What Is Modifier GT Used for in Medical Billing?
Learn how Modifier GT ensures accurate medical billing for synchronous telehealth services. Understand its critical role in remote patient care.
Medical billing uses a complex system of codes to detail healthcare services, with Current Procedural Terminology (CPT) modifiers providing additional information beyond the basic procedure code. These two-character codes communicate unique circumstances, such as changes in service, extent of service, or special conditions impacting billing. Modifier GT specifically identifies services delivered via synchronous telecommunication, involving real-time audio and video interaction between a healthcare provider and a patient. This modifier is important for accurately reporting and processing telehealth claims.
Understanding Modifier GT
Modifier GT stands for “via interactive audio and video telecommunication systems,” signifying a real-time, two-way communication link between the provider and patient, similar to an in-person encounter.
The purpose of Modifier GT is to indicate that a service, typically performed face-to-face, was delivered remotely using technology. By appending this modifier, providers signal that the telehealth service is equivalent to its in-person counterpart. This distinction is important for accurate billing and meeting remote delivery criteria.
While Modifier GT was once a standard for telehealth claims, especially for Medicare, its usage has evolved. Some payers, including Medicare, now rely on Place of Service (POS) codes, such as POS 02 or POS 10, or other modifiers like Modifier 95, for synchronous telehealth services. Despite these changes, Modifier GT is still recognized and required by certain insurance companies and for specific institutional claims.
Applying Modifier GT
Modifier GT applies where direct, real-time interaction is necessary and can be conducted remotely via audio and video technology. This includes services traditionally requiring a face-to-face component but suitable for virtual delivery, such as evaluation and management (E/M) services, psychotherapy sessions, and other medical consultations.
The key condition for using Modifier GT is the synchronous nature of the communication, meaning the provider and patient interact simultaneously through live video and audio. This ensures a direct and immediate exchange of information and clinical assessment.
While Modifier GT can be appended to various CPT codes for telemedicine services, it is important to verify individual payer guidelines. Some payers might have specific lists of eligible CPT codes or prefer other modifiers, such as Modifier 95, for synchronous telehealth services. Understanding these variations is important for proper application and to avoid claim denials.
Claim Submission and Documentation
When submitting claims, Modifier GT is appended to the CPT code for the service rendered. For example, an office visit CPT code might be reported as “99213-GT” to indicate it was performed via telehealth. This communicates to the payer that the service was delivered remotely.
Documentation in the patient’s medical record is important to support Modifier GT use. This documentation should state the service was provided via telehealth, noting the date, time, and technology used (e.g., video conferencing platform). It is also important to record the location of both the patient and the provider.
Accurate and detailed records help substantiate claims during audits and ensure compliance with billing regulations. Documentation should also include patient consent for the telehealth encounter and a brief explanation if there was a clinical reason for using telehealth, supporting medical necessity and appropriate modifier use.