With the increase in telehealth adoption by various healthcare sectors, the question of reimbursement continues to be an area of uncertainty for some. Depending on the insurance company, a multitude of policies are upheld which may or may not be advantageous to telehealth reimbursement. Therefore, many providers assume that reimbursement for telehealth sessions is little to none. However, there are ways in which you, as a healthcare provider, can bill a patient’s visit to maximize your chances of 100% reimbursement.
What are CPT and GT Modifier Codes?
Learning how to use the proper CPT and GT modifier on your insurance claims codes takes care and precision. Both are used in the same respect in the medical billing process, but for different purposes.
Current Procedural Terminology (CPT) codes, also known as service codes, are universally recognized as identification for medical procedures that your practice offered to the patient during their session. This code usually consists of five digits that are uniquely specific to the service that was provided. Often confused with ICD-10 codes, CPT codes do not identify a diagnosis, but instead specify the treatment the patient received. These codes are updated each year, so it’s crucial for providers to be well-versed on the codes for their specialty.
The GT modifier indicates to the insurance company that the services took place via an interactive audio and video telecommunications system. By pairing a CPT code with either the proper GT modifier, it can maximize your reimbursement rate. However, guidelines are specific to the type of insurance carrier the patient has, so clarifying the policies with each insurance company is vital for reimbursement.
Some insurance companies, such as Medicare, also accept modifier 95, which means that the visit was a synchronous telehealth service administered via real-time interactive audio and video telecommunications system. There is much overlap between the use of GT and 95 modifiers, but 95 is commonly used for psychiatric, nutrition, and genetic services, among others.
Before submitting claims to the insurance payer, it’s important to verify your patient’s coverage. Most major insurance payers, including Medicare, will provide coverage for telehealth services so long as the provider uses the correct codes on their claims. Read more about verifying your patients’ coverage for telehealth here.
CPT and GT Codes for Telemedicine
The requirements for CPT and GT codes on insurance claims have changed over the course of this year, due to an increased need for telehealth services during the pandemic. Overall, the recommended guideline billing for virtual care is to follow the exact same protocols you would for a normal face-to-face office visit. However, certain changes must be made to maximize the amount of coverage received.
CPT codes indicate the services that you are providing. This is the primary billing code and indicates the service you will be billing for.
Beginning in March, with the exacerbation of the pandemic, Medicare has expanded the list of telehealth services eligible for coverage. Telehealth coverage is now provided to all Medicare beneficiaries, new or established, no matter their location. Newly covered services include medical nutrition therapy, care planning fo4r patients with cognitive impairment, psychological and neuropsychological testing, physical therapy, and occupational therapy.
Due to an increased effort to prevent the spread, Medicare has also waived their requirements dictating the types of practitioners who may provide telehealth services. Now, providers including physical therapists, speech-language pathologists, and occupational therapists may provide telehealth services. You’ll notice that some codes are considered “E/M” codes, which stands for “evaluation and management.”
- 97802, 97803 – Medical Nutrition Therapy
- 97804 – Medical Nutrition Therapy in a group setting
- 97161, 97162, 97163 – PT Eval
- 97165, 97166, 97167, 97168 – OT Eval
- 99441, 99442, 99443 – Phone E/M for Physicians and Other Clinicians
- 92507, 92508, 92521, 92522, 92523 – Speech and language therapy
- 96156, 96158, 96159 – Health behaviors assessments and interventions
- 96160 – Patient health risk assessment
- 96164, 96165, 19167, 96168 – Group and family health interventions
- 99201, 99202, 99203, 99204, 99205 – Office/outpatient visit for new patients
- 99211, 99212, 99213, 99213, 99215 – Office/outpatient visit for established patients
Additionally, Medicare providers may waive telehealth co-pays for beneficiaries with the original Medicare, to ease the financial burden of healthcare services during the pandemic. Certain exceptions also allow some services to be provided without the use of video-conferencing, but this is not universal. Other updates include certain services have become eligible for coverage if they take place using only audio communications, rather than both video and audio.
The GT modifier is used to indicate the session was administered via a telecommunications system. The reason the GT modifier is used is to signify to the insurance company the delivery of your services has changed (i.e. over video call). The GT modifier is actually becoming less and less common and has been replaced by either modifier 95 or the place of service code 02. Some private insurance companies still recognize and accept the GT modifier for telehealth services. Be sure to verify which of the telehealth modifiers your insurance company accepts most widely to ensure maximum reimbursement.
Place of Service Codes
Telehealth is unlike that of an office visit in that it takes place in a home setting over a video or phone call. Place of service codes specify where the health services were administered. When billing for telehealth, it’s unclear what place of service code to use.
Recent guidelines have recommended keeping the normal service facility that you are registered under in your CMS-1500. Unless your office was approved to be a facility to administer virtual patient care, then it is best to bill using the code (11) Office. Depending on the insurance, they may require you to bill under (02) Telehealth. However, in some cases, using (02) can lower your percentage of reimbursement. Medicare is one of the insurances that have an option for billing under (12) Home. Place of Service codes are specific to the insurance and can be confirmed through a representative.
Facility fees are charged and added onto the initial visit as reimbursable services and are used to cover the cost of maintaining the appointment facility. Some insurers will either pay a small fraction of the fee or refuse to pay any at all. Depending on the patient’s insurance provider, they are expected to pay some or all of the fee in full. To ensure reimbursement for facility fees for telehealth programs, it’s important to use the HCPCS code Q3014. It also must be billed by a facility where the patient is located.
Using Healthie for Telemedicine Insurance Billing
Healthie’s practice management and telehealth platform allows you to host virtual appointments with clients and easily generate and submit insurance claims using CPT and GT modifier codes for reimbursement.
- EHR: By leveraging Healthie’s HIPAA-compliant electronic health record, it allows you to keep clients’ personal health information secure, and track client progress using custom-built chart notes.
- Insurance Billing: Easily create a CMS-1500 claim and submit to your clearinghouse directly on the Healthie platform. Monitor claim status and store client’s telehealth insurance information throughout the billing process for simplified insurance billing.
- Quick Profile: Healthie allows you to retrieve relevant information on clients, such as their date of birth and insurance.It also allows you to quickly access patient information when filling out chart notes or forms.
- Packages and Invoices: Create custom package offerings and authorize client payments using our integration with Stripe. Easily generate invoices and receipts for payments.
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