Telehealth has become a major part of healthcare delivery. Video visits, remote consultations, and virtual follow-ups are now common across many specialties. As virtual care has grown, medical billing has had to keep pace with it.
Accurate coding ensures that virtual visits are recognized correctly by payers, and one code plays a central role in this process. That code is Modifier 95. This article explains its purpose, when to use it, what documentation it requires, and how it differs from a similar telehealth code.
Modifier 95 in medical billing is a two-character code attached to a procedure code. It indicates that a service was delivered through a real-time telecommunications system rather than an in-person visit.
Here are the key points to understand:
The modifier 95 description, set by the American Medical Association, states that it applies to synchronous telemedicine services delivered through a real-time interactive audio and video system.
This description sets two clear requirements:
What generally falls outside this scope:
This description sets two clear requirements:
Insurance payers rely on accurate coding to determine reimbursement and to track how services are delivered.
The problem without a modifier:
How the modifier 95 for telehealth helps:
Providers and billing staff should confirm the following points before adding this modifier to a claim:
Meeting these conditions helps ensure that modifier 95 telehealth claims align with payer expectations and reduces the risk of denial.
Adding telehealth modifier 95 does not directly increase or decrease the payment tied to a procedure code.
What it actually does,
How payers may respond differently,
For this reason, billing teams should always verify current reimbursement policy before submitting a claim, rather than relying on past outcomes.
A range of CPT codes across multiple specialties are frequently billed with this modifier. Common categories include:
Payers regularly update their lists of telehealth-eligible codes, so billing staff should check current payer bulletins before finalizing a claim.
Thorough documentation is necessary to support any claim submitted with this modifier. When using the 95 modifier for telehealth, the medical record should clearly show:
Maintaining this level of detail protects providers during payer audits and supports the medical necessity of the service.
The GT modifier vs 95 modifier comparison remains a common source of confusion among billing professionals, especially those new to telehealth coding.
A brief history:
Current usage:
Confirming payer-specific requirements before submission remains the safest way to choose between these two modifiers.
Related: Telehealth Modifiers 2026
The following practices support consistent and accurate use of this modifier across a billing department:
When billing teams apply this modifier consistently and correctly, several clear benefits follow:
Together, these outcomes contribute to a smoother and more reliable billing process.
Telehealth continues to grow as a core part of healthcare delivery, and accurate billing remains essential to its continued success. Modifier 95 serves a specific and necessary function by clearly identifying virtual visits and supporting correct payer processing. A solid understanding of its description, application requirements, documentation standards, and its relationship to the GT modifier equips billing professionals to manage telehealth claims with greater accuracy and confidence.
POS 10 for a patient at home, POS 02 for a patient at another location like a telehealth hub. POS 10 pays the higher non-facility rate; POS 02 pays the lower facility rate.
No. Audio-only visits use Modifier 93. Billing audio-only visits under Modifier 95 is a compliance risk and can trigger payer recoupment.
Yes, in some cases. GT retired for Medicare Part B in 2018, but some state Medicaid programs and commercial payers still require it instead of Modifier 95.
They're currently extended through December 31, 2027, under the Consolidated Appropriations Act, 2026. Billing teams should monitor for future legislative updates.
Not usually, Medicare typically relies on POS codes instead. The main exception is outpatient therapy delivered via telehealth by hospital-employed PT, OT, and speech-language therapists, where Modifier 95 is still required.
Ensure every virtual visit is coded correctly and reimbursed without delay.
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