CPT/HCPS Description Modifier
90791 Psychiatric Diagnostic Evaluation GT
90792 Psychiatric Diagnostic Eval W/Medical Services GT
90832 Psychotherapy Patient & / Family 30 Minutes GT
90833 Psychotherapy Pt & /Family W/E & M Srvcs 30 Min GT
90834 Psychotherapy Patient & / Family 45 Minutes GT
90836 Psychotherapy Pt & /Family W/E & M Srvcs 45 Min GT
90837 Psychotherapy Patient & / Family 60 Minutes GT
90838 Psychotherapy Pt & /Family W/E & M Srvcs 60 Min GT
96150 Hlth & Behavior Assmt Ea 15 Min W/Pt 1st Assmt GT
96151 Hlth & Behavior Assmt Ea 15 Min W/Pt Re-Assmt GT
96152 Hlth & Behavior Ivntj Ea 15 Min Indiv GT
96153 Hlth & Behavior Ivntj Ea 15 Min Grp 2/Gt Pts GT
96154 Hlth & Behavior Ivntj Ea 15 Min Fam W/Pt GT
99354 Prolng Svc Office O/P Dir Contact 1st Hr GT
99355 Prolng Svc Office O/P Dir Contact Ea 30 Min GT
99406 Tobacco Use Cessation Intermediate 3-10 Minutes GT
99407 Tobacco Use Cessation Intensive Gt10 Minutes GT
99495 Transitional Care Manage Service 14 Day Discharge GT
99496 Transitional Care Manage Service 7 Day Discharge GT
99201 Office Outpatient New 10 Minutes GT
99202 Office Outpatient New 20 Minutes GT
99203 Office Outpatient New 30 Minutes GT
99204 Office Outpatient New 45 Minutes GT
99205 Office Outpatient New 60 Minutes GT
99211 Office Outpatient Visit 5 Minutes GT
99212 Office Outpatient Visit 10 Minutes GT
99213 Office Outpatient Visit 15 Minutes GT
99214 Office Outpatient Visit 25 Minutes GT
99215 Office Outpatient Visit 40 Minutes GT
H2011 Therapeutic consultation GT
H2019 Crisis intervention GT
All reimbursable telehealth services must be provided and billed in accordance with appropriate licensure standards, Idaho Medicaid Telehealth Policy, Information Release MA15-11, and applicable handbooks. Codes covered by telemedicine must always be billed with the GT modifier. The procedure codes listed below are the ONLY services that can receive Medicaid reimbursement when delivered via telehealth
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