Additional Billing Information

Place of Service:

Use Place of Service 02-Telehealth

Modifiers:

Modifiers used for Telemedicine are:

• GT – Via interactive audio and video telecommunication systems
• 95 – Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System

NOTE: Medicare stopped the use of modifier GT in 2017 when the place of service code 02 (telehealth) was introduced. If your payers reject a telehealth claim and the 95 modifier is not appropriate, ask about modifier GT.

Originating Sites:

The location where a patient receives the care is the originating site.

*Originating Site requirement waived during COVID-19

Eligible Providers

• Nurse Practitioners
• Physician Assistants
• Nurse-midwives
• Clinical Nurse Specialists
• Certified Registered Nurse Anesthetists
• Clinical psychologists and social workers*
• Registered dietitians or nutrition professional

* Some stipulations apply to CPs and CSWs.

Eligible Services - CPT

• 99201-99215 – new or established outpatient/office visits
• 99231-99233 – subsequent hospital services (limited to 1 every 3 days)
• 99307-99310 – SNF visits (limited to 1 every 30 days)
• 99495-99498 – Transitional care management and Advance Care Planning
• 99354-99357 – Prolonged care
• 96160-96161 – Health Risk Assessments

*See Appendix M in the CPT Book for eligible codes, per AMA

Eligible Services - HCPCS

G0425-G0427 – Telehealth consultations, emergency department or initial inpatient

• G0406-G0408 – Follow-up inpatient telehealth consultations furnished to patients in hospitals or SNFs.
• G0442-G0447 – Alcohol, depression, STD, CV and obesity screenings and counseling
• G0436-G0437 and 99406-99407 – smoking cessati

Insurance Reimbursement:

34 States and DC currently require private payers to reimburse telemedicine at the same rate as in-person visit.

Eligibility Verification for Telemedicine:

The big insurance carriers (BCBS, Aetna, Cigna, United Healthcare) cover telemedicine. The largest commercial payers do cover telemedicine. However, whether they will reimburse for a telemedicine service is policy-dependent, meaning one patient might be covered under their BCBS policy and another may not if their policy excludes telemedicine. You have to call insurance to confirm the eligibility.