Revised Service Grid with
Telehealth Procedure Codes

Service Grid Revision:
The Service Grid is being revised effective 2/6/09.  The new Service Grid version date is 2/6/09.  These revisions are taking place so that Outpatient and Medication Management Services can be authorized to be provided via Telehealth.

For more information about Telehealth, please see the MaineCare Benefits Manual Chapter 1, page 18, at this link: http://www.maine.gov/sos/cec/rules/10/144/ch101/c1s.doc

To be authorized for services provided via Telehealth, the modifier “GT” is added after the procedure code.

The following procedure codes for outpatient assessment, outpatient therapy, and medication management, for adults, children, psychological services, and substance abuse services are now available in APS CareConnectionÒ with the GT modifier:

H2000GT
H2000HH GT
H0004GT
H0004HH GT
H2010GT

All utilization review requirements, typical authorized days and units are the same for codes using the GT modifier as for the same codes without the GT modifier.

Only these listed codes are available with the GT modifier at this time.