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Use of MODIFIER GQ – Telehealth Modifier

Use of MODIFIER GQ – Telehealth Modifier

What is the GQ modifier?

Per the AMA, Modifier GQ means, “Via an asynchronous telecommunications system.” Asynchronous telemedicine means that medical care was provided via image and video that was not provided in real-time.

According to John Verhovshek, when reporting a covered end-stage renal disease-related service telehealth code (e.g., 90951 End-stage renal disease (ESRD) related services monthly, for patients younger than 2 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 4 or more face-to-face visits by a physician or other qualified health care professional per month), appending modifier GT also certifies that one visit per month was furnished “hands on” to examine the vascular access site, per the code descriptor requirement.

In those cases (limited to Alaska and Hawaii) when you may bill Medicare for non “face-to-face” telehealth services, you should report the appropriate code for the professional service with modifier GQ Via an asynchronous telecommunications system.

Submit professional telehealth service claims using the appropriate CPT or HCPCS code. If you performed telehealth services “through an asynchronous telecommunications system”, add the telehealth GQ modifier with the professional service CPT or HCPCS code (for example, 99201 GQ). You are certifying the asynchronous medical file was collected and transmitted to you at the distant site from a Federal telemedicine demonstration project conducted in Alaska or Hawaii.

What is a GQ modifier used for?

GQ modifier may be submitted with telehealth services. Usually, interactive audio and video communications is used in real-time communication between the provider and patient. The patient must be available and joining in the telehealth visit. 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
  • “Store and forward” substitutes for an interactive encounter with the patient present; the patient is not present in real-time
  • 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
  • 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
  • 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.
  • Asynchronous communication does not include telephone calls, images transmitted via fax machines and text messages without visualization of the patient (electronic mail)
  • 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.

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