Wiki modifier 95?

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Modifier 95

Per AAPC Coder guidance:
Append modifier 95 to a service to identify those services provided through a synchronous or real-time audiovisual conference between a patient and a provider, in which the provider at a distant site provides healthcare services for a patient at a different location.
Modifier 95 denotes a telehealth system that provides two-way, real time audiovisual conferencing between a patient and the provider, in which the provider at a distant site provides healthcare services including an examination for a patient at a different location. The patient must be an active participant in the telehealth visit.
Payers may designate specific codes for which the provider may use this modifier, such as an office visit code 99201–99215, neurobehavioral status exam code 96116, or nutrition therapy codes 97802 and 97803. Check with the individual payer for their specific policies and guidelines, and codes for which modifier 95 assignment is applicable. Some payers may require use of modifier GT Via interactive audio and video telecommunications system, instead.

CodingKing

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Someone asked the same. I couldn't find much info about it all. Just 2 articles behind paywalls that mention it ( I cant access) . The Medicare HCPCS file for 2017 indicates no change to GT modifier. I checked the additional after the fact HCPSC changes file but no mention on it either
 

Dfreddie

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I had asked the same question, and no response. There's really not much information on it that I can find, other than the mention in the Healthcare Monthly magazine. I haven't gotten a clear answer anywhere.
 

mitchellde

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The 95 modifier is a CPT modifier New for 2017. It is well defined in the CPT book in the modifiers section. It is to be used only with the codes identified in appendix P of the CPT book. A more thorough explanation can be found in the CPT changes book. Essentially it is for use for those payers that do not recognize the HCPC II modifier GT. You will still use GT for Medicare but 95 for other commercial payers. This is a little bit like the use of the PT for Medicare but 33 for other payers when you have a preventive colonoscopy that becomes diagnostic.
 

ellzeycoding

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New Telehealth Modifier (for synchronous 2-way telehealth services)

CPT officially has a telehealth modifier.

95 Synchronous Telemedicine Services Rendered Via a Real-Time Interactive Audio and Video Telecommunications System

See Appendix P of 2017 CPT for a list of codes that may be billed with modifier 95

CMS will continue to recognize telehealth modifiers GT and GQ.

A new place of service code has also been established for Telehealth, 02.


In my opinion it's only been introduced and is in sort of a phase-in or transition period. Commercials will start recognizing it.

VT Mediciaid allows use... http://www.vtmedicaid.com/assets/banners/CurrentBanner.pdf
 
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jkeenen1

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QUESTION: We are billing for telehealth for the first time and I'm a little confused about the placement of the modifier 95 or GT. does the modifier go on the procedure code - ex: 92507 GN 95 or do we attach the modifier to the 98968 (time based code). I appreciate any information on this subject. Thanks in advance for your impute.
 

EWOG7286

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Question: When billing for an MD, what is the placement for a modifier 95 for a 99212 with an add-on code 90833? Does the modifier only go on the 99212?

-95 is only for certain codes (ie 99201-99215)
-GT is for all other codes

There is overlap between the 2 modifiers.

I am using -95 when acceptable and GT for other codes. Some insurances want GT vs 95 (IE-Tricare East).

So you may have to check with the individual insurance carrier.
 

csperoni

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A visit is billing an office visit E&M for telehealth with mod 95, physician is ortho, should we add mod 95 to the X-ray and POS telehealth. thank you
Maybe I'm missing something, but how do you perform an x-ray without the patient present??
Are you just interpreting the xray? If so, wouldn't that be x-ray with -26 just like before the emergency?
 
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