In 2017, the Centers for Medicare and Medicaid Services (CMS) has added even more services to its approved telemedicine list, and you can be sure that the agency will continue this trend in coming years. That’s great news for both your potential patients and your practice. But the coding is hardly straightforward, and you have to get it right or you can be sure you’ll be seeing denials rather than checks in the mail.

Before you actual apply the correct CPT codes to the telehealth claims, the first step is determining if you’re reporting for an originating site or a distant site:

• Originating site — the patient’s location at the time the service was furnished.
• Distant site — the location of the physician or other licensed healthcare provider delivering the service.

An originating site receives a telehealth facility fee, and you should report this with HCPCS code Q3014 (Telehealth originating site facility fee). Generally, only those facilities in low population density areas or rural portions of urban and high population counties are eligible for this reimbursement.

For the distant site, the coding centers more on the service provided — with a slight twist. There are specific services for which Medicare will reimburse telemedicine charges, and you can download that list from the CMS website (https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes.html).

When you code for one of these services for the healthcare provider at the distant site, you have to report the appropriate CPT® or HCPCS code with one of the following modifiers:

• Modifier GT — Telehealth service rendered via interactive audio and video telecommunications system. You will use this modifier for Medicare claims to indicate that the distant site clinician certifies that the patient was present at an eligible originating site when he furnished the service.
• Modifier 95 — Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system. This is a CPT modifier that’s new for 2017, and you will use it for those payers that do not accept modifier GT.
• Modifier GQ — Telehealth service rendered via asynchronous telecommunications system. You’ll only use this modifier if your providers participate in the federal telemedicine demonstration programs in Alaska and Hawaii. If that’s the case, then you will report the appropriate CPT or HCPCS code appended with modifier GQ.

For example, a remote clinic in a lightly populated area on the other side of the state contracts with your office to provide telemedicine services. The clinic contacts your practice and requests a service for one of its new Medicare patients. Your physician performs a comprehensive history, comprehensive examination and moderate-complexity medical decision-making to assess and address the patient’s condition.

To report this type of care, the originating clinic would report Q3014 for its facility fee. And your physician would submit his evaluation and management service with 99204-GT. You would consider the patient new because the provider has never seen her before.

REMEMBER: Although Medicare requires you to use modifiers GT and GQ for telemedicine services, some private payers may have other requirements, such as using modifier 95 or relying on the consultation codes (99241-99245) without modifiers. So be sure to check with your payers before reporting telemedicine services to ensure you follow their specific rules.

Take Aways:

• Know your site — originating or distant — to select the proper codes for the telemedicine visit.
• You’ll need modifier GT to code for distant site services for Medicare patients, unless your part of special programs in Alaska and Hawaii, where you’ll rely on modifier GQ. Or you may submit modifier 95 to some private carriers.
• Contact your private payers to determine how they would like you to report telemedicine services.