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Telehealth Modifiers GT and GQ

Telehealth Modifiers GT and GQ

Modifiers GT Via interactive audio and video telecommunications systems and GQ Via an asynchronous telecommunications system apply only when reporting telehealth services.
Centers for Medicare & Medicaid Services (CMS) rules stipulate that as a condition of payment for telehealth services, providers “…must use an interactive audio and video telecommunications system that permits real-time communication between [the provider], at the distant site, and the benefciary, at the originating site. Asynchronous ‘store and forward’ technology is permitted only in Federal telemedicine demonstration programs in Alaska or Hawaii.”
In other words, telehealth has to be delivered such that the patient and provider are in constant, two-way communication during the service.
To indicate that the service has been provided in accordance with this CMS requirement, you must append modifier GT to the appropriate service code(s). For example, to bill a level 3 established patient office visit provided via telehealth, report 99213-GT. By appending the modifier, the provider is certifying that the beneficiary was present at an eligible originating site when the telehealth service was furnished.
When reporting a covered end-stage renal disease-related service telehealth code (e.g., 90951 End-stage renal disease (ESRD) related services monthly, for patients younger than 2 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 4 or more face-to-face visits by a physician or other qualified health care professional per month), appending modifier GT also certifies that one visit per month was furnished “hands on” to examine the vascular access site, per the code descriptor requirement.
In those cases (limited to Alaska and Hawaii) when you may bill Medicare for non “face-to-face” telehealth services, you should report the appropriate code for the professional service with modifier GQ Via an asynchronous telecommunications system.

John Verhovshek
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About Has 577 Posts

John Verhovshek, MA, CPC, is a contributing editor at AAPC. He has been covering medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University.

8 Responses to “Telehealth Modifiers GT and GQ”

  1. Donna Gibson says:

    I have a question my provider wants to bill for telemedicine if they can. I am confusing myself on this. Provider calls patient via video and audio (is skype acceptable or does a special software have to be bought) the patient is in their home. Provider is at his/her office, they are not part of an ACO.
    Some people have told me yes the provider can. But I guess where I am getting messed up at the patient is in their home. Hopefully this makes sense to whoever is answering.
    Thanks, Donna Gibson, CPC

  2. Mike Greiwe says:

    Hello Donna,
    Skype is not an acceptable (HIPAA-compliant) form of communication for patients.
    Your office will need to purchase software to ensure that there is HIPAA-compliance.

  3. Rj Sz says:

    Regardless of the modifier does the POS still need to be ’02’?

  4. Sherll Coffey says:

    What is the difference between modifier GQ & GT?

  5. RGaeta says:

    I am reading in other forums POS 2 should be utilized … This article does not mention the Place of Service at all …

  6. Marie says:

    Hi my name is Marie and i read somewhere that the telehealth service has to be billed seperately on a 1500 form so my question is do we bill the 02 and the Q3014 seperately? The example given above doesn’t even have the HCPCS Q3014 at all. So where does this code come into play?

  7. Sage says:

    Are the modifiers different for Facility charges and Professional charges? There is a lot of conflicting information online.

  8. Cheryl Waller says:

    What is the modifier used for telehealth in behavioral health? Am specifically needing for Humana Military Tricare. Have contacted them and cannot seem to get an answer except for ” we cannot tell you how to bill “.
    Very frustrating!
    Thank you for your help.