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Telehealth

Marilyn Posted Thu 28th of May, 2020 15:52:55 PM
Aware when to use the Modifier -GT, but should -95 be used for all payers? There are times "video" session is noted on superbill, then we see Tele. What is the difference?
SuperCoder Answered Fri 29th of May, 2020 09:30:37 AM

Hello Marilyn,

Hope you’re doing well!

Thank you for your question.

 

Modifier 95 denotes a telehealth system that provides two–way, real–time audiovisual conferencing between a patient and the provider, in which the provider at a distant site provides healthcare services including an examination for a patient at a different location. The patient must be an active participant in the telehealth visit.

Synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction.

 

Note: Commercial payers mostly accept modifier 95. It is important to note that Medicare and Medicaid do not recognize modifier 95. CMS on an interim basis accepting the use of modifier 95 which should be applied to claim lines that describe services furnished via telehealth.

 

Insurance companies may reimburse for phone or video sessions. In general, insurance companies are likely to provide some reimbursement for video sessions but no reimbursement for phone sessions.  During COVID-19 pandemic, some insurance companies are modifying their plans to help provide more reimbursement. We encourage you to check with your insurance company for specific guidelines around the same.

 

Hope that helps!

Please feel free to write if you have any question.

Thanks

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