Wednesday, September 2, 2015

CPT modifier GT, HT, HQ, GQ, T1016, H2011

Modifier   Description

GQ Via Asynchronous Telecommunications systems


GT Via Interactive Audio and Video Telecommunications systems


Modifier GT BILLING AND PAYMENT FOR PROFESSIONAL SERVICES FURNISHED VIA TELEHEALTH


Submit claims for telehealth services using the appropriate CPT or HCPCS code for the professional service along with the telehealth modifier GT, “via interactive audio and video telecommunications systems” (for example, 99201 GT). By coding and billing the GT modifier with a covered telehealth procedure code, you are certifying that the beneficiary was present at an eligible originating site when you furnished the telehealth service. By coding and billing the GT modifier with a covered ESRD-related service telehealth code, you are certifying that you furnished one “hands on” visit per month to examine the vascular access site.

For Federal telemedicine demonstration programs in Alaska or Hawaii, submit claims using the appropriate CPT or HCPCS code for the professional service along with the telehealth modifier GQ if you performed telehealth services “via an asynchronous telecommunications system” (for example, 99201 GQ). By coding and billing the GQ modifier, you are certifying that the asynchronous medical file was collected and transmitted to you at the distant site from a Federal telemedicine demonstration project conducted in Alaska or Hawaii.

You should bill the Medicare Administrative Contractor (MAC) for covered telehealth services. Medicare pays you the appropriate amount under the Medicare Physician Fee Schedule (PFS) for telehealth services. When you are located in a CAH and reassigned your billing rights to a CAH that elected the Optional Payment Method, the CAH bills the MAC for telehealth services and the payment amount is 80 percent of the Medicare PFS for telehealth services.


CODING

The following list of codes is provided as an informational tool only, to help identify some of the applicable Current Procedural Terminology (CPT®)' codes/code ranges and Healthcare Common Procedure Coding System Level II (HCPCS)  codes/modifiers that may be utilized in reporting telemedicine/telehealth services. The inclusion or exclusion of a specific code does not indicate eligibility for reimbursement and/or coverage in all situations.

CPT codes that ordinarily describe direct face-to-face services, but signify telemedicine services

when used with modifier GT:

• 99201-99215 -- Office or other outpatient Evaluation and management services

• 99241-99245 -- Office or other outpatient consultations

• 90791-90792 -- Psychiatric diagnostic evaluation

• 90832-90838 -- Individual psychotherapy services

• 90863 ----------- Pharmacologic management service (List separately in addition to the code for primary procedure)


Category III CPT codes specific to telemedicine/telehealth:

• 0188T---------- Remote real-time interactive video-conferenced critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes

• 0189T---------- Remote real-time interactive video-conferenced critical care, evaluation and management of the critically ill or critically injured patient; each additional 30 minutes (List  separately in addition to code for primary list)


HCPCS codes/modifiers:

• G0406 -- Follow-up inpatient consultation, limited, physicians typically spend 15 minutes communicating with the patient via telehealth

• G0407 -- follow-up inpatient consultation, intermediate, physicians typically spend 25 minutes communicating with the patient via telehealth.

• G0408 -- Follow-up inpatient consultation, complex, physicians typically spend 35 minutes or more communicating with the patient via telehealth

• G0425 -- Telehealth consultation, emergency department or initial inpatient, typically 30 minutes communicating with the patient via telehealth

• G0426 -- Telehealth consultation, emergency department or initial inpatient, typically 50 minutes communicating with the patient via telehealth

• G0427 -- Telehealth consultation, emergency department or initial inpatient, typically 70 minutes or more communicating with the patient via telehealth

• G0459 -- Inpatient telehealth pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy.

• GT ------ Modifier signifying: Via interactive audio and video telecommunications HCPCS codes/modifiers that are not eligible for separate reimbursement:

• Q3014 -- Telehealth originating site facility fee

• T1014 -- Telehealth transmission, per minute, professional services bill separately

• GQ ------ Modifier signifying: Via asynchronous telecommunications system

CPT codes that are not eligible for reimbursement in accordance with the Health Plan’s Bundled Services and Supplies Reimbursement Policy:

• 98966-98968 -- Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian

• 98969 -- Online assessment and management service provided by a qualified non-physician health care professional to an established patient or guardian, using the Internet or similar electronic communications network.

• 99441-99443 --Telephone evaluation and management service provided by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian

Crisis Intervention and Case Management (non-targeted Levels I and II)


Case Management T1016

One (1) unit equals 15 minutes. Billing Instructions: This service is covered for children and adults that meet Levels I and II in the Intensity of Needs Grid only. For Levels III-VI, Targeted Case Management (code T1017) is billed under provider type 54. See MSM Chapter 2500 for service limitations and criteria.

Crisis Intervention H2011 Crisis intervention service, per 15 minutes

H2011 GT Crisis intervention service, per 15 minutes
Modifier GT indicates telephonic services.

H2011 HT Crisis intervention service, per 15 minutes Modifier HT indicates team services.

Rehabilitative Mental Health Services

H0038 Self-help/peer services, per 15 minutes (Peer-to-Peer Services)
H0038 HQ Self-help/peer services, per 15 minutes (Peer-to-Peer Services)
Modifier HQ indicates group services.

H2012 Behavioral health day treatment, per hour Prior Authorization and Billing Instructions: Only Provider Type 14 Behavioral Health Community Network groups that have an approved Day Treatment Model and Specialty 308 Enrollment Checklist can request prior authorization for Day Treatment and bill code H2012. Prior authorization is required and authorization requests for Day Treatment services must be submitted via the Provider Web Portal effective April 1, 2015. Please be advised: No retroactive authorizations will be permitted for Day Treatment services. The provider must first enroll as a provider type 14 and will then be eligible to apply for the Day Treatment Specialty.

H2014 Skills training and development, per 15 minutes (Basic Skills Training)

H2014 HQ
Skills training and development, per 15 minutes (Basic Skills Training)
Modifier HQ indicates group services.

H2017 Psychosocial rehabilitation services, per 15 minutes
H2017 HQ

Psychosocial rehabilitation services, per 15 minutes
Modifier HQ indicates group services.



Q: If a provider renders the professional component for a diagnostic service, at a distant site from the patient, should modifier GT be reported?

A: No. Modifier GT indicates a face-to-face encounter utilizing interactive audio-visual communication technology. Therefore, it is not appropriate to report modifier GT in this scenario since this does not represent a face-to-face encounter. However, use of modifier 26 would be appropriate to designate that the professional component of the diagnostic service was provided.

Modifier Guidelines

Modifier GT designates services performed via interactive audio and video telecommunication systems and will be allowed with codes specified in the Corporate Reimbursement Policy titled, “Telehealth.”


9/10/07 Modifier GT - Via interactive audio and video telecommunication systems will be allowed with code 99201 - 99205, 99212 - 99215(Office or Other Outpatient Services) and 99241 - 99245 (Office or Other Outpatient Consultations) added to “When a Modifier may be covered”. Modifier GQ - Via asynchronous telecommunications system will not be allowed specifically with code 99201 - 99215(Office or Other Outpatient Services) and 99241 - 99245(Office or Other Outpatient Consultations) and Modifier GT - will not be recognized with a minimal office visit for an established patient (99211) added to “When a modifier may not be covered”. Modifier GT - will not be recognized with a minimal office visit for an established patient (99211) added to “When a modifier may not be covered.” Added to Policy Guidelines: BCBSNC does not reimburse for evaluation and management and consultation services provided via telephone, Internet, or other communication network or devices that do not involve direct, in-person patient contact. Revised wording related to modifier 57 from “Modifier - 57 designates the decision to do surgery. It is accepted only with inpatient and observation E&M codes when the decision is made to do a major surgical procedure. A major surgical procedure is defined as one with a 90 day global period. The global period starts the day prior to surgery. The modifier is appropriate to signify that the decision was made to do a major surgery procedure within the global period.” to “Modifier 57 - is an evaluation and management service that results in the initial decision to perform surgery.” from “When a modifier may be covered.” Statement “Modifier -57 will not be recognized with any E&M code other than inpatient or observation” removed from “When a modifier may not be covered”. Medical Policy reviewed 08/17/07 by Senior Medical Director of Provider Partnerships, Medical and Reimbursement Policy.

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