Telehealth modifiers are two-character codes that you add to CPT or HCPCS procedure codes. They tell the payer how you delivered a virtual visit. In 2026, three modifiers matter most:
Getting these right is the difference between a paid claim and a denied one. Practices that misapply a telehealth modifier risk denials, audits, and revenue loss that grows over time. If your team is navigating these rules without a clear system, explore how EZ MD Solutions supports compliant telehealth billing from intake to reimbursement.
Telehealth modifiers work alongside POS codes to complete an accurate claim. Getting this combination wrong is one of the top reasons telehealth claims get denied. The CMS Telehealth Services List is updated annually and should be your first reference when confirming which codes qualify for telehealth billing.
|
Telehealth Modifier Code
|
Full Description
|
Primary Use
|
2026 Status
|
|---|---|---|---|
|
95
|
Synchronous telehealth via real-time audio and video
|
Commercial payers; some Medicare scenarios
|
Active, primary
|
|
93
|
Synchronous telehealth via real-time audio only
|
Medicare audio-only; some commercial payers
|
Active, primary
|
|
GT
|
Via interactive audio and video telecommunications
|
Critical Access Hospital Method II only
|
Limited, legacy
|
|
GQ
|
Via asynchronous (store-and-forward) telehealth
|
Alaska and Hawaii Federal Demonstration only
|
Limited, specific
|
|
FQ
|
Audio-only behavioral health at FQHCs and RHCs
|
FQHCs, RHCs, behavioral health services
|
Active, specialized
|
A modifier is a short code that you add after a procedure code. It gives the payer extra details about how or where you delivered a service. It does not change the procedure itself. It only adds important context.
For example, CPT code 99214 describes a mid-level office visit. When you add Modifier 95, you tell the payer that this visit happened over a live video call, not in person.
CPT modifiers and HCPCS modifiers serve three key purposes in telehealth billing:
According to the American Medical Association’s CPT guidelines, using the correct modifier is a foundational requirement for clean claim submission.
Modifier 95 signals a synchronous telehealth service. This means the provider and patient connected over a real-time, interactive audio and video link. The AMA introduced Modifier 95 in January 2017, and it is now the dominant telehealth modifier across Medicare and commercial payers.
“Synchronous” simply means the provider and patient connected at the same time. Both audio and video must stay active during the entire visit for Modifier 95 to apply.
All three conditions below must be true before you use Modifier 95:
If video drops and the visit continues as audio-only, switch to Modifier 93 not 95.
For commercial payer billing using traditional E/M codes 99202 to 99215, Modifier 95 is still required to flag the visit as telehealth. However, you do not need Modifier 95 when billing the new 98000 to 98007 audio-video telemedicine codes. These codes already describe the telehealth delivery method in their own descriptors. Learn more about how ezmdsolutions.com manages commercial payer billing and credentialing.
For original Medicare telehealth fee-for-service, use POS 10 when the patient is at home and POS 02 when the patient is not at home. This tells Medicare the service was telehealth. Modifier 95 is for commercial payers and Medicare Advantage. Adding Modifier 95 to fee-for-service Medicare claims is not required and may cause confusion.
Modifier 93 applies to synchronous audio-only telehealth services. Use it when a provider and patient connect by telephone or another real-time audio system with no video.
Audio-only telehealth is a real-time phone call with no video. The provider and patient connect at the same time but only through sound.
Use Modifier 93 in these situations:
Only use Modifier 93 when the patient requests audio-only or does not consent to video.
Medicare requires Modifier 93 on all audio-only telehealth claims when billing traditional E/M codes. For Medicare telehealth services in 2026, providers should continue billing 99202 to 99215 with POS 02 or POS 10 and Modifier 93 for audio-only visits.
Medicare fully covers audio-only telehealth when you apply Modifier 93. Audio-only works best for established patients where video adds minimal clinical value.
Behavioral health has permanent Medicare coverage for audio-only telehealth under a law passed in 2023. Per the Health Resources and Services Administration’s telehealth policy resources, the in-person visit requirement for mental health audio-only services is currently delayed until January 1, 2028.
Applying Modifier 95 to a phone session misrepresents the delivery mode, creates a billing compliance risk, and may result in denial if the payer’s records show a phone-based encounter.
Both modifiers apply to real-time visits. The only difference is whether the video was present. That single difference changes the modifier, the coding compliance requirements, and sometimes the reimbursement outcome.
|
Feature
|
Modifier 93
|
Modifier 95
|
|---|---|---|
|
Technology needed
|
Audio only (phone or equivalent)
|
Audio and video, both active
|
|
Visit type
|
Synchronous (real-time)
|
Synchronous (real-time)
|
|
Video required?
|
No
|
Yes
|
|
Medicare requirement
|
Required for audio-only claims
|
Not required for FFS Medicare
|
|
Commercial payer billing
|
Limited, payer-specific
|
Widely required
|
|
Correct POS pairing
|
POS 02 or POS 10
|
POS 02 or POS 10
|
|
Behavioral health use
|
Yes, including audio-only services
|
Only when video is active
|
Modifier GT used to identify telehealth services that providers delivered through live interactive audio and video. Practices used it widely before Modifier 95 became the standard. Today, its active use is very limited.
CMS removed the GT requirement for professional claims in 2018, and most commercial payers followed. Modifier GT now survives only on Critical Access Hospital Method II institutional claims.
Modifier GT retired from Medicare Part B in 2018 and survives only on Critical Access Hospital Method II claims. Submitting Modifier GT on standard Medicare professional claims creates processing errors.
Modifier GQ identifies asynchronous telehealth, a different type of service from the real-time visits that Modifiers 95 and 93 cover. Asynchronous means the provider and patient are not connected at the same time.
Modifier GQ indicates a telehealth service that a provider delivered through an asynchronous telecommunications system. For example, a patient may have a service recorded as video or captured as an image, and the provider reviews it later.
Modifier GQ applies only to the Alaska and Hawaii Federal Telemedicine Demonstration Projects under Medicare. Outside those programs, Modifier GQ has very limited use.
Providers must bill Modifier GQ with the distant site code. This shows that someone collected and sent an asynchronous medical file to the provider at the distant site.
|
Feature
|
Modifier GQ
|
Modifiers 93 and 95
|
|---|---|---|
|
Visit type
|
Asynchronous (not real-time)
|
Synchronous (real-time)
|
|
Provider-patient interaction
|
At separate times
|
At the same time
|
|
Geographic scope
|
Alaska and Hawaii Demo only
|
Broad use
|
|
2026 usage
|
Very limited
|
Widespread
|
Modifier FQ is for Federally Qualified Health Centers and Rural Health Clinics that provide audio-only telehealth services. You can use it alongside Modifier 93 when the payer requires it.
Modifier FQ applies to a specific combination: the provider is an FQHC or RHC, the service is behavioral health, and the provider delivered the visit through audio-only communication.
A major billing change takes effect on October 1, 2026 for FQHCs and RHCs. Before this date, these providers used one single code G2025 for all telehealth services regardless of type. That approach ends on October 1, 2026.
Starting October 1, 2026, RHCs must bill individual HCPCS codes that describe the specific telehealth services they deliver to Medicare patients, instead of using G2025 for every service. They must also report Modifier 93 for audio-only telehealth services and Modifier 95 for audio-visual telehealth.
This shift from G2025 to service-specific CPT and HCPCS modifiers will improve claims reporting accuracy. However, it also brings new documentation, coding, and billing responsibilities.
Use this list to prepare for the October 2026 transition:
Need help structuring your telehealth documentation workflow? Our medical coding experts can audit your current process and close the gaps before payers do.
Modifier requirements differ by payer. What Medicare requires is not always what a commercial insurer requires.
|
Payer Type
|
Modifier 95 Required?
|
Audio-Only Modifier
|
Notes
|
|---|---|---|---|
|
Original Medicare FFS
|
No
|
Modifier 93 required
|
POS code identifies telehealth
|
|
Medicare Advantage
|
Yes, most plans
|
Modifier 93
|
Follows commercial rules
|
|
Commercial payers
|
Yes, most plans
|
Modifier 93 where covered
|
Verify each policy bulletin
|
|
Medicaid
|
Varies by state
|
Modifier 93 or state-specific
|
Check state Medicaid portal
|
|
CAH Method II
|
Modifier GT required
|
Modifier 93
|
Institutional claims only
|
Follow this process before you submit any telehealth billing claim.
If yes, continue. If no, you do not need a modifier.
If not, do not add a modifier. A modifier will not make a non-covered service payable.
Practices lose 30 to 40 percent of telehealth claims to modifier and POS mismatches or missing documentation.
|
Common Error
|
Why It Causes Denial
|
The Fix
|
|---|---|---|
|
Modifier 95 on audio-only visits
|
Misrepresents delivery mode
|
Switch to Modifier 93
|
|
Modifier GT on Medicare Part B professional claims
|
GT retired in 2018
|
Use POS 02 or POS 10
|
|
Leaving out Modifier 95 on commercial claims
|
Commercial payer billing requires it
|
Add Modifier 95 to all commercial video claims
|
|
POS 02 when the patient is at home
|
Lower payment and payer mismatch
|
Verify location, use POS 10
|
|
POS 10 when the patient is at a clinic
|
Triggers audit; claim does not match records
|
Verify location, use POS 02
|
|
Modifiers on non-covered codes
|
Modifier does not create coverage
|
Check CPT eligibility first
|
|
Modifier 95 on 98000-series codes
|
Telehealth is already in the descriptor
|
Remove the modifier
|
|
Billing deleted codes 99441, 99442, or 99443
|
These codes no longer exist
|
Use updated codes with Modifier 93
|
|
No documentation of visit modality
|
Audit failure and clawback risk
|
Note audio-video or audio-only in every record
|
|
Applying commercial rules to Medicare FFS claims
|
Different modifier rules apply
|
Keep Medicare and commercial billing separate
|
A claim with the right telehealth modifier can still get denied if the documentation does not match. Include all of the following in every telehealth visit note:
A modifier for telehealth is a two-character code that you add to a CPT or HCPCS procedure code. It tells the payer how you delivered the virtual visit. Modifier 95 means live audio and video. Modifier 93 means audio-only. These are the two most widely used telehealth modifiers in 2026.
Medicare does not require Modifier 95. It uses POS codes to identify telehealth claims. POS 02 or POS 10 shows the service was telehealth for standard Medicare fee-for-service. You still need Modifier 93 for audio-only Medicare claims.
Only use Modifier GT when you bill Critical Access Hospitals under Method II on institutional claims. All other providers should not use GT on standard Medicare Part B professional claims.
Use POS 02 when the patient is at a facility or office. Use POS 10 when the patient is at home. POS 10 results in higher telehealth reimbursement at the non-facility rate. Both codes follow the patient's location, not the provider's.
No. A single visit uses only one delivery mode. It is either audio-video (Modifier 95) or audio-only (Modifier 93). You cannot apply both to the same encounter.
If video drops and the visit continues audio-only, switch to Modifier 93 instead of Modifier 95. Document this clearly in the clinical note. Billing Modifier 95 after the video was lost is a coding compliance error.
Practices that pair accurate telehealth modifier coding with proper documentation see dramatically faster payment cycles and lower administrative overhead.
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