by Wyn Staheli
August 4th, 2017
Medicare has proposed making some changes to policies regarding telehealth services. They are adding some new codes to their covered list of telehealth services and propose eliminating the requirement to use the GT modifier. Since many payers adopt similar policies, watch for further announcements from other third-party payers.
- HCPCS code G0296 (Visit to determine low dose computed tomography (LDCT) eligibility)
- CPT code 90785 (Interactive Complexity)
- CPT codes 96160 and 96161 (Health Risk Assessment)
- HCPCS code G0506 (Care Planning for Chronic Care Management)
- CPT codes 90839 and 90840 (Psychotherapy for Crisis)
Reminder: Medicare pays both a facility fee to the originating site and to the "distant site practitioner furnishing the service."
In 2017, CMS finalized a requirement to use a new Place of Service (POS) Code describing services furnished via telehealth. This requirement became effective January 1, 2017. The use of modifier GT for billing professional services (on the 1500 Claim Form) is now redundant when used with the new POS code for telehealth.
For institutional claims which use the UB-04 and do not use a POS code, the proposal is that distant site practitioners will bill under CAH Method II and to continue to use modifier GT for their institutional claims.
Note that the federal telemedicine demonstration programs in Alaska or Hawaii will still use modifier GQ.