When to use GT or 95 modifier?
Asked by: Dr. Devin Gerhold Sr. | Last update: July 4, 2025Score: 4.6/5 (31 votes)
Do I use modifier 95 or GT?
What is the difference between GT and 95 modifiers? There is much overlap between the use of GT and 95 modifiers, but 95 is commonly used for psychiatric, nutrition, and genetic services, among others. Modifier 95 is like GT in use cases, but unlike GT there are limits to the codes that it can be appended.
What is modifier 95 or GT Aetna?
When a provider reports modifier GT or 95, it certifies the patient received services via an audiovisual telecommunications system. • GT: Telehealth service rendered via interactive audio and. video telecommunications system. • 95: Synchronous telemedicine service rendered via real-time.
When did Medicare stop using GT modifiers?
Does Medicare Accept GT? No. The CMS standards changed in the beginning of 2018, when they replaced GT with 95. Medicaid also requires 95.
Is modifier 95 still required for telehealth services in 2024?
Therapy providers, including SLPs, will continue to use modifier “95” to indicate telehealth services and will not use one of the POS codes for telehealth services, regardless of settings. SLPs should continue to report the POS code that best reflects where services would have been provided in person.
What is a GT Modifier?
How to code 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.
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.
Can you bill a preventive visit via telehealth?
Yes, billable providers may utilize a telehealth modality to provide FQHC, RHC, or Tribal 638 covered services via synchronous telehealth (audio-visual, two-way communication) to “established” patients. Please see the Provider Manuals provided by telehealth.
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.
What CPT codes can be billed with modifier GT?
In terms of telemedicine services, GT modifiers identify and showcase that a virtual consultation took place between a healthcare provider and a patient. It is commonly used for codes like 99201-05, 99211-15, behavioral health codes, and other services that are medically appropriate for telemedicine.
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.
How does modifier 95 affect reimbursement?
Billing: When Modifier 95 is used correctly, it ensures the claim is processed as a telehealth service and eligible for reimbursement, often under the same rates as in-person care, depending on the payer.
What POS does Medicare use 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.
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.
When should GP modifier be used?
Use a GP modifier in any case where there could be confusion as to which provider delivered services to a patient, such as in any interdisciplinary therapy setting.
How do you know if a 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 are the most used modifiers in medical billing?
Understanding commonly used modifiers in medical billing is crucial for accurate reimbursement and avoiding claim denials. Modifiers such as 22, 25, 26, 33, 50, 51, and 59 play a significant role in communicating additional information about the services provided.
Will Medicare pay with a GA modifier?
If Medicare pays the claim, the GA modifier is irrelevant. If the claim is denied, the beneficiary will be fully and personally liable to pay you for the service, personally or through other insurance.
What is the UE modifier?
For example, the “UE” modifier is used when the durable medical equipment (DME) item identified by a HCPCS code is "used equipment," and the “NU” modifier is used to identify "new equipment." For more information on HCPCS Level II codes, refer to HCPCS Level II Coding Process.
Should I use GT or 95 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.
Does Medicare require modifier 95 for telemedicine?
CMS and private payers regularly change their instructions about using these modifiers and what place of service to use. In 2024, CMS is no longer requiring modifier 95 on claims, but is requiring using POS 02 or POS 10. Modifier 95 is for use with real-time, audio/visual visits.
Can you bill 99213 for a telehealth visit?
During the COVID-19 public health emergency, many physiatrists are performing standard office visits via telehealth. These services should be billed using standard E/M codes. For example, a level 3 office visit provided to an established patient via telehealth should be billed using code 99213.
What is the GT modifier for UHC?
Modifier GT indicates a face-to-face encounter utilizing interactive audio-visual communication technology.
What is the modifier for telehealth in 2024?
For institutional billing, use modifier 95 for dates of service on and after January 1, 2024, through December 31, 2024, when: The clinician is in the hospital and the patient is in their home. Outpatient therapy provided via telehealth by PTs, OTs or SLPs employed by hospitals.
How to bill for telephone visits?
Billing and Coding
Use modifier -93 for the reporting of medical services that are provided via real-time interaction between the physician or other qualified health care professional (QHP) and a patient through audio-only technology.