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.
GT Modifier Description
The GT modifier is defined as services provided 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?
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 Modifier Reimbursement
The amount reimbursed can be 100% of the allowed amount for that CPT code without the telehealth modifier but it may be lowered depending on the client’s insurance coverage.
In 2020, Medicare has approved but lowered fees as therapy is not considered routine service.
GT vs. GQ
GQ is another similar modifier used for Telehealth visits. The difference is that it is for aysnchronous telecommunication systems.
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.