GT Modifier for Mental Health Billing

The GT modifier is a coding modifier used for Telehealth claims. For many years it was the standard for signifying Telehealth claims before being mainly supplanted by the 95 modifier. In 2018, when CMS and Medicare stopped using this mainly companies followed suit and switched to 95 modifier. Despite this, there are still some insurance companies that accept GT modifier claims and even require them.

What does the GT Modifier Signify? Is there a Difference Between GT and 95?

The GT modifier is defined as services via synchronous telecommmunication. This is a very similar but not identical definition to the 95 modifier which is also defined as synchronous Telehealth. Synchronous means that it must occur at the same time and not asynchronously like email, and is a fancy way of signifying a video call. Please note that under some older definitions Telehealth could be seen as voice only, but is standardized as including both video and audio now.

2020 Telehealth Standards

With the onset of COVID19, the Telehealth billing standards for Telehealth have rapidly changed. This includes many insurers switching their standards or just being more flexible. Some insurance companies accept GT and 95 whereas other companies ask that you code with a certain one.

Not sure which code to use. If you use a billing service we can help by calling the insurance company to ensure the correct coding standards for a Telehealth visit.

What CPT Code Do I Use With the GT Modifier? How Is it Reimbursed?

This is billed with standard mental health CPT codes like 90791, 90834, or 90837.

If it is accepted, claims with GT modifier are generally reimbursed at the same rate as in-person visits. They use the same CPT, procedure code so the fee schedule is the same.

GT vs. GQ

GQ is another similar modifier used for Telehealth visits. The difference is that it is for aysnchronous telecommunication systems.

Billing GT Modifier

Does Medicare Accept GT?

No. The CMS standards changed in the beginning of 2018, when they replaced GT with 95. Medicaid also requires 95.

Place of Service Code. 02 or 11?

This has still not been standardized in 2020. Non-telehealth visits are coded with a place of service 11 to indicate an office whereas 02 is defined as Telehealth. Generally Telehealth claims should use 02 as a place of service code. Nevertheless, there is enough variation that this is another area where we recommend contacting or researching ahead of time before filing a claim.

How Do I Bill the GT Modifier on a CMS 1500 Form?

The GT modifier is billed under the 24d field on the CMS 1500, with the CPT code in 24c.

CMS 1500 GT Modifier