Wiki Denied Telehealth billing for EM code with 99417. Modifier GT cannot be used with 99417 so how would you bill this.

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Hello. I have a client in Washington who is billing telehealth visits for an EM code with 99417. Modifier GT cannot be used with 99417 so how would you bill this? REGENCE of WA requires POS 02 and modifier GT when billing telehealth, but modifier GT is not valid when billing 99417. We billed POS 02 for 99417only, but the claim denied 99417 for invalid POS/modifier. I have received a suggestion to bill both codes with POS 11 and modifier 95, but REGENCE states not to use modifier 95 or POS 11 as this is no longer valid for telehealth. Any suggestions from anyone else billing REGENCE in WA, or AETNA? Thank you in advance.
 
Hello. I have a client in Washington who is billing telehealth visits for an EM code with 99417. Modifier GT cannot be used with 99417 so how would you bill this? REGENCE of WA requires POS 02 and modifier GT when billing telehealth, but modifier GT is not valid when billing 99417. We billed POS 02 for 99417only, but the claim denied 99417 for invalid POS/modifier. I have received a suggestion to bill both codes with POS 11 and modifier 95, but REGENCE states not to use modifier 95 or POS 11 as this is no longer valid for telehealth. Any suggestions from anyone else billing REGENCE in WA, or AETNA? Thank you in advance.
What is the E/M code you are billing with 99417? I do know modifier 95 can be used with 99417 per EncoderPro. " Telemedicine services may be reported by the performing provider by adding modifier 95 to this procedure code and using the appropriate place of service."
 
I'm finding the same issue. Insurance companies do not seem to want to pay for prolonged telehealth visits. Does anyone have any suggestions? Billed with a level 5 and time documented over 15 (+) minutes audio and video.
Thank you in advance,
Deb
 
Hi Scott and Dstein, :)
I believe you are using the wrong modifier with CPT 99417. Use 95 not GT modifier as NJY Carter stated. Check out page in section Appendix P in CPT manual year 2023, pg 1033. Telehealth CPT codes in 2 types for staff of MD DO, NP and PA use CPT 99441-99443 phone calls ensure add minutes in record. Whereas QHP staff and nurses use for phone call 98960-98986. If using CPT 99215 this is for patient told go to hospital or true high risk scenario . Other Eva Mgmn codes can be used CPT 99202-99215 with modifier 95 linked for the proper clinical staff.
Well hope helped you.:)
Lady T
 
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