Wiki Telemed Modifier Question

[ColleenW]

Hello.
I would like some clarification. I am a new biller and I am having no luck as to the answer I am looking for on the internet or inquiring with fellow colleagues in the field
(Also I am in PA if that is necessary to know)

Telehealth visit for Amerihealth .... it currently is showing as billing it as a -GT modifier ..... was this always the case?
For example; visit from 03/2021 coded with a -95 modifier .... I am trying to figure out if this was coded incorrectly OR if at the time of DOS it was being billed that way so it was correct.

(and yes, I know there is a timely filing issue, but I need to have this answer. Thank you in advance )

 

[csperoni]

The best reference to answer your question is Amerihealth. Each carrier set their own policy regarding telehealth. Some stated they would follow whatever CMS guidelines are. Some came up with their own guidelines. In fact, some carriers have different policies depending on the type of plan.
In my large healthcare organization, a team from the corporate offices analyzed and built each carrier's rules into the system. So the coders and billers use the CMS guidelines for all patients, and then the system will correct if the carrier's guidelines differ.
I found this with Google which seems to indicate they will accept either -GT or -95. https://medpolicy.amerihealth.com/a...icy/1002e8fe-a49d-49be-8dbd-c619d51b0916.aspx

 

[lesleyterry10]

Where is the best place to find this information for the payers. I have searched multiple payers and find the information is vague at best. Thank you in advance.

 

[csperoni]

Where is the best place to find this information for the payers. I have searched multiple payers and find the information is vague at best. Thank you in advance.

Unfortunately, only the payor could officially inform you about their policies. Websites and bulletins/updates are the best options.