One of the questions that we get most often from providers and organizations interested in offering virtual services is about telemedicine CPT codes for billing claims. Billing telemedicine can seem confusing and overwhelming, but the actual codes used are probably the simplest part of implementing a telemedicine program.
One of the things to remember is that, as with any insurance claim, there is no guarantee of payment unless it’s a covered benefit and in your contract with the organization. That being said, if you’re ready to submit the claims and you just need to be pointed in the right direction, it’s a pretty straight path to the right options.
Know Your Modifiers
In most cases, billing for telemedicine looks a whole lot like billing for in-person evaluation and medication management. The biggest different is that you will add a modifier. There are three potential modifiers that earmark a claim as telehealth: GT, GQ and 95.
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.
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 categories:
- Psychiatric and behavioral health treatment
- Genetic counseling and evaluation
- Some remote ophthalmologic services
- Office and outpatient services
- Some inpatient consults
- Nursing facility evaluations and prolonged monitoring services
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.
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.
Place of Service
A frequent area of confusion for billing telemedicine CPT codes was whether the place of service changes. If the provider is at the facility but the patient is at home, is the place of service still 11? As of January 1, 2017, the recommended Place of Service for telemedicine was “02”. This references a location where the service is received through telemedicine technology. Not all payers require the 02 place of service to bill a telemedicine claim, but it’s good information to have if you receive remittance advice indicating that the Place of Service is incorrect.
A Few More Codes To Consider
There are a few codes that are specific to telemedicine, but they do not have to be used to bill telemedicine. 99444 can be used to billed an online E/M service provided by a physician and 98969 is meant for online assessment and management services.
Are You Ready To Get Billing?
Knowing how to submit the claims is actually the easy part. What you need now is a partner who can finish out the rest of the picture and make the technology and implementation just as simple. That’s what Mend can do. If you’re ready to get started, request a demo from our website!