Common Procedural Terminology
Common Procedural Terminology (CPT) codes are what Medicare, Medicaid, and other payers use to determine coverage. CPT codes are a uniform language for coding medical services and procedures. They are five-digits and can be numeric or alphanumeric depending on the category.
Category I: Codes have descriptors that correspond to a procedure services. These codes range from 00100-99499 and are generally ordered into sub-categories baed on procedure/service type and anatomy.
Category II: Alphanumeric tracking codes are supplemental codes used for performance measurement. Using them is optional and not required for correct coding.
Category III: Temporary alphanumeric codes for new and developing technology, procedures and services. They were created for data collection, assessment and in some instances, payment of new services and procedures that currently don’t meet the criteria for a Category I code.
Modifiers
Modifiers are two-digit numbers, two-character modifiers, or alpha-numeric indicators. Modifiers provide additional information to payers to make sure services are paid correctly. More than one modifier may be used with a single procedure code. Note that some modifiers are not applicable or may not be used in particular categories of codes. Some examples of CPT modifiers can be found below.
- G0: (zero): Used to identify telehealth services furnished for purposes of diagnosis, evaluation, or treatment of symptoms of an acute stroke.
- GQ: (not used unless you are in Alaska or Hawaii): asynchronous telehealth service.
- GT: Critical Access Hospital distant site providers billing under CAH Optional Method II. This goes on an institutional claim and pays 80% of the Professional Fee Service rate.
- GY: Notice of Liability Not Issued, Not Required Under Payer Policy. Used to report that an Advanced Beneficiary Notice (ABN) was not issued because item or service is statutorily excluded or does not meet definition of any Medicare benefit. (Note: only to be used when the patient is not at an eligible originating site.)
- FR: Supervising practitioner present through two-way, audio and video communication.
- FQ: A telehealth service was furnished using real-time audio-only communication technology.
- 93: Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system.
- 95: Synchronous telemedicine service rendered via real-time interactive audio and video telecommunications system.
Resources
Department of Health and Human Services Billing for Telehealth
South Central Telehealth Resource Center Billing Guide
Medicare Fee For Service Claims
American Academy of Family Physicians Telehealth Coding and Billing