Question GT modifier

Aerickson

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New Richmond, WI
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I work for a clinic and they are wanting us to add a GT modifier to certain CPT with a POS 2 just because it is in a contract with an insurance company.

We are not a CAH to use this modifier, would this be fraudulent billing if we did this just because the contract with the insurance type wants this?

Any resources would be helpful that support why it is ok or why it is not. My boss who is not a coder or has no experience with coding indicates that we need to do this no matter what.

Thank you in advance!
 

SharonCollachi

True Blue
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Clovis, CA
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It is not fraudulent, and it is a valid code. Why do you think it's invalid?

Insurance companies cannot agree on pos 2 or pos 11, modifier GT or modifier 95. These are not the old rules of telemedicine - this is the chaos of pandemic.
 

Aerickson

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New Richmond, WI
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It is not fraudulent, and it is a valid code. Why do you think it's invalid?

Insurance companies cannot agree on pos 2 or pos 11, modifier GT or modifier 95. These are not the old rules of telemedicine - this is the chaos of pandemic.
I guess because at the beginning of this we were submitting with POS 2 but all insurance companies denied them and wanted POS 11, with the 95, I just wanted someone else's opinion on if this is valid or not. Also anytime we use GT they all deny, again as I stated this is only on 99241 series that they want it this way, they want the E/M with 95 and POS 11


Thank you!
 
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