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Check These Essential 2024 Telehealth Modifiers for Faster Pay

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Check These Essential 2024 Telehealth Modifiers for Faster Pay

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Telehealth services

Medicare billing data indicates that most practices are still reporting a healthy number of services via telehealth. If you occasionally see denials for those visits, the problem may involve the modifiers you do and don’t use.

Consider these three modifiers when you’re submitting telehealth claims to Medicare so you can collect accurate pay more quickly and reduce denials.

Modifier 95

While modifier 95 (Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system) was required on all telehealth claims during the public health emergency (PHE), the PHE is now over, which has led some practices to wonder whether it’s still necessary at all.

In black and white: CMS said in an April 2024 Fact Sheet, “The 95 modifier is required on claims from all institutional providers, except for Critical Access Hospitals (CAHs) electing Method II, as soon as hospitals needing to do so can update their systems.”

For example: Suppose the patient is at home but the provider is in the hospital, and a telehealth appointment occurs. In this case, you should use modifier 95 on your telehealth claim. You must also use modifier 95 “for outpatient therapy services provided via telehealth by qualified PTs, OTs, or SLPs employed by hospitals through December 31, 2024,” CMS advises.

For your standard outpatient telehealth claims, CMS no longer requires modifier 95 to be appended to the corresponding CPT code. Keep in mind, however, that other payers may still want it, so always check payer policies before billing.

Modifier GT

Providers that are performing telehealth under Critical Access Hospital (CAH) Method II should use modifier GT (Via interactive audio and video telecommuni­cation systems) with institutional claims, CMS says.

Keep in mind that CMS does allow CAHs to use the Method II payment option for their outpatient professional services and not just for inpatient services, so the modifier GT may be needed on both types of telehealth claims submitted by CAHs.

Modifier GQ

If you perform telehealth via asynchronous communication, you should append modifier GQ (Via asynchronous telecommunications system) to your CPT or HCPCS code when billing Medicare. However, there’s one major caveat to this modifier — you only need to use it if you collect and send the asynchronous medical file “from a federal telemedicine demonstration conducted in Alaska or Hawaii.”

In other words, this modifier is essential if you’re in one of these two states and performing asynchronous telehealth, but it won’t apply to other providers.

Want more information about how to ensure your telehealth claims get paid? You may need help from coding expert Maya Turner, CPC, CPMA, AAPC-Approved Instructor. During her online training event, Prevent Top Telehealth Billing/Coding Errors to Boost 2024 Pay Up, Maya will share the strategies you must know to optimize your telehealth reimbursement and curb errors. Register today!


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