Modifier GQ: Appropriate Use
Basics of Modifier GQ: Centers for Medicare & Medicaid Services (CMS) rules stipulate that as a condition of payment for telehealth services, providers must use interactive audio and video telecommunications system that permits real-time communication between (the provider), at the distant site, and the beneficiary, at the originating site. Asynchronous ‘store and forward’ technology is permitted only in Federal telemedicine demonstration programs in Alaska or Hawaii. In other words, telehealth has to be delivered such that the patient and provider are in constant, two-way communication during the service.
Guidelines for Modifier GQ
Modifier GQ may be submitted with telehealth services. Generally, interactive audio and video communications must be used to permit real-time communication between the distant site physician/practitioner and the Medicare beneficiary. The only exception to the real-time communication requirement is for federal demonstration projects conducted in Alaska and Hawaii.
- The originating site and distant site practitioner must be included in the definition of the demonstration program
- “Store and forward” means that asynchronous transmission of medical information to be reviewed at a later time by a physician or practitioner at the distant site
- A patient’s medical information may include video clips, still images, X-rays, MRIs, EKGs, EEGs, laboratory results, audio clips and text
- The physician or practitioner at the distant site reviews the case without the patient being present
- “Store and forward” substitutes for an interactive encounter with the patient present; the patient is not present in real-time
- Asynchronous communication does not include telephone calls, images transmitted via fax machines and text messages without visualization of the patient (electronic mail)
- Photographs must be specific to the patient’s condition and adequate for rendering or confirming a diagnosis or a treatment plan. Dermatological photographs (e.g., photographs of a skin lesion) may be considered to meet the requirement of a single media format under this instruction.
- A medical professional is not required to present the beneficiary to the practitioner at the distant site unless medically necessary. The decision of medical necessity will be made by the physician or practitioner located at the distant site.
- Only in Alaska and Hawaii, asynchronous “store and forward technology,” in single or multimedia formats, may be used as a substitute for an interactive telecommunications system
Modifier GQ may only be submitted by following practitioners:
- Nurse practitioner
- Physician assistant
- Nurse midwife
- Clinical nurse specialist
- Clinical psychologist (with some restrictions)
- Clinical social worker (with some restrictions)
- Registered dietician or nutrition professional
CPTs and Modifiers © Copyright 2021 American Medical Association
For accurate telehealth/telemedicine medical billing, knowing your CPT codes along with modifiers is the most important thing. Also view our blog series of ‘Know Your Codes’ or ‘KYC,’ where we discussed the most common CPT codes in detail and when to use them. E2E Medical Billing Services is known for its accurate Mental/Behavioral Health medical billing and coding. To know more about our services call us at 888-552-1290 or write to us at info@e2eMedicalBilling.com