What Is the GT Modifier and When Should You Use It?
Master the nuances of a key professional service modifier. Learn its purpose, when to apply it, and critical considerations for accurate use.
Current Procedural Terminology (CPT) modifiers play a specific role in medical billing, providing additional details about a service or procedure performed. These two-digit codes are appended to CPT codes to convey important information that might affect reimbursement or statistical analysis.
Understanding the GT Modifier
The GT modifier means “Via Interactive Audio and Video Telecommunications Systems.” Its purpose is to indicate a service, typically performed in person, was delivered remotely through a real-time interactive audio and video telecommunication system. This signifies a “distant site” service, where the patient and provider are in different physical locations. The interaction must be synchronous, occurring simultaneously, not through asynchronous methods like email.
When to Use the GT Modifier
The GT modifier is appropriate for professional services delivered remotely via real-time audio and visual communication. This includes evaluations and management (E/M) services, such as office or other outpatient visits (e.g., CPT codes 99201-99205 and 99211-99215). It is also used for behavioral health services, including psychotherapy codes (e.g., 90791, 90834, 90837), when furnished via a secure, interactive audio-visual link. The modifier applies when the patient and provider are in different physical locations and interact through a live, synchronous video call. It is used for services that would otherwise necessitate an in-person visit but are medically appropriate for telehealth delivery.
Proper Application of the GT Modifier
Append the GT modifier directly after the five-digit CPT code on a claim form, such as 99203GT. This informs the payer the service was rendered via synchronous telecommunications technology. The GT modifier is used by the distant site provider, where the healthcare professional is situated during the telehealth encounter. For Medicare, the GT modifier is generally allowed only on institutional claims billed by Critical Access Hospitals (CAH). Other provider types often use different modifiers or place of service codes for professional claims.
Payer-Specific Policies and Documentation
Payer policies vary significantly for the GT modifier, so verifying individual payer requirements is important. While Medicare has specific guidelines, private insurance companies may have different rules regarding covered telehealth services, preferred modifiers, or reimbursement rates. Some payers may accept or require the GT modifier, while others prefer alternative telehealth modifiers like Modifier 95, which also denotes synchronous telemedicine services. Confirming the specific payer’s accepted modifier for telehealth claims ensures accurate and timely payment.
Documentation in the patient’s medical record supports the use of the GT modifier and helps prevent claim denials or audit issues. The documentation should confirm the service was provided via a synchronous audio/visual telecommunication system. It needs to include the exact start and end times of the telehealth encounter, detailing the duration of the direct interaction. The physical location of both the patient and the provider during the service must be noted. Medical necessity and the appropriateness of delivering the service via telehealth should be explicitly stated, along with any informed consent obtained from the patient for receiving services remotely.