What payers require GC modifier?
Asked by: Cassidy Stracke | Last update: June 6, 2025Score: 4.3/5 (71 votes)
When should the GC modifier be used?
Modifiers GC and GE are used to identify the involvement of a resident in the care of the patient. These modifiers should be used on Medicare and Medicaid patients whenever a resident is involved in the care provided.
Is GC modifier for Medicare only?
Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare & Medicaid Services (CMS).
What is the difference between GE and GC modifier?
Modifier GC –This service has been performed in part by a Resident under the direction of a Teaching Physician. Modifier GE –This service has been performed by a Resident without the presence of a Teaching Physician under the Primary Care Exception.
Does modifier GC affect payment?
GC modifier has no impact on payment unless it is discovered on appeal that the teaching physician failed to document and electronically sign their attestation note. If you have a teaching physician supervising a resident, the GC modifier must be appended to that service.
CPC/CPB Practice Exam Review: Modifiers
What payers require the GC modifier?
Government payers (Medi-Cal and Medicare) require the GC modifier to be appended to E/M codes when a resident, under the direction of a teaching physician in an approved teaching program, is involved in the care of a patient.
How do you know if a CPT code needs a modifier?
- The service or procedure has both professional and technical components.
- More than one provider performed the service or procedure.
- More than one location was involved.
- A service or procedure was increased or reduced in comparison to what the code typically requires.
What is CG modifier used for?
Modifier CG should be reported only with the medical service HCPCS code that represents the primary reason for the medically necessary face-to-face visit when medical and preventive services are furnished on the same day.
Who is considered a teaching physician?
Teaching Physician means a physician (other than a resident) who involves residents in the care of his or her patients. 1.2. Fully licensed physicians who are not participating in a graduate medical education program recognized by the ACGME or ABMS may be considered Teaching Physicians.
What are the modifiers required for telehealth services?
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.
Do you use a GC modifier in critical care?
Modifiers. When a resident is involved in a critical care service with a teaching physician and the teaching physician presence and documentation requirements are met, append modifier -GC (this service has been performed in part by a resident under the direction of a teaching physician).
What modifier is not accepted by Medicare?
GZ - Service is not covered by Medicare
The GZ modifier identifies that 1) an item or service is expected to be denied as not reasonable and necessary, and 2) no advance notice of non-coverage was supplied to the member.
When to use GV and GW modifier?
The GV and GW modifiers are used for Medicare hospice patients. The GV modifier is used to report services related to a patient's hospice care, while the GW modifier is used to report services that are unrelated to the patient's hospice care.
What is the GC modifier for anesthesia?
GC - these services have been performed by a resident under the direction of a teaching physician. The GC modifier is reported by the teaching physician to indicate he/she rendered the service in compliance with the teaching physician requirements in section 9789.18.
What modifier should be added to 99213?
Get to know them
In this case, you may submit codes for both a preventive service (such as 99396) and a regular office visit (such as 99213) by attaching -25 to the office-visit code.
Can a medical fellow bill for services?
For the specialty in which the fellow is studying, s/he is treated as a resident; i.e. you don't bill for those services under the fellow's name. However ... occasionally you may have a fellow who is already board certified in a different specialty and s/he may be billable in that area under the fellow's own NPI.
When to use GC modifier?
If there is no attestation or the supervising provider does not indicated they saw the patient but only read and approved the documented the visit is not billable. So the use of the GC modifier is the assurance that the qualification for a billable service when provided by a resident has been met.
Which of the following is not acceptable documented from a teaching physician?
Following are examples of unacceptable documentation:
A legible countersignature or identity alone. Such documentation is not acceptable, because the documentation does not make it possible to determine whether the teaching physician was present, evaluated the patient, and/or had any involvement with the plan of care.
Is a PhD considered a physician?
A MD is a Doctor of Medicine, whilst a PhD is a Doctor of Philosophy. A MD program focuses on the application of medicine to diagnose and treat patients. A PhD program research focuses on research (in any field) to expand knowledge.
Is modifier GC a pricing modifier?
Modifier -GC (which is only for Medicare to my understanding) is an informational code only and does not affect payment. It would be attached to the teaching physician's claim in the situation that the fellow performed part of the surgery (cannot be a "key" portion unless the teaching surgeon is physically present).
Does G2025 require CG modifier?
For distant site services rendered between January 27th, 2020, and June 30th, 2020, RHCs must bill G2025 with modifier CG. After July 1, RHCs will no longer need modifier CG. Furthermore, modifier 95 is completely optional for all G2025 claims.
What is CG in healthcare?
Methods: Calculated globulin (CG), derived from the difference between serum total protein and albumin levels, reflects immunoglobulin serum levels and has shown to have a predictive value in the early diagnosis of antibody deficiencies.
How do you 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 the modifier for supervising physician?
SA Modifier: A supervising physician should use this modifier when billing on behalf of a PA, APN, of CRNFA for non-surgical services. (Modifier SA is used when the PA, APN, or CRNFA is assisting with any other procedure that DOES NOT include surgery.)
How do I know if a CPT code needs a laterality modifier?
The -RT and -LT modifiers should be used whenever a procedure is performed on one side. For instance, when reporting CPT code 27560 (closed treatment of patellar dislocation; without anesthesia), modifier -RT or -LT should be appended if only one knee is treated.