What are the modifiers required for telehealth services?

Does UHC require 95 modifier for telehealth?

UnitedHealthcare requires one of the telehealth-associated modifiers (GT, GQ, G0 or 95) to be reported when performing a service via Telehealth to indicate the type of technology used and to identify the service as Telehealth.

When to use modifier 92?

Alternative Laboratory Platform Testing: When laboratory testing is being performed using a kit or transportable instrument that wholly or in part consists of a single use, disposable analytical chamber, the service may be identified by adding modifier 92 to the usual laboratory procedure code (HIV testing 86701-86703) ...

How to bill telehealth visits in 2024?

Coding for Audio-video Visits

Use the POS that aligns with the patient's location. As of January 1, 2024, Medicare pays telehealth services provided in the patient's home (POS 10) at the non-facility rate. Telehealth services provided at an originating site (POS 02) are paid at the facility rate.

What modifier does Aetna use for telemedicine?

Modifiers GT, 95, FR

When a provider reports modifier GT or 95, it certifies the patient received services via an audiovisual telecommunications system. Click herefor more information about our telemedicine liberalization in response to the Coronavirus COVID-19 outbreak.

What is the difference between telehealth and telemedicine?

While telemedicine refers specifically to remote clinical services, telehealth can refer to remote non-clinical services, such as provider training, administrative meetings, and continuing medical education, in addition to clinical services. There are several other ways to define telehealth.

How to bill for telehealth for behavioral health?

What is the 24 modifier?

Use CPT modifier 24 for unrelated evaluation and management service during a postoperative (global) period. The global period of a major surgery is the day prior to, day of and 90 days after the surgery.

Will Medicare pay for telehealth in 2025?

Medicare patients can receive telehealth services for non-behavioral/mental health care in their home through March 31, 2025. There are no geographic restrictions for originating site for Medicare non-behavioral/mental telehealth services through March 31, 2025.

What are two modifiers that can be used for billing telehealth?

The two most commonly used modifiers are the GT modifier for telehealth service rendered via interactive audio and video telecommunications systems, and the 95 modifier for synchronous telemedicine service rendered via a real-time interactive audio and video communications system.

Is telehealth ending in 2024?

We continue to carefully consider the input received and are working to promulgate a final set of telemedicine regulations. However, with the end of 2024 quickly approaching, DEA, jointly with HHS, has extended current telemedicine flexibilities through December 31, 2025.

What code is used for telehealth?

Place of Service codes: When billing telehealth claims, it is important to understand the place of service (POS) codes as it affects reimbursement. POS 02 refers to telehealth provided other than in patient's home and POS 10 refers to telehealth provided in patient's home.

What is the modifier for UHC telehealth?

UnitedHealthcare Community Plan requires one of the telehealth-associated modifiers (GT, GQ, G0 or 95) to be reported when performing a service via Telehealth to indicate the type of technology used and to identify the service as Telehealth.

Is Aetna no longer covering telehealth?

Aetna recently announced it was excluding fully insured commercial plans in all 50 states from its new telehealth policy that took effect December 1, 2023, eliminating coverage for audio-only and asynchronous telehealth services.

What is the modifier for 90834 telehealth?

Telehealth with modifiers and codes

In behavioral health, the modifier 95 is added to the original code to signify teletherapy. For example, you would add the 95 modifier to 90834 to signify a 45-minute teletherapy session (i.e., 90834-95).

Is modifier 95 required for telehealth services?

Modifier 95 must be used for Medi-Cal covered benefits or services delivered via synchronous, interactive audio/visual, telecommunications systems. Only the portion(s) of the telehealth service rendered at the distant site are billed with modifier 95.

What is the 7 day rule for telehealth?

If within 7 days of the initial patient-initiated contact a separate E/M visit (in person or synchronous telemedicine) occurs, then the Online Digital visit is not billed but the time is incorporated into the subsequent E/M visit.

What is the difference between 95 and GT modifier?

Both Modifier 95 and the GT modifier indicate synchronous telehealth, but they are not always interchangeable: Modifier 95 is generally preferred by commercial insurers and Medicaid for most telehealth services. It's often used with codes listed in Appendix P of the CPT manual.

What is a 73 modifier used for?

Modifier -73 is used by the facility to indicate that a surgical or diagnostic procedure requiring anesthesia was terminated due to extenuating circumstances or to circumstances that threatened the well being of the patient after the patient had been prepared for the procedure (including procedural pre-medication when ...

How do I know which modifier to use?

The correct modifier to use is determined by payor preference. There can be instances where a CPT code is further defined by an HCPCS modifier, for example, to describe the side of the body the procedure is performed on, such as left (modifier -LT) or right (modifier -RT).

What is modifier 97 used for?

When a service or procedure that may be either habilitative or rehabilitative in nature is provided for rehabilitative purposes, the physician or other qualified health care professional may add modifier 97 to the service or procedure code to indicate that the service or procedure provided was a rehabilitative service.