GT modifier
GT modifier is a specific modifier which signifies that services were provided through telehealth using real-time interactive audio and video technology. In the world of billing, modifiers play a crucial role in the reimbursement of services. Modifiers are used to accurately describe the services that are provided to clients.
Summary
- The GT modifier indicates that telehealth services were delivered via real-time interactive audio and video, ensuring accurate billing for live, synchronous therapy sessions.
- Unlike the 95 modifier, which is used for asynchronous services such as pre-recorded content, the GT modifier is specifically for sessions involving real-time interaction between the therapist and the client.
- Accurate use of the GT modifier requires thorough documentation of patient consent, session details, technology used, and time spent to meet payer guidelines and avoid common billing errors. Enrolling in an insurance billing course for therapists can be beneficial.
- By leveraging an EHR for efficient documentation and claim submission, therapists can improve compliance with HIPAA and payer guidelines, ensure timely reimbursement, and enhance overall billing accuracy for telehealth services.
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Understanding the intricacies of billing is critical for therapy providers in order to maintain the financial viability of their practice.
Follow along as we dive into the details surrounding the GT modifier, how to use it appropriately, and best practices for therapists to follow for ensuring accurate documentation and billing of teletherapy services.
What is a GT Modifier?
The GT modifier is a code that indicates that a service was delivered via synchronous telecommunication between the therapist and the client. In other words, the code is used to specify a teletherapy session.
The GT modifier was initially used by Medicare for telehealth services. However, the code’s usage has expanded to other payers, including private insurance companies and Medicaid.
The GT modifier should not be confused with the 95 modifier. Both codes relate to telehealth, however, the 95 modifier is typically used to indicate asynchronous services such as pre-recorded content or email, in which a real-time interaction did not occur.
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When should therapists use the GT modifier?
The GT modifier can be used in the following situations:
- Real-time therapy services: This includes occupational therapy, physical therapy, speech therapy, or mental health counseling, conducted via live video.
- Remote patient monitoring (with real-time interaction): The GT modifier can be used when monitoring a client’s progress remotely while also interacting with them in real-time.
- Therapy interventions for clients unable to attend in-person sessions: Teletherapy is a convenient, effective solution for clients who live in remote areas or have mobility issues that make it difficult to attend in-person therapy sessions.
The GT modifier should not be used for:
- Pre-recorded content: In situations when a therapist provides pre-recorded therapy exercises or materials, the GT modifier does not apply.
- Asynchronous telehealth services: Services that do not involve real-time interaction between the client and therapist, such as emails or phone consultations, do not qualify for use of the GT modifier.
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Billing guidelines for the GT modifier
To ensure accurate billing, it’s important for therapists to pair the GT modifier with the appropriate CPT codes. Specific requirements can vary among payers, such as Medicare, Medicaid, and private insurance.
- Time-based billing and documentation: Ensure that the time spent in telehealth sessions is accurately reflected in billing to maintain compliance with payers’ guidelines.
- Pitfalls and common mistakes: Avoid common errors, such as incorrect documentation, use of the incorrect modifier, or failing to obtain prior consent from the client.
Advantages of using the GT modifier for telehealth
Offering telehealth services and using the GT modifier to code sessions offers several advantages for both therapists and clients.
- Increased access to services: Therapists are able to provide services to clients who live in rural or underserved areas.
- Continuity of care: Participating in telehealth services allows clients with mobility issues to continue to receive services despite having barriers to receiving in-person therapy.
- Reimbursement: Using the GT modifier to code the appropriate delivery method of therapy services helps therapists ensure proper reimbursement.
Documentation best practices for the GT modifier
Accurate and thorough documentation is essential when using the GT modifier.
The following information must be recorded in order to justify using the GT modifier:
- Patient consent: Document that risks and benefits of teletherapy have been explained to the client and that they understand and wish to proceed.
- Session details: The date, time, and duration of the session should be recorded, in addition to the specific services provided.
- Technology used: Document the technology platform that was used to provide the teletherapy session. For example, Zoom or a HIPAA-compliant platform.
Therapy notes should be structured specifically to reflect virtual interaction and client outcomes.
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Here is an example of a session note that documents the GT modifier:
Patient Name: [Patient’s Name]
Date: [Date of Session]
Service: [CP Code] (GT Modifier)
Duration: [Duration of Session]
Technology Used: [Platform/Method of Interaction]
Summary: [Brief overview of session goals, intervention, and outcomes]
Patient Consent: [Indicate whether consent was obtained for teletherapy]
Ethical and legal considerations for using the GT modifier
Therapists must ensure that they maintain HIPAA compliance when providing teletherapy services, adhering to regulations to protect patient privacy and confidentiality. This includes ensuring that the technology used offers a secure platform, and that patient information remains confidential.
Obtain informed consent for teletherapy from patients prior to initiating services through this method. Inform clients and caregivers of confidentiality limits, how sessions will be conducted, and any potential risks associated with receiving telehealth services.
Remember to stay informed about state and federal laws regarding telehealth. Therapists should be conscious of the legal implications of providing services via telehealth. This includes licensure requirements and regulations, which may vary by state. For example, therapists may need to be licensed to practice in the state where the client resides.
State and insurance-specified guidelines for the GT modifier
- Variation by state: Some states may require the GT modifier for telehealth services, while others use the 95 modifier. Therapists must be aware of local laws and adapt practices accordingly.
- Payer-Specific rules: Each insurer (including Medicare, Medicaid, and private payers) may have different guidelines on how they handle telehealth billing with the GT modifier. Therapists can stay up to date on these specific variations in order to avoid issues with billing and reimbursement.
The GT modifier is an essential tool for therapists who provide telehealth services. Understanding the appropriate way to use the GT modifier, billing guidelines, and best practices for documentation allows therapists to ensure they are in compliance with state and federal legal regulations. It can also facilitate accurate billing to avoid issues with reimbursement from payers.
How EHR and practice management software can save you time with insurance billing for therapists
EHRs with integrated billing software and clearing houses, such as TheraPlatform, offer therapists significant advantages in creating an efficient insurance billing process. The key is minimizing the amount of time dedicated to developing, sending, and tracking medical claims through features such as automation and batching.
What are automation and batching?
- Automation refers to setting up software to perform tasks with limited human interaction.
- Batching or performing administrative tasks in blocks of time at once allows you to perform a task from a single entry point with less clicking.
Which billing and medical claim tasks can be automated and batched through billing software?
- Invoices: Create multiple invoices for multiple clients with a click or two of a button or set up auto-invoice creation, and the software will automatically create invoices for you at the preferred time. You can even have the system automatically send invoices to your clients.
- Credit card processing: Charge multiple clients with a click of a button or set up auto credit card billing, and the billing software will automatically charge the card (easier than swiping!)
- Email payment reminders: Never manually send another reminder email for payment again, or skip this altogether by enabling auto credit card charges.
- Automated claim creation and submission: Batch multiple claims with one button click or turn auto claim creation and submission on.
- Live claim validation: The system reviews each claim to catch any human errors before submission, saving you time and reducing rejected claims.
- Automated payment posting: Streamline posting procedures for paid medical claims with ERA. When insurance offers ERA, all their payments will post automatically on TheraPlatform's EHR.
- Tracking: Track payment and profits, including aging invoices, overdue invoices, transactions, billed services, service providers
Utilizing billing software integrated with an EHR and practice management software can make storing and sharing billing and insurance easy and save providers time when it comes to insurance billing for therapists.
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More resources
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- The Ultimate Guide to Starting a Private Therapy Practice
- Insurance billing 101
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References
Burks, K., Shields, J., Evans, J., Plumley, J., Gerlach, J., & Flesher, S. (2022). A systematic review of outpatient billing practices. SAGE Open Medicine, 10, 20503121221099021. DOI: https://doi.org/10.1177/20503121221099021.
McCullough, A. (2001). Viability and effectiveness of teletherapy for pre‐school children with special needs. International journal of language & communication disorders, 36(S1), 321-326. DOI: https://onlinelibrary.wiley.com/doi/abs/10.3109/13682820109177905?casa_token=rdIfqd_j72sAAAAA:8YK9WZt2GzSFNEuC0mR5RXxw_VoAnMbVIB-3kKp5P7S9GGg5FDO6YtRzKPV-Qm91OunGIJn_MhAYF-JL
Temel, S., & Durst, S. (2021). Knowledge risk prevention strategies for handling new technological innovations in small businesses. VINE journal of information and knowledge management systems, 51(4), 655-673. DOI: https://www.emerald.com/insight/content/doi/10.1108/VJIKMS-10-2019-0155/full/html
