Medical billing uses short codes called modifiers to provide payers, such as government entities and private insurers, with additional information about a service or procedure. These two-character codes clarify why a service was performed, where it occurred, or if a specific circumstance affected the delivery of care. Modifier GQ serves a specialized function within this system, specifically flagging a service delivered using technology that differs from the standard requirements for remote patient care.
Defining Modifier GQ
Modifier GQ is a specific code within the Healthcare Common Procedure Coding System (HCPCS) Level II coding set. The official definition of this modifier is a service rendered “via an asynchronous telecommunications system.” This method is commonly referred to as “store-and-forward” technology in the healthcare setting.
Asynchronous communication involves the collection and transmission of a patient’s medical information, such as still images, video clips, X-rays, or electronic health record data, to a distant provider who reviews it later. Unlike a live video visit, the provider and the patient are not interacting in real-time. By appending the GQ modifier to a procedure code, the billing entity certifies that the service meets the technical requirements of this store-and-forward method.
Services and Settings Requiring Modifier GQ
The use of Modifier GQ is mandated for services provided under specific governmental or commercial pilot programs. For Medicare, the application of this modifier is tied almost exclusively to Federal telemedicine demonstration projects conducted only in Alaska and Hawaii. This is a rare exception to the general Medicare policy, which usually requires real-time, interactive audio and video communication for telehealth services to be covered.
Within these demonstration projects, the asynchronous “store-and-forward” method is permitted as a substitute for an interactive encounter. The medical file, which may include photographs, rhythm strips, or teleradiology images, is collected at the patient’s originating site and sent to the distant site practitioner for later review. The use of this modifier confirms that both the originating site and the distant site practitioner are included within the boundaries of the specific demonstration program. Some state Medicaid programs, like Medi-Cal, also require the GQ modifier for asynchronous telehealth services such as teledermatology and teleophthalmology.
Impact on Provider Reimbursement
The Modifier GQ acts as a signal to the payer that the service falls outside of the standard fee-for-service payment rules. For Medicare, the modifier verifies that the claim is associated with a specific Federal demonstration project budget or authority. This mechanism allows the Centers for Medicare and Medicaid Services (CMS) to track and pay for services under temporary rules that differ from the typical coverage requirements.
Providers who are part of these authorized demonstration projects receive payment for the professional service equal to what they would have been paid for an in-person service. Providers must document their participation in the specific Federal demonstration program in Alaska or Hawaii when billing Medicare with this code. A claim submitted with Modifier GQ by a provider not affiliated with an authorized project will lead to an automatic denial or rejection. This ensures that the experimental payment and service delivery models are correctly tracked within their intended study parameters.