Telemedicine Billing: GT, 95 & GQ Modifier Differences

The world of telemedicine has become increasingly important in recent years, and telemedicine services are growing at a rapid pace, especially since 2020. It has become increasingly crucial to receive healthcare services from a distance and accommodate the preference of many clients who wish to have healthcare visits from the comfort of their homes.

Understanding Telemedicine Billing Essentials

As more healthcare providers and clients turn to virtual health visits, providers must understand the correct billing practices and use appropriate modifiers on their claims. Specifically, for those practicing telemedicine, knowing how to use appropriate modifiers and CPT codes is essential for proper reimbursement.

While this may seem complex, in most cases, billing for telemedicine resembles billing for in-person healthcare services. The main difference is the need to add a modifier. Accurate coding and modifier application are crucial to preventing claim denials and maintaining financial stability for telehealth services.

In this post, we’ll explore the main modifiers and codes associated with telehealth services.

GT Modifiers: What Are They and Why Are They Important?

Historically, the GT modifier was used for telehealth services rendered via interactive audio and video telecommunications systems. Although it was once a prevalent modifier, it has become much less common for commercial payers to require or accept the GT modifier. Instead, many commercial payers have shifted their policies to favor other modifiers or have incorporated telehealth into standard E/M codes without specific modifiers, especially for services that are inherently virtual.

When widely used, GT modifiers identified and showcased that a virtual consultation had taken place between a healthcare provider and a client. It is commonly used for codes like 99202-05, 99211-15, behavioral health codes and other services that are medically appropriate for telemedicine. Note: The GT modifier is only allowed on institutional claims billed by CAH Method II providers.

The GT modifier was added to the CPT code, which is a standard numerical code used to describe medical procedures and services. By appending the GT modifier to the appropriate CPT code, healthcare providers could ensure that telemedicine services were documented correctly and billed to the insurance company. This ensured that accurate payment was made to telehealth providers for their services.

When to Use the GT Modifier

Given the evolving landscape, the GT modifier is typically used when a service would normally be provided in person but is instead provided remotely, though its application is now highly payer-specific and declining. This can be a useful option for clients who are unable or unwilling to travel to a healthcare facility or for providers who consult with clients who aren’t within close proximity to their office.

Some common scenarios in which the GT modifier might have been used include virtual checkup appointments, remote consultations for ongoing medical care and virtual messaging. It’s important to note that not all services are appropriate for telemedicine, and the decision to use the GT modifier should be carefully considered based on the specific needs of the client and the type of care being provided.

Ultimately, the decision to use the GT modifier should be made by taking into consideration the guidelines and regulations set forth by the Centers for Medicare & Medicaid Services (CMS) and other relevant authorities. Providers should also ensure that they comply with any applicable state laws or regulations related to telemedicine. Staying current with each payer’s specific telehealth policy is paramount to ensure compliant and successful billing.

What Is the Difference Between GT and 95 Modifiers?

Modifier 95 was first introduced in January 2017 and has since become widely adopted and integrated into standard billing practices, reflecting its established role in telehealth reimbursement. According to the AMA, modifier 95 means: “synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system.” It’s similar to GT in terms of use cases, but unlike GT, there are limits to the codes to which it can be appended.

Modifier 95 is only applicable to codes listed in Appendix P of the CPT manual. There is considerable overlap between situations for using GT and 95. Codes listed in Appendix P are likely to fall under the following categories:

Understanding the nuances of modifier 95, particularly its synchronous nature and the limitations outlined in CPT Appendix P, is key to accurate claims submission.

Additional Common Telehealth Modifiers

Modifier 93

Modifier 93 is a synchronous telemedicine service via telephone or other real-time interactive audio-only telecommunications system. Synchronous telemedicine service is defined as a real-time interaction between a qualified health care professional and a client located at a site that is away from the health care professional. Note: This modifier should only be used by Opioid Treatment Programs (OTPs), Rural Health Clinics (RHCs), and Federally Qualified Health Centers (FQHCs).

Its widespread adoption underscores the increasing recognition of audio-only telehealth as a vital component of patient care, particularly for vulnerable populations or in situations where video is not feasible.

Modifier G0

Modifier G0 telehealth service provided for purposes of diagnosis, evaluation, or treatment of symptoms of an acute stroke. Modifier G0 is used to indicate a service provided outside of a geographic location (such as a telehealth appointment).

Modifier GQ

Modifier GQ is a telehealth service rendered via an asynchronous telecommunications system. Asynchronous telemedicine refers to medical care that is provided via images and video, but not in real time. For example, a client may undergo a service recorded as a video or captured as an image, and the provider evaluates it later.

Modifier FQ

Modifier FQ indicates a service or procedure was provided as part of a federally qualified health center (FQHC) or rural health clinic (RHC) visit. This modifier helps ensure accurate and appropriate reimbursement for services performed at these specific designated healthcare facilities.

Place of Service (POS) Codes: 02 and 10

In addition to modifiers, the Place of Service (POS) codes 02 and 10 have become equally important for proper reimbursement of telehealth services. POS code 02 designates a telehealth service provided other than in the client’s home, while POS code 10 indicates a telehealth service provided in the client’s home.

These codes specify the client’s location during the telehealth encounter, which can significantly impact how claims are processed and reimbursed by different payers. Accurate use of POS codes, along with the appropriate modifiers, is crucial for compliance and maximizing revenue cycle efficiency.

As with any service billed, healthcare providers need to check the billing and coding guidelines of the specific payer they are working with to ensure accurate and timely reimbursement as well as minimize claim denials.

Guide to CPT Codes for Telemedicine

It’s imperative for practices to be aware of newly introduced codes that specifically address the growing needs of telehealth.

New Telehealth CPT Codes 98000-98015

A significant development in telehealth coding is the introduction of a new range of CPT codes (98000-98015) designed to capture specific aspects of digital health services more comprehensively. These codes often relate to digital medicine, remote therapeutic monitoring and interprofessional consultations, allowing for more granular billing and better tracking of complex virtual care pathways.

Providers should review the AMA’s guidelines and payer policies for these new codes, as they represent a major shift toward recognizing and reimbursing a broader spectrum of technology-enabled healthcare. Note that Medicare did not adopt these audio-only E/M codes and may deny claims billed that way.

Now that we understand the importance of modifiers and POS codes, let’s explore the various CPT codes relevant to virtual medical services.

1. E-Visits

E-visits are digital, remote communications between a healthcare provider and a client. They typically involve the exchange of information via a client portal or secure messaging, such as asking a non-urgent question related to a health concern.

CPT codes 99421-99423 are used to report e-visits, depending on the amount of time spent on the communication.

2. Virtual Check-Ins

Virtual check-ins are typically brief, client-initiated communications with a healthcare provider, usually conducted by phone or other real-time technology that allows for audio/video capabilities.

CPT codes 99421-99423 are also used to report virtual check-ins, again based on the length of the communication.

3. Telephone Evaluation and Management Services

Telephone evaluation and management (E/M) services involve a healthcare provider conducting a comprehensive client assessment and providing medical advice over the phone.

CPT codes 98008-98016 are used to report these services, depending on the complexity and nature of the service provided.

4. Online Digital Evaluation and Management Services

Online digital E/M services are similar to telephone E/M services, but the communication occurs through secure online platforms.

CPT codes 99421-99423 can be used to report these services, depending on the duration and complexity of the consultation.

5. Telehealth Services

Telehealth encompasses a wide range of services, including consultations and treatments provided via interactive audio and video systems. These services may include initial consultations, follow-up visits, and remote monitoring.

CPT codes 99201-99499, along with the appropriate GT modifier (where still applicable), are used to report these varying telehealth services.

It’s important to note that these codes and modifiers are subject to change, so it’s essential to stay updated and informed with the latest guidelines issued by insurance companies to ensure your healthcare practices stay current for timely payment. Regular training and access to updated coding resources are crucial for mitigating risks associated with evolving telehealth regulations.

What Is the Purpose of HCPCS Codes and How Do They Differ From CPT Codes?

Created by the Centers for Medicare & Medicaid Services (CMS), HCPCS codes differ from CPT codes in that they cover a wide range of healthcare services, including procedures, supplies and equipment. HCPCS codes are used by Medicare and other payers to identify and reimburse for these various services.

While Level I (CPT) codes are universally accepted, Level II codes are often used by government payers, such as Medicare and Medicaid.

In essence, CPT codes are a subset of HCPCS codes (specifically, Level I of HCPCS), and although they overlap in many areas, they serve different purposes. It’s vital to understand both coding systems and their distinct nuances for accurate billing and reimbursement.

Why Choose Us for Your Telemedicine Billing Needs?

Navigating the complexities of telemedicine billing can be a daunting task for any healthcare practice. The constant evolution of codes, modifiers and payer-specific rules demands vigilant attention and expert knowledge. Mend offers dedicated solutions that provide unparalleled support, optimizing your revenue cycle and ensuring compliance.

We stay updated with the latest changes from CMS, commercial payers and state regulations, translating these updates into seamless billing processes for your practice. Our team understands every dollar counts, and our proactive approach helps identify potential issues before they become denials, safeguarding your financial health.

Partnering with Mend means gaining a strategic ally in your telehealth journey. We free up your administrative burden, allowing your team to focus on delivering exceptional client care.

Are You Ready to Get Telemedicine Billing?

Having a comprehensive understanding of the key telemedicine billing modifiers and codes is only the first step for reimbursement. You also need a collaborative partner capable of streamlining the complexities of telemedicine billing, simplifying both the technology and implementation processes. As a premium, one-stop telemedicine company, Mend provides the expertise and systems needed to succeed.

2026 Telemedicine Billing: GT, 95 & GQ Modifier Differences