Telemedicine Modifier and Place of Service Codes
We understand telemedicine billing can be difficult and confusing sometimes. Each state has specific regulations for telehealth and the requirements for billing and coding differ by payer.
The Rules Engine offers preferred modifier recommendations when a recommendation is available. The introduction of Modifier 95 by AMA in 2017 has made it easier to determine what codes may be appended with a Modifier 95, these codes are identified by a star icon in the CPT codebook. We recommend that you refer to the payer's policies prior to submitting a claim.
During the Covid-19 PHE: Billing a POS 02 may result in a reduced payment or denied claims due to current insurance system limitations. Billing a typical place of service will ensure providers receive the same reimbursement as they typically get for a face-to-face visit. Please contact your payers to ensure you are billing correctly.
Below are the most common synchronous telemedicine indicators.
- The GT modifier is used to indicate a service was rendered via synchronous (audio and video) telecommunication.
- In 2018, CMS replaced the GT modifier with POS 02. However, this does not mean that the GT modifier is no longer recognized. Some private payers still recognize and prefer the GT modifier.
- Depending on the payer policy, Modifier GT is only for use with those services provided via synchronous telemedicine for which modifier 95 cannot be used.
- Modifier 95 is used to indicate services were rendered via synchronous telemedicine service rendered via a real-time interactive audio and video telecommunication system.
- There is a new star icon in CPT that identifies the codes that modifier 95 can be appended to as well as a new Appendix P, CPT Codes That May Be Used for Synchronous Telemedicine Services.
- It is important to note that Medicare does not recognize modifier 95. As with the GT modifier, not all payers recognize modifier 95.
Place of Service 02:
- According to CMS, POS 02 is defined as "the location where health services and health-related services are provided or received, through a telecommunication system."
- As stated in the GT modifier section, CMS has replaced the GT modifier with POS 02. POS 02 can be used when billing CMS claims for synchronous telemedicine visits.
- Other payers may require the use of POS 02, please refer to the payer's policy.