Wiki Tele-Mental Health

[MJohnsonMartinez]

Our mid sized outpatient organization is starting Telehealth - not as an originating facility but providing outpatient mental health services...
I've read everything from using a modifier 95, GT and / or GQ for 90791, 9083X's...
Anyone currently billing claims with the telehealth modifiers?
Thanks for the input,
Marie

 

[Bella2939]

Our office uses GT modifier, with no issues.

 

[mitchellde]

This is from Medicare
Effective January 1, 2018 CMS has decided to largely eliminate the requirement to use the GT modifier on telehealth claims.

Instead of using the GT modifier, providers must mark their telehealth services claims with “of Service (POS) 02.” A POS code is required on professional claims for all services – telehealth or otherwise – and using POS 02 signals to Medicare that the service was provided via telehealth. Previously, providers were instructed to use the POS code for where the patient was located at the time of the service. Effective January 1, 2018, POS 02 is to be used for all telehealth services under Medicare. The introduction of POS 02 rendered it unnecessary to also require the distant site practitioner report the GT modifier on the claim
There are a couple specific situations where CMS still wants providers to use GT or GQ modifiers. Critical Access Hospitals (CAHs) billing for distant site practitioners under Method II must continue to use the GT modifier on institutional claims. This is because institutional claims do not use a POS code, so Medicare still needs a way to identify those services as telehealth. In addition, for those providers participating in the Alaska or Hawaii federal telemedicine demonstration programs, they must still use the GQ modifier to maintain the distinction between synchronous and asynchronous telehealth services.

For non Medicare claims:

Modifier 95 – Synchronous Telemedicine Service o via Real-Time Interactive Audio and Video Telecommunications System may only appended to a specific set of CPT® codes. Those codes are listed in Appendix P, CPT® Codes that May Be Used for Synchronous Telemedicine Services, of the 2017 CPT® code book. In addition to being listed in Appendix P, codes appropriate for use with modifier 95 are indicated by a star symbol (*) throughout the CPT® code book.

 

[ccrayden]

Can you please explain what a originating facility is. Thanks!

 

[mitchellde]

From the Medicare manual on telehealth
There are five main conditions for coverage for telehealth services under Medicare.

• The beneficiary is located in a qualifying rural area (providers can check if the originating site is in a qualifying rural area by using the Medicare Telehealth Payment Eligibility Analyzer);
• The beneficiary is located at one of eight qualifying originating sites (i.e., the offices of physicians or practitioners; Hospitals; Critical Access Hospitals; Rural Health Clinics; Federally Qualified Health Centers; Hospital-based or CAH-based Renal Dialysis Centers (including satellites); Skilled Nursing Facilities; and Community Mental Health Centers);
• The services are provided by one of ten distant site practitioner types eligible to furnish and receive Medicare payment for telehealth services (i.e., physicians; nurse practitioners; physician assistants; nurse-midwives; clinical nurse specialists; certified registered nurse anesthetists; clinical psychologists; clinical social workers; registered dietitians; and nutrition professionals);
• The beneficiary and distant site practitioner communicate via an interactive audio and video telecommunications system that permits real-time communication between them (store and forward is covered in Alaska and Hawaii under demonstration programs); and
• The CPT/HCPCS (Current Procedural Terminology/Healthcare Common Procedure Coding System) code for the service itself is named on the current year list of covered Medicare telehealth services.