Question Telemedicine 95,GT,GQ modifier NEED HELP

EWOG7286

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Synchronous refers to the delivery of health information in real-time. This allows for a live discussion with the patient or provider to deliver medical expertise.
Asynchronous telemedicine refers to the “store-and-forward” technique, whereas a patient or physician collects medical history, images, and pathology reports and then sends it to a specialist physician for diagnostic and treatment expertise.

GT Modifier GT is the modifier that is most commonly used for telehealth claims. Per the AMA, the modifier means “via interactive audio and video telecommunications systems.” You can append GT to any CPT code for services that were provided via telemedicine. It is most often used for codes like 99201-05, 99211-15, behavioral health codes and other services that are medically appropriate for telemedicine.

95 Modifier Modifier 95 is similar to GT in use cases, but, unlike GT, there are limits to the codes that it can be appended to. Modifier 95 was introduced in January 2017, and it is one of the newest additions to the telemedicine billing landscape. Per the AMA, modifier 95 means: “synchronous telemedicine service rendered via a REAL-TIME interactive audio and video telecommunications system.”
Modifier 95 is only for codes that are listed in Appendix P of the CPT manual. There is considerable overlap between situations for using GT and 95. Codes listed in Appendix P are likely to fall under the following:

The specific codes include:
  • Consults- 99241-45
  • E/M For Established Patients- 99211-15
  • New Patient Evaluation and E/M- 99201-05
  • Most behavioral health codes
In What Situations Do I Use GT? 95? In short, ask your payers. Rules vary by payer, with some requiring one while others will prefer the other. It’s pretty difficult to predict, so asking is the right way to go. Reimbursement should be the same regardless of the modifier, but that might be a good question to ask as well.

POS may be "2-telehealth" or "report the POS code that would have been reported had the service been furnished in person."

GQ Modifier GQ is an option for certain situations where asynchronous telemedicine would be appropriate. Per the AMA, GQ means, “Via an asynchronous telecommunications system.” Asynchronous telemedicine means that medical care was provided via image and video that was not provided in real-time. A patient will undergo a service that is recorded as video or captured as an image, and the provider will evaluate it at a later time. Usually, the evaluation is completed within the same day, but there may be situations where that is not the case. GQ is reimbursed by some payers, but the reimbursement is not as common as the GT modifier. Most use cases for asynchronous telemedicine are in spaces where providers would normally be reviewing the information after the service. It’s frequent with imaging studies and ophthalmology, but there are many use cases.
 
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