How should vendors bill for approved telehealth services? (Updated April 14, 2020)
Please note: The billing guidance below is meant to provide vendors with the appropriate telehealth modifiers, so that vendors can begin providing telehealth services without delay. DDD is currently making changes to its billing system and intends to have new modifiers added by April 8, 2020 for the initial batch of approved services. The rest will be added by the end of April. Any claims using these new modifiers will deny if billed. Any claims billed before implementation of the new modifiers will assist DDD in tracking use of telehealth services and DDD Business Operations will work with vendors to re-bill.
Vendor will complete the DDD Uniform Billing Template as usual, adding the appropriate Procedure Modifier under column Y, Z, or AA. If the member is at home during the service, the POS is 12 under column X.
For example: Service code STA [column F], POS 12 [column X], procedure modifier GT [column Y].
Or complete the CMS 1500 or 837 as usual, adding the appropriate Procedure Modifier in Box 24 D-Modifier. If the member is at home during the service, the POS is 12 under Box 24 B – Place of Service.
Definitions: Place of Service - Place of service (POS) is the originating site which is the location of the AHCCCS member at the time the service is being furnished via telehealth or where the asynchronous service originates. Many services can be provided when the member is at home. Home is POS 12.
Modifiers GT [live] or GQ [pre-recorded] must be used depending on the type of telehealth services provided:
GT: Via interactive “live” audio and video telecommunication systems- The use of telecommunications and information technology to provide access to health assessment diagnosis, intervention, consultation, supervision and information across distance. Most DDD services will use this modifier.
GQ: Via asynchronous “pre-recorded” telecommunication systems (Store and forward). The transfer of data from one site to another through the use of a camera or similar device that records (stores) an image that is sent (forwarded) via telecommunication to another site for consultation. Asynchronous or “store and forward” applications would not be considered telemedicine but may be utilized to deliver services.
UD: Via interactive "live" audio-only telecommunication systems.