CMS Updates for Telehealth billing

GT Modifier limited to CAH billing

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In the CY 2018 PFS final rule, the requirement to use the GT modifier was eliminated for all professional claims. CR10152, which implemented that policy, included a business requirement instructing MACs to be aware that the GT modifier is only allowed for distant site services billed when the type of bill is a Method II CAH with a revenue code 96X, 97X, or 98X or with a service line that contains HCPCS code Q3014 or the type of bill is a Method II CAH with revenue code 942 and contains G0420 or G0421. As of January 1, 2018, the GT modifier is only allowed on institutional claims billed under CAH Method II. If the GT modifier is billed under any circumstances, except as just outlined for Method II CAHs, the claim line will be rejected with the following remittance codes:

• Group Code CO – Contractual obligation
• Claim Adjustment Reason Code 4 – The procedure code is inconsistent with the modifier used or a required modifier is missing. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 07/01/2017
• Remittance Advice Remarks Code N519 – Invalid combination of HCPCS modifiers.

Visit the Medicare Learning Network page for additional information.