NC Medicaid Telehealth Codes

[wjbruton]

Hello -

I am not sure if this would be the right forum, but this code is specifically for folks who have dealt with NC Medicaid in the telehealth setting. We have had a few denials over the correct combination of POS, telehealth vs outpatient codes, and modifiers (-95 vs -GT) any NC folks having luck with telehealth Medicaid? What combinations are you all using? Discussing this with NC Medicaid themselves has unfortunately not been helpful either.

 

[TThivierge]

Hello -

I am not sure if this would be the right forum, but this code is specifically for folks who have dealt with NC Medicaid in the telehealth setting. We have had a few denials over the correct combination of POS, telehealth vs outpatient codes, and modifiers (-95 vs -GT) any NC folks having luck with telehealth Medicaid? What combinations are you all using? Discussing this with NC Medicaid themselves has unfortunately not been helpful either.

WJ Burton
GT as modifier is invalid. Modifiers 93 and 95 used for mental health CPT services but minutes and type of mode used for treating. There is a list of CPT codes for doctor, PA, NP but minutes need to be in documentation and tell if video or audio or face 2 face used as differ modes. They must do atleast 10 minutes to be billable in treating pts.
Also some states only use video or audio 93 or 95 modifiers with beh health services. But if insurance payer check their billing rules
CPT to use for NP, PA and docs are VVC video 98000-98003 New pts.
CPT 98004-98007 VVC video Est.patients use & add minutes in documentation too.
Audio or phone calls use CPT 98008-98011 New patients
Audio or phone calls use 98012-98015 Est.patients
If tech, nurse, or nonphysician can use CPT codes 98966-98968 and must have at least 5 minutes for such staff
I hope this data helps you!
Lady T