HCPCS Modifier GQ

• 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
• 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.

This modifier may only be submitted with codes listed on the CMS Telehealth website.

The following types of medical practitioners are permitted to perform telehealth services. This modifier may only be submitted by these practitioners:

• Physician
• Nurse practitioner
• Physician assistant
• Nurse midwife
• Clinical nurse specialist
• Clinical psychologist (with some restrictions: refer to CMS Pub. 100-04 as described in the Reference section below)
• Clinical social worker (with some restrictions: refer to CMS Pub. 100-04 as described in the Reference section below)
• Registered dietician or nutrition professional

 References

• CMS Pub. 100-02, Chapter 15, Section 270.2 (PDF, 1.26 MB)
• CMS Pub. 100-04, Chapter 12, Section 190 (PDF, 1.4 MB)