May 24th, 2018 - CoderRich
Just wondering, for a BCBS Managed Care Plan, if performing telehealth which CPT code does the doctor use? I have never billed telehealth services before. Thanks.
Keep in mind that while there are specific codes for telehealth, different payers can have different requirements. In most cases, you simply report the applicable procedure code with the appropriate modifier (95, GT, or GQ) and/or Place of Service code.
Jul 18th, 2018 - MarinENTzac 5
I concur with Wyn. For most private insurances, it seems modifier 95, GT(synchronous), GQ(asynchronous) and POS "02", along with the appropriate professional service code, is needed to bill a telehealth services.
ChrisW put in a great link to the medicare website. I suggest, though, right clicking on the link, choose "open in new tab", eliminate any characters after 'TelehealthSrvcsfctsht.pdf' in the address box, then press enter, because the link adds a few things to the end of the address so it points to a "Error: Page Not Found" page.
The document states that for Medicare specifically, Place of Service (POS) 02 now takes the place of the GT modifier as of January 1, 2018. Unless, you have distant site services billed under Critical Access Hospital (CAH) method II on institutional claims then the GT modifier will still be required or for Federal telemedicine demonstration programs in Alaska or Hawaii then use GQ modifier.