Telemedicine Billing Tips
See our Telemedicine Services page for benefit information and approval requirements.
Synchronous Telemedicine Services
Synchronous telemedicine services involve an interactive, electronic information exchange in at least two directions in the same time period.
Providers must bill using CPT® or HCPCS codes with a GT or 95 modifier for distant site and Q3014 for an applicable originating site to distinguish telemedicine services. Payment for Q3014 will not be made when a patient's home is the originating site. The distant site and originating site cannot be billed by the same provider.
For professional claims, use the place of service code (POS) that represents the location from which he/she rendered the telemedicine visit. For example, POS 11 if services are rendered from the provider's office.
- Exception: At this time, applied behavior analysis (ABA) claims continue to require the appropriate telemedicine modifier and POS 02 for all telemedicine claims.
- See FAQs below for information on resubmitting non-facility claims previously submitted with POS 02.
By billing the GT or 95 modifier with a covered telemedicine procedure code, the distant site provider certifies the beneficiary was present at an eligible originating site when the telemedicine service was furnished.
Asynchronous Telemedicine Services
Asynchronous telemedicine services involve storing, forwarding and transmitting medical information on telemedicine encounters in one direction at a time.
Providers must bill using CPT or HCPCS codes with a GQ modifier. For professional claims, use the place of service code (POS) that represents the location from which he/she rendered the telemedicine visit. For example, POS 11 if services are rendered from the provider's office. However, at this time, ABA claims continue to require the appropriate telemedicine modifier and POS 02 for all telemedicine claims.
Note: When submitting claims for telemedicine services, the originating site provider may indicate "Signature not required – distance telemedicine site" in the required Patient Signature field.
Per the Interim Final Rule (IFR) – TRICARE Coverage and Payment for Certain Services in Response to the COVID-19 Pandemic, TRICARE is temporarily allowing for audio-only telehealth. Please review these frequently asked questions.
How will a physician know if the telemedicine services are considered medically necessary?
TRICARE defines medically necessity as appropriate, reasonable and adequate care for the patient’s condition (as defined in Regulation 32 CFR 199). Providers should document in the medical records why audio only was chosen in lieu of an audio/video combination. Audio-only telehealth should not be used for care that normally requires a physical examination or a visual evaluation. Administrative services such as making appointments or verifying prescriptions are not separately reimbursable.
How do physicians bill for audio-only visits?
Current coding manuals include CPT codes 99441–43, 98966–68 and HCPCS code G2012 as audio-only telehealth. CMS 1500 professional claims should have the place of service “02” or one of the telemedicine modifiers GT, GQ or 95, with appropriate CPT or HCPCS codes. UB04 claims must contain one of the telemedicine GT, GQ or 95 modifiers.
Why is the physician required to document when it’s an audio-only visit?
The language in the IFR reads, “If the decision to provide care via a traditional audio/visual method is chosen, the reasons for that decision should be documented as well. For recurring care, the rationale for choosing audio-only or audio and visual should be documented only at the initiation of remote care, or upon any change in modality."
Will audio-only telehealth claims be reimbursed using the CMAC rates posted by locality on health.mil?
Yes, claims will be reimbursed at CMACs published on www.health.mil.
Why did my professional claim for telemedicine services pay at a different rate than when I provided the services in person?
We recognize due to the use of POS 02, certain telemedicine claims for professional services may have been reimbursed at the facility CHAMPUS Maximum Allowable Charge (CMAC) rate, rather than a non-facility CMAC. If you provided telemedicine services from a non-facility setting, you may submit a corrected claim with the actual HIPAA POS to ensure claims are adjusted and paid at the appropriate reimbursement level.
Are audio-only services covered under the Autism Care Demonstration?
Audio-only services are not allowed under the Autism Care Demonstration. Parent/caregiver guidance performed via telemedicine must be rendered using audio AND video platforms. See our ABA Billing page for additional information.