Denied Telehealth Claims Due to Modifier Mistakes?
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Modifier 93 vs 95 are telehealth billing modifiers that identify how a virtual medical service was delivered. Modifier 93 applies to synchronous audio-only telehealth services, while Modifier 95 applies to real-time interactive audio-visual encounters. These modifiers allow payers to understand the technology used during a visit and apply the correct reimbursement rules.
Telehealth claims increased by more than 154 percent after 2020, yet incorrect modifier use remains a major cause of denials. Industry reviews show that 20 to 30 percent of telehealth claims are denied due to errors related to modifiers or Place of Service codes.
These denials often result in delayed payments and increased administrative work. Correct use of Modifier 93 and Modifier 95 helps ensure payment accuracy, supports compliance, and protects providers as telehealth policies continue to change in 2026.
As telehealth continues to expand across healthcare settings, correct modifier usage has become essential. CMS and commercial payer policies continue to evolve through 2026, making it critical for providers, coders, and billing teams to understand when and how to use each modifier.
Modifier 93 identifies synchronous telehealth services delivered through real-time audio-only communication. This modifier applies when a provider and patient interact using a telephone or another interactive audio system without any video component. Audio-only telehealth supports access to care for patients who lack video technology or reliable internet access.
93 modifier description is officially defined as a synchronous telemedicine service provided over the phone or similar real-time interactive audio-only telecommunication technology. This definition confirms that no visual interaction occurred during the encounter.
Modifier 93 may only be used with CPT codes that allow audio-only reporting. These services are listed in CPT Appendix T. Common eligible services include:
Modifier 93 was introduced after the COVID public health emergency to preserve access to care. CMS later made audio-only telehealth permanent for behavioral health services due to its effectiveness and patient preference. For other specialties, audio-only billing remains limited and subject to payer rules in 2026.
Modifier 95 describes concurrent telehealth services provided via real-time interactive voice and video communication. This modifier confirms that the provider and patient engaged in a live virtual face-to-face encounter that included both sound and video.
According to the official 95 modifier description, 95 Modifier represents a synchronous telemedicine service delivered over a real-time interactive audio and visual telecommunications technology. Both components must be present throughout the visit.
Modifier 95 applies to CPT codes listed in CPT Appendix P. Common eligible services include:
Modifier 95 was introduced in 2017 and became widely used during the rapid expansion of telehealth. Although CMS now emphasizes Place of Service reporting, many commercial payers still require Modifier 95 in 2026. Claims submitted without this modifier, when needed, are often denied.
Related: You Must Know These Remote Patient Monitoring CPT Codes in 2025
Aspect | Modifier 93 (Audio-Only) | Modifier 95 (Audio-Visual) |
Type of Telehealth | Synchronous audio-only communication | Synchronous real-time audio and video communication |
Technology Used | Telephone or interactive audio system | Live two-way audio and video platform |
CPT Appendix | Appendix T | Appendix P |
Visual Component | Not required | Required throughout the visit |
Common Clinical Use | Behavioral health, follow-up visits, medication management | New and established patient visits, visual evaluations, chronic care |
Patient Access | Used when video is unavailable or inappropriate | Used when both patient and provider have video capability |
Reimbursement Impact | May be lower unless parity rules apply | More likely to receive payment parity |
CMS Preference | Allowed for restricted services; fixed for behavioral health. | Often reported using Place of Service codes |
Commercial Payer Use | Accepted by some plans with restrictions | Frequently required for video visits |
Audit Risk | High if video is documented but billed as audio-only | High if audio-only is billed as video |
Place of Service reporting plays a central role in telehealth billing and has become mandatory for accurate reimbursement since 2025. The Place of Service code informs the payer about the patient’s physical location at the time of the telehealth contact. This information directly influences payment rates, claim acceptance, and audit outcomes. Even when the correct modifier for telehealth is applied, an incorrect Place of Service code can still lead to denial or reduced payment.
Two Place of Service codes are primarily used for telehealth services:
Telehealth services invoiced through POS 10 are usually paid at the non-facility rate, which is frequently greater than the facility rate. Because of this, correct POS reporting is essential for accurate payment. One of the most typical billing problems is when the Place of Service code does not correspond to the reported patient location. This mismatch frequently results in underpayment, claim denial, or post-payment audits.
To avoid these issues, practices should update billing systems, templates, and workflows to capture patient location at the start of every telehealth visit. Staff training and claim audits help ensure that Place of Service reporting consistently aligns with documentation and payer requirements, especially as home-based telehealth remains a permanent part of care delivery.
Proper telehealth documentation ensures accurate billing, supports compliance, and reduces audit risk. Clear, complete records demonstrate the service delivered and the technology used during each virtual encounter.
Modifier 93 vs 95 are essential tools for accurate telehealth billing in 2026. Modifier 93 applies to synchronous audio-only services, while Modifier 95 applies to real-time audio-video encounters. Correct usage ensures claims align with payer rules, support reimbursement parity, and reduce audit risk.
Accurate Place of Service reporting, accurate modifier selection, and extensive documentation are crucial for avoiding refusal. Common errors, such as mismatched modifiers, incorrect CPT codes, or missing patient consent, can be prevented with staff training, internal audits, and pre-bill verification.
By following best practices for telehealth documentation, monitoring denial trends, and maintaining consistent workflows, providers can protect revenue, comply with CMS and commercial payer requirements, and deliver high-quality virtual care efficiently.
Telehealth modifiers indicate how a virtual service was delivered. Common modifiers include 95 for real-time audio-video, 93 for audio-only, GT for legacy interactive telehealth, and GQ for asynchronous or store-and-forward services. Providers use these modifiers to ensure payers correctly process telehealth claims and reimburse services accurately.
Not all insurance companies accept Modifier 95. Most commercial payers and Medicare use it for synchronous audio-video telehealth, but some plans still require older modifiers like GT. Providers must verify each payer’s telehealth rules before billing to prevent claim denials and ensure correct reimbursement for virtual encounters.
Modifier 95 and GT both indicate telehealth services delivered via interactive audio-video. However, Modifier 95 is the current standard, while GT is older and still required by some private insurers or Medicaid programs. Providers must choose the correct modifier based on payer requirements to secure accurate reimbursement.
Modifier 93 identifies telehealth services delivered through real-time audio-only communication, such as a telephone call. Providers use this modifier when video is unavailable or inappropriate. It helps payers recognize that the encounter was audio-only, ensuring correct claim processing and reimbursement, particularly for behavioral health or follow-up visits.
Modifier 95 indicates telehealth services delivered via real-time audio and video interaction. Providers attach it to CPT codes to show that both visual and audio components occurred during the encounter. Using Modifier 95 ensures that payers understand the service type and apply correct reimbursement rules for synchronous telemedicine visits.
Incorrect telehealth modifiers cause denials and delays. We ensure every virtual visit is coded and reported correctly.
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