Primary Care Coding Alert

Question: When telehealth services are provided from our practice office, should our practice use modifier GT, 02, or 11?

Codify Subscriber

Answer: As we reported in this publication in January 2018 (Volume 20, Number 1), the annual revision of the Medicare Physician Fee Schedule (PFS) the Centers for Medicare and Medicaid Services (CMS) released in November 2017 contained the ruling that modifier GT (Via interactive audio and video telecommunication systems) is now eliminated for coding purposes on professional claims.

Instead, CMS began relying on place of service (POS) code 02 (Telehealth) at the beginning of 2017 for the express purpose of indicating “the location where health services and health-related services are provided or received, through a telecommunication system.” POS code 11 (Office), on the other hand, refers to locations where health professionals provide more traditional face-to-face services such as “health examinations, diagnosis, and treatment of illness or injury on an ambulatory basis” [italics added]. To the extent private payers use the same POS codes, you can use POS 02 when telehealth services are provided to non-Medicare patients as well.