What Is Modifier GT in Medical Billing?
Demystify Modifier GT in medical billing. Learn its purpose, proper application, and effect on telehealth service claims.
Medical billing involves a complex system of codes and modifiers that accurately describe the services provided to patients. These modifiers are two-character codes appended to standard medical procedure codes, known as CPT or HCPCS codes, to offer additional information about a service without changing its fundamental definition. Among these, Modifier GT has historically played a role in the context of telehealth services, indicating that a medical consultation or procedure was delivered remotely rather than in a traditional in-person setting.
What Modifier GT Signifies
Modifier GT is specifically used in medical billing to denote that a service was provided “Via Interactive Audio and Video Telecommunications Systems.” This means the interaction between the healthcare provider and the patient occurred in real-time, using technology that allowed for both synchronous audio and visual communication. It signals to payers that the interaction involved a two-way, real-time video and audio connection. This modifier is typically combined with a standard CPT code, which identifies the specific medical procedure or service performed. For instance, an office visit code (e.g., 99201) would be appended with GT (e.g., 99201 GT) to indicate its telehealth delivery.
When Modifier GT Is Used
Modifier GT is applied when a healthcare service that would normally be provided in person is instead delivered remotely through a synchronous, interactive audio and video telecommunications system. This includes services such as certain evaluation and management (E/M) visits, which cover routine check-ups and consultations, and specific behavioral health services like psychotherapy.
The technology employed must support simultaneous audio and video, ensuring a comprehensive virtual encounter. This excludes scenarios involving only audio communication or those where information is transmitted and reviewed at a later time, such as through secure messaging or image forwarding.
Healthcare professionals who utilize telehealth platforms for virtual check-ups, remote consultations for ongoing care, or second opinions via specialists are the typical users of this modifier. While historically broad in its application, it is important to note that the Centers for Medicare & Medicaid Services (CMS) largely transitioned away from requiring Modifier GT for most professional claims, instead relying on Place of Service (POS) code 02 to identify telehealth services. However, some private payers and specific institutional claims, like those from Critical Access Hospitals (CAH) Method II providers, may still require its use.
How Modifier GT Impacts Billing
The inclusion of Modifier GT on a medical claim communicates to the payer that a service was rendered via a synchronous audio and video telehealth system. While Medicare has largely moved to using Place of Service code 02 for telehealth, many private insurance companies may still accept or even require Modifier GT.
The modifier helps ensure that the billed service aligns with the payer’s specific policies regarding telehealth coverage. Without the appropriate modifier or POS code, a telehealth claim may be denied, leading to delays in reimbursement and increased administrative work for providers.
When accepted, services billed with Modifier GT are often reimbursed at a rate comparable to in-person visits, depending on the payer’s policies and the specific CPT code used. Therefore, understanding payer-specific guidelines remains important for accurate billing and successful claims submission.