GT Modifier (2022) Description, Uses, Guidelines & Examples

GT Modifier appends with the service when the physician performs services via interactive audio and video telecommunication systems.

Summary

Modifier GT uses for the services when synchronous telemedicine service renders to the patient via interactive audio and video telecommunication systems. There is an exception for demonstrations in Alaska and Hawaii, and all telehealth must be interactive.

CMS requires exceptional modifiers such as GT and GQ with CPT and HCPCS level II codes for telehealth services as informational indicators. GQ modifier appropriates when the physician renders the service using an asynchronous medium. In contrast, GT Modifier applies to real-time interactive audio and video telecommunications systems. 

The following are the two ways telehealth services render:

Synchronous telemedicine service signifies a real-time interaction between the patient and the physician or other qualified healthcare professional and the patient on a different site from the provider or qualified professional. It allows a live conversation between the patient or provider to deliver medical service.

Asynchronous telemedicine implies a “store and forward technique.” The physician gathers medical records, images, pathology reports, and history and then sends them to a specialist physician for diagnostic and treatment expertise.

The POS 02 is used for the services when the physician provides the telehealth service and meets the particular requirements. It eliminates the need for modifier GT when performed via interactive audio and video telecommunication systems on the professional claim.

It also certifies the service rendered by the physician as a telehealth visit. According to CMS guidelines 2018, GT Modifier is not applicable for professional claims effective from January 1, 2018.

The POS 02 uses earlier to indicate the patient’s location when the physician renders the telemedicine service. Therefore, it must require professional claims when bills to medicare insurance for all services-telehealth or to mark the service provided as telehealth instead of modifier GT. 

The provider must adhere to CMS guidelines for bills with POS 02, GT Modifier, or GQ and meet all the requirements for telehealth services. In addition, it must include all the statutory requirements for telehealth service coverage under Medicare (e.g., originating site, rural area, interactive audio, and video telecommunications system).

For instance, a Physician delivers the service to a Medicare patient located at the home instead of the originating site. It does not meet the Medicare statutory requirements, and it is inappropriate to use POS 02, GT Modifier, or GQ for this telehealth service. It may lead to overpayments, audits, and potential liability under the False Claims Act for False or erroneous coding of claims.

Modifier GT applies to Critical Access Hospitals (CAHs) billing circumstances. CAHs may still use modifier GT for distant site practitioners under Method II on institutional claims. The POS 02 only applies to the professional claim and does not report on institutional claims. Modifier GT stills required by Medicare to signify the telehealth service. 

GT Modifier Description

GT Modifier appends with the service when the physician performs services via interactive audio and video telecommunication systems.

What Is GT Modifier?

GT Modifier indicates the telehealth service provided by the physician. If the service renders in Alaska and Hawaii, it may not be an interactive session. However, all the other services must furnish as an interactive session.

Modifier GT is used for the service when the physician renders at the originating sites. It frequently bills with office visit codes (99201-99215), behavioral health codes, and other medically appropriate services for a telehealth visit. It is now replaced with POS 02 to indicate the telehealth service and does not require modifier GT.

However, some payors still accept modifier GT instead of changing the POS 02. 

When To Use GT Modifier

The following are the use of Modifier GT:

Modifier GT indicates the service renders to the patient at the originating site when present for the telehealth or telemedicine visit.

The physician must have been distant from the patient’s site. 

The encounter occurs between the patient and the physician via interactive audio and video telecommunication systems.

GT Modifier Guidelines

The following are the guidelines when GT Modifier is applicable with the services:

Telehealth services do recognize by the Medicare and Medicaid Services (CMS). Documentation must establish the medical necessity of the service when bills with modifier GT.  

Modifier GT and POS may use interchangeably with the service. For example, the distant site of the provider indicates POS 02 or 10 on column 24 B in CMS 1500 form when the patient has a telehealth visit at the originating site.  

GT Modifier does not require identifying Telehealth services but is appropriate as an informational if reported on claims with eligible Telehealth services.

The following are the providers who are eligible for telehealth services:

• Nurse practitioner
• Nurse-midwife
• Physician assistant
• Therapy providers (e.g., Occupational Therapy, Physical Therapy, Speech Therapy)  
• Clinical psychologist 
• Clinical social worker 
• Clinical nurse specialist
• Physician
• Registered dietitian or nutrition professional 
• Certified Registered Nurse Anesthetists 

GT Modifier only applies to the service of specific occupational, physical, and speech therapy (OT, PT, or ST). Telehealth services delivered by qualified health care professionals rendered via interactive audio and video technology

GT Modifier Examples

The following are the example GT Modifier Bills:

Example 1

A twenty-eight-year-old male presents to the office with a history of prostate cancer and now offers a routine screening visit. He has no complex problems, and his PCP is at a distant site. 

The office staff arranged the computer and video camera for the live chat, and the patient had no problem with this visit.  

The physician has discussed all his activities and reviewed all the systems. The patient denies swelling, SOB, nausea, vomiting, itching, or headache. The patient appearance seems normal in the video. 

The physician ordered the routine test for screening and prescribed medicine for minor problems such as body aches. 

Example 2 

A thirty-six-year-old woman presents to the federally qualified health center (FQHC) for a history of endometrial cancer stage III. Unfortunately, she does not want to come office due to the pandemic covid 19 situation.

She is currently on medication of letrozole and everolimus for three months. The PCP suggests having a telehealth visit via video chat because of the patient’s desire not to come into the office. 

The physician ordered a CT and MRI of the Pelvis region to know the patient’s current situation. She denies significant issues such as nausea, vomiting, dizziness, headache, and swelling in the upper and lower extremities. 

The physician changes the dosage of letrozole and everolimus, prescribes a new medication, and schedules the follow-up visit in two months. 

Example 3 

An eighty-two-year-old female presents to the PCP office with a lung nodule in the right upper lobe for a telemedicine encounter. The patient emphasizes the clinical staff discuss with the physician via video chat. Unfortunately, the physician was out of town for the holidays. 

The physician agreed to come on a video chat and check the patient face to face on the video chat and did not find any complex problems. The patient denies any cough, SOB, headache, or numbness upon the review of the system. The patient seems normal in appearance and has a healthy skin color.

The physician ordered laboratory and radiology tests to identify the problems and scheduled an office appointment for next week. 

Modifier GT vs 95

CMS introduced modifier 95 in 2017 for telemedicine services billing. Unlike modifier GT, Modifier 95 confines to appendix P CPT codes in the AMA CPT code book. GT Modifier and 95 append to services interchangeable, and both report for the telemedicine services. Therefore, both Moidfers 95 and GT may use in overlapping situations.

GT modifier may use more frequently for telehealth services, and no restriction on CPT codes. However, it may vary according to the insurance policies, and some Commercial payors may require modifier GT instead of modifier 95 for telemedicine services. 

90837 GT Modifier

Modifier 90837 appends with the service when the physician provides the Psychotherapy service for 60 minutes with the patient. GT Modifier is inappropriate to use with CPT 90837 when synchronous telemedicine services offer to the patient via audio and video, and It does list in the APPENDIX P. 

Modifier GT was used previously for telehealth services before COVID-19. Modifier 95 applies to the service declared in the AMA CPT code book Appendix P. Modifier 95 applies to the benefits due to the pandemic covid 19 situation.

It must confirm by the insurance before the billing, and it may vary from insurance to insurance. The payor may accept GT Modifier or 95 interchangeably. 

99214 Modifier GT 

CPT 99214 is appended with the service when the physician or other qualified health professional provides E/M service to an established patient in an office or different hospital outpatient setting. It requires appropriate history and exam and a low level of decision making.

If it is time-based, it requires 30-39 minutes of total time spent during the encounter. GT Modifier does not apply to CPT code 99214 when the telehealth service offers to the patient. 

CPT 99214 lists in AMA CPT Code book appendix P, and Modifier 95 applies to the service instead of GT Modifier to the service mentioned in Appendix P. Therefore, the payor may accept GT or 95 interchangeably.

However, it must confirm by the insurance before the billing, and it may vary from insurance to insurance.