April 19, 2018
We want to offer telehealth in our office as an added service line to our patients. How do we indicate to the insurance company that the visit was a telehealth visit?
There are a few ways that your claim form will tell a payor that the visit was performed remotely. A new Place of Service code was added to denote a telehealth visit – 02. Using this place of service instead of 11 for office will let the payor know that the visit was done via telehealth. Commercial payors may also require modifier 95, GT, or GQ to denote a telehealth service. Modifier 95 is a CPT modifier that states that the service was done via live, interactive video. Modifier GT is a HCPCS II modifier that states the same thing, but was used first until modifier 95 was added. Modifier GQ is a HCPCS II modifier that states the visit was done using store and forward technology (not live). Check with your carriers to see which modifier they require. For Medicare, only modifier GQ is required when used appropriately for Alaska and Hawaii. Otherwise, Medicare uses the place of service to indicate the visit was via telehealth. With those two pieces of information for commercial payors (place of service and modifier), they will know that the visit was a telehealth visit.
*This response is based on the best information available as of 04/19/18.