October 5, 2017
An ever-increasing number of patients receive their healthcare via telehealth by using a secure, encrypted telecommunications system.
To correctly identify and distinguish these services on a claim form, there are key data elements that must be included on each claim.
To identify a telehealth service, add two key data elements to each code line: Place of Service (POS) code and a correct modifier.
Place of Service Code 02 - Telehealth (effective with dates of service January 1, 2017 and after)
When the patient sees a distant site provider through a telecommunications system that's synchronous, a telehealth POS code must be added to each service on the claim that is submitted by the distant site provider.
POS code 11-Provider Office should not be used since the member is not being seen in the provider's office, but via a telecommunications system.
Modifiers 95, GT and GQ
Each service submitted for a telehealth visit must have one of the following modifiers appended to the procedure code:
- 95 - Synchronous Telemedicine Service Rendered via a Real-Time Interactive Audio and Video Telecommunications System (effective January 1, 2017). Use of this modifier indicates a real-time interaction between a physician or other qualified healthcare professional and a patient located at another site.
- GT - Via interactive audio and video telecommunication systems. Use of this modifier certifies that the member was present at an eligible originating site when the telehealth service was rendered.
- GQ - Via Asynchronous telecommunications system. Use of this modifier certifies that the asynchronous medical file was collected and transmitted to a provider at a distant site (store and forward technologies).
Combined with the correct POS code, these modifiers help to identify a service rendered as part of a telehealth visit. Review the Telehealth/Telemedicine services payment policy for further details on billing telehealth services.