Don't have a TCI SuperCoder account yet? Become a Member >>

Regular Price: $24.95

Ask An Expert Starting at $24.95
Have a medical coding or compliance question? Don’t sacrifice your valuable time to endless research. Choose Ask an Expert to get clear answers from the TCI SuperCoder team. And here’s a tip for the budget-conscious: Select the 12-question pack to get the best rate per question!

Browse Past Questions By Specialty

+View all

TELEPHONE E/M DURING COVID 19

Rebecca Posted Mon 23rd of March, 2020 16:06:20 PM
TELEPHONE EVALS ( WE ARE NOT SET UP FOR AUDIO VIDEO VISITS) I SPOKE WITH UHC TODAY-IF WE PROVIDE AN E/M OVER THE PHONE WE USE CPT CODES 99201-99205 AND 99211-99215 POS 11 (THIS IS FOR UHC I BELIEVE CMS(MEDICARE REQUIRES 02-SO POS WILL DEPEND ON THE CARRIER ) I JUST NEED CLARIFICATION ON WHAT MODIFIER TO USE GT-(INTERVATIVE AUDIO VIDEO TELECOMMUNICAION)--SO I WOULD SAY NO DONT USE GQ-(VIA ASYNCHRONOUS TELECOMMINICATIONS SYSTEMS-AND IS THIS ONLY IF YOU ARE IN ALASKIA OR HAWAII ?), 95 (VIA REALTIME INTERACTIVE AUDIO AND VIDEO TELECOMMUNICATIO)-SO I WOULD SAY NO Q0 I BELIEVE THIS IS FOR A PATIENT THAT HAS HAD A STROKE -SO NO I WOULD NOT USE IT (PT DIDNT HAVE A STROKE) TY
SuperCoder Answered Tue 24th of March, 2020 10:11:21 AM

Hi,

 

Thanks for your question.

 

The UHC is temporarily waiving the CMS and state-based originating site restrictions, where applicable, for Medicare Advantage, Medicaid and commercial members. Care providers will be able to bill for telehealth services performed while a patient is at home.

 

UHC reimburse telehealth services based on its telehealth reimbursement policies. It depends on whether a claim is for a Medicare Advantage, Medicaid or commercial member, those policies require slightly different modifiers or place of service indicators for a telehealth claim to get reimbursed. These policy changes will allow you to simply bill for telehealth services performed while the patient is at home.

 

Please check the link below for the information on usage of appropriate modifier:

https://www.uhcprovider.com/en/resource-library/news/provider-telehealth-policies.html

 

For all UHC commercial plans, any originating site requirements that may apply under UHC reimbursement policies are waived, so that telehealth services provided via a real-time audio and video communication system can be billed for members at home or another location. UHC will reimburse telehealth services that are:

-Recognized by CMS and appended with modifiers GT or GQ and,

-Recognized by AMA included in Appendix P of CPT and appended with modifier 95. Reimbursable codes can be found embedded in the reimbursement policy.

 

Modifier GT denotes a telehealth system, real time audiovisual conferencing between a patient and provider, in which a provider at a distant site provides healthcare services for a patient at a different location, including an examination. The patient must be an active participant in a telehealth visit, but it is not necessary for the provider to personally perform all portions of a telehealth service, as his clinical staff may provide some services. 

 

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.

 

Modifier GQ denotes healthcare services provided via an asynchronous communication method. Asynchronous communication does not take place in real time. An example of delivery of a service via asychronous communication includes a provider at a distant location, even in another state, who receives X–ray images transmitted across a secure network and then transmits the report of his reading of the images for later review by the patient's primary care provider. An exchange of email between a patient and a provider also constitute asynchronous telecommunication services.

 

Medicare reimburses modifier GT to only providers who have a licence to provide telehealth services under the laws of their state.

Payers may designate only specific codes the provider may use with this modifier, such as office visit codes 99201 through 99215, neurobehavioral status exam code 96116, and individual medical nutrition therapy codes G0270, 97802, and 97803. Check payer policies for specific codes.

 

Hope this helps.

Thanks.

Related Topics