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Provider Notice Issued 09/01/2021

Date:   September 1, 2021

To:       Enrolled Community Mental Health Centers; Behavioral Health Clinics; Physicians; Licensed Clinical Psychologists; and Licensed Clinical Social Workers

Re:      Use of Modifier GT and Place of Service Code 02 to Specify Telehealth Delivery Mode for Behavioral Health Services Effective October 1, 2021

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 This notice informs providers of new billing instructions related to the use of procedure code modifier GT – Via Audio and Video Telecommunications Systems and Place of Service Code
02 - Telehealth. These instructions apply to claims billed under the Medicaid fee-for-service program and the managed care plans.

Effective with dates of service beginning October 1, 2021, providers billing a service from the Community Based Behavioral  Services Fee Schedule that was performed via audio or video communication must append the procedure code with modifier GT and use Place of Service Code 02. This coding is needed for HFS to track the mode of service delivery. The GT modifier and Place of Service Code 02 are for reporting purposes only and do not affect current payment methodology.

The new billing instructions apply to any service being billed as a telehealth service, whether it is:

  • a code identified in the Community Based Behavioral Services Handbook that historically could be provided via phone and/or video delivery modes independent of the current public health emergency, or
  • a behavioral health service allowed via telehealth per the current public health emergency telehealth policy stated in the March 20, 2020 provider notice. This list of codes includes the following services from the CBS Fee Schedule: 96110, 96112, 96127 and H1000.

 
The following providers billing from the Community Based Behavioral Services Fee Schedule are impacted:

  • Community Mental Health Centers
  • Behavioral Health Clinics
  • Physicians
  • Licensed Clinical Psychologists
  • Licensed Clinical Social Workers

 
Modifier GT and other appropriate modifiers can be used in conjunction on the same claim in no specific order. 

Fee-for-service claims received with a procedure code/modifier/place of service combination that is not recognized by the Department, or for which the GT modifier is not valid, will receive error code A59 - Procedure/Modifier/POS Combination Invalid.         

Questions regarding fee-for-service claims may be directed to a Community Mental Health Billing Consultant in the Bureau of Professional and Ancillary Services at 877-782-5565. Questions regarding managed care claims should be directed to the applicable managed care plan.

 
Kelly Cunningham, Administrator
Division of Medical Programs



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