedicine patient care services.

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