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Modifier 95, GT, QT with telehealth services

kathleeng

Networker
Messages
59
Location
Fresno, CA
Best answers
0
Can anyone do a quick breakdown of modifiers 95, GT, and QT when attaching to 99201-99215 POS 2 for telehealth services. I am looking into them but a bit confused. Appears we would bill with modifier 95 for these e&m codes. We just started this today so I'm trying to gain as much information as I can. By the way, I work for a oncology/hematology visit, if that helps.
 

kimlawson

Contributor
Messages
12
Best answers
0
I have been using established office visit cpt code with modifier 95 and am getting paid except BCBS and Aetna. Anyone else getting paid for telemed services with Aetna and BCBS?
Do you bill Medicare with 95 modifier?
 

mitchellde

True Blue
Messages
13,537
Location
Columbia, MO
Best answers
2
No you do not use the 95 modifer with Medicare and you do not use the GT unless you are ina specifically designated location. Use the visit level with POS 02 for Medicare. You use QT only for those in Alaska or Hawaii to record the visit to send to a provider In the main US continent due to the time difference
 

harpermmb

Contributor
Messages
12
Location
McKinney, TX
Best answers
0
No you do not use the 95 modifer with Medicare and you do not use the GT unless you are ina specifically designated location. Use the visit level with POS 02 for Medicare. You use QT only for those in Alaska or Hawaii to record the visit to send to a provider In the main US continent due to the time difference
Thank you
 

ponesko

New
Messages
1
Location
Fredericksburg, VA
Best answers
0
Just started to bill these this week. This is so confusing Medicare No modifiers and use POS 02
all other ins us POS 11 and can use -95 and GT modifiers?
 

klane7

New
Messages
7
Best answers
0
This is a very fluid situation and changes quickly. I am finding that carriers (Cigna, Tricare & UHC) that we have billed a few telehealth visits to are applying copays and deductibles if the visit is not for a COVID related illness. The only information I can find from CMS states "physicians CAN waive all cost-sharing for telemedicine services." Does anyone have any further information on billing the patient for any balances for televisits?
 
Messages
2
Best answers
0
So as of Friday 4/3/2020-we are not to use POS 02 for telehealth, but use the modifier 95 For 99211-99215? Is this what I am getting from CMS & what about other carriers?
 

gcohen

Networker
Messages
99
Location
Upland
Best answers
0
all information states to use modifier 95 for telehealth. GT is for Medicaid. Reimbursements all over the place, some payors requiring POS 11 for in office reimbursement. Some specify cover cost sharing for all telehealth, others state for COVID related only. Any suggestions to this daily changing dilemma?
 

EWOG7286

Contributor
Messages
16
Best answers
0
I have received a few claims back so far.

Tricare East - POS 2 - Modifier GT (same reimbursement rate as POS 11)
Ambetter by Magnolia Health - POS 2 - Modifier GT (same reimbursement rate as POS 11)
Medicare - POS 2 - no modifier (received lower reimbursement)
But now Medicare changed guidelines to POS-11 and modifier 95 so I will have to correct the claims I already sent in.

I checked the BCBS-MS portal and the claims say "pending". I looked at the detailed notes ands it says awaiting originating site code. I sent an email to our BCBS rep to see what needs to be done to get the claims processed.
 

jmgiles

New
Messages
8
Best answers
0
Below is an attachment hopefully will help everyone.
Thanks so much! This is very helpful information. Another question that I have is about CMS relaxing the requirement for an e/m visit to have both audio and video. In our office, we were sent information on Friday saying that if video was not available Medicare would still allow the use of a 992xx code. Also, here on the AAPC site there was an FAQ article that eluded to the same. Then, in the office today, we were told that clarity was needed as to whether the video requirement had been waived. I've been searching online all evening trying to find a definite answer. I watched the CMS video and based on that I believe that both audio and video are required to bill 992xx codes. Am I right? Can anyone point me in the right direction? Thanks and sorry for the lengthy post! :)
 

EWOG7286

Contributor
Messages
16
Best answers
0
Thanks so much! This is very helpful information. Another question that I have is about CMS relaxing the requirement for an e/m visit to have both audio and video. In our office, we were sent information on Friday saying that if video was not available Medicare would still allow the use of a 992xx code. Also, here on the AAPC site there was an FAQ article that eluded to the same. Then, in the office today, we were told that clarity was needed as to whether the video requirement had been waived. I've been searching online all evening trying to find a definite answer. I watched the CMS video and based on that I believe that both audio and video are required to bill 992xx codes. Am I right? Can anyone point me in the right direction? Thanks and sorry for the lengthy post! :)

FURTHER PROMOTE TELEHEALTH IN MEDICARE:
CMS is expanding access to telehealth services for people with Medicare. This means they can receive care where they are: at home or in a nursing or assisted living facility. If they have COVID-19, they can remain in isolation and prevent spread the virus. If they aren’t infected, they can get care without risking exposure to others who may be ill. CMS will now pay for more than 80 additional services when furnished via telehealth. These include emergency department visits, initial nursing facility and discharge visits, and home visits, which must be provided by a clinician that is allowed to provide telehealth.
Providers also can evaluate beneficiaries who have audio phones only.
 

jmgiles

New
Messages
8
Best answers
0
Do you take that to mean that a 99201-99215 can be performed with audio only? Or would audio only still need to be billed with 99441-99443 or G2012? On Friday, our coding compliance said that 99201-99215 could be used if the patient didn't have access to video. Then, today the compliance team seemed less certain of that.
 

shanamarie

Networker
Messages
60
Location
Eagan
Best answers
0
I b

FURTHER PROMOTE TELEHEALTH IN MEDICARE:
CMS is expanding access to telehealth services for people with Medicare. This means they can receive care where they are: at home or in a nursing or assisted living facility. If they have COVID-19, they can remain in isolation and prevent spread the virus. If they aren’t infected, they can get care without risking exposure to others who may be ill. CMS will now pay for more than 80 additional services when furnished via telehealth. These include emergency department visits, initial nursing facility and discharge visits, and home visits, which must be provided by a clinician that is allowed to provide telehealth.
Providers also can evaluate beneficiaries who have audio phones only.
I believe what CMS is referencing by this is audio phone
Do you take that to mean that a 99201-99215 can be performed with audio only? Or would audio only still need to be billed with 99441-99443 or G2012? On Friday, our coding compliance said that 99201-99215 could be used if the patient didn't have access to video. Then, today the compliance team seemed less certain of that.
I interpret this to mean audio only is billed as phone visits 99441-99443 and G2012 since these were recently added as a covered service. I think the office visits still need to have audio and video. I’m interested to see how other people interpret this though. I know that other payors are now allowing audio only e/m visits. We confirmed this today with Cigna and health partners in MN.
 

jmgiles

New
Messages
8
Best answers
0
Thanks for your response...all of this information has been thrown at us so suddenly and seems to be ever-changing. I really appreciate your help. :)
 

EWOG7286

Contributor
Messages
16
Best answers
0
Medicare Telehealth Visits:
Effective for services starting March 6, 2020, and for the duration of the COVID-19 Public Health Emergency (PHE), Medicare will make payments for Medicare telehealth services furnished to patients in broadened circumstances.

During the PHE, clinicians can use popular applications that allow for video chat such as Apple FaceTime and Skype, thanks in part to enforcement discretion by the HHS Office of Civil Rights. Clinicians who seek additional privacy protections for telehealth while using video communication products should provide such services through technology vendors that offer HIPAA business associate agreements (BAAs) with their video communication products.

In addition, clinicians may utilize telephone without video for other communication technology-based services.
•Patients may be either a new or established patient.
•These visits are the same services as would be provided during in-person visit and are paid at the same rate as in-person visits.
•The patient may be located in any geographic location (not just those designated as rural), in any healthcare facility, or in their home.
•The Medicare coinsurance and deductible would generally apply to these services; however, the HHS Office of the Inspector General is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs.

Common telehealth CPT and HCPCS codes include:
99201-99215: Office or other outpatient visits
G0425-G0427: Telehealth consultations, emergency department or initial inpatient
G0406-G0408: Follow up inpatient telehealth consultations furnished to beneficiaries in hospitals or skilled nursing facility (SNF)

Please note: In a case where two-way audio and video technology required to furnish a Medicare telehealth service might not be available, there are circumstances where prolonged, audio-only communication between the practitioner and the patient could be clinically appropriate yet not fully replace a face-to-face visit.

For the duration of the PHE for the COVID-19 pandemic, Medicare will make separate payment for audio-only visits described by CPT codes 98966-98968 and CPT codes 99441-99443 as outlined on page 125 in the Interim Final Rule with Comment.

 
Messages
1
Best answers
0
BCBS was requiring MOD 95 AND POS 2 for some reason until about a month ago. should be good now
also, you can bill 95 modifier to MAOs for sure. not sure about regular medicare FFS, but I would assume the same?
 
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