A telehealth claim with the wrong modifier is denied. The right modifier on the wrong POS code also denies. Both situations mean lost revenue, and both are preventable.
Telehealth modifiers are 2-character CPT appendages placed on the CMS-1500 claim form. They tell health insurance companies how a virtual medical visit was conducted. (e.g., live video, phone call, or online portal). Without them, insurers may process your claim as an
In 2026, 95, 93, GT, and GQ are commonly used. They show how the telehealth service was delivered. These modifiers should be reported with the correct Place of Service (POS) code.
- Modifier 95: for live audio-video visits
- Modifier 93: Audio only service.
- Modifier GT: typically only used on Critical Access Hospital claims.
- Modifier GQ: for approved store and forward TeleHealth.
If the incorrect modifier is used, it can lead to claim denials.
What Do Telehealth Modifiers Do on a Claim?
Telehealth modifiers identify the delivery mode of a service. This helps payers apply the correct fee schedule, coverage rules, and reimbursement rate.
Telehealth modifiers are entered in Box 24D of a CMS-1500 paper claim form. It is the same section as all of the other CPT modifiers. These need to be distinct modifiers for each service line.
The same modifier information is transmitted on the 837P claim, in the SV101 service line, for electronic billing. This way, a payer will get the right bill details, whether paper or electronic.
These are the three factors that determine which telehealth modifier you apply to your claim:
- Delivery mode
- Payer type
- Patient location at time of service
What Is Modifier 95 for Telehealth?
Modifier 95 shows that a telehealth visit was done through real-time video and audio. It means the provider and patient could see and hear each other during the same session using a secure platform.
The AMA defines Modifier 95 as:
“synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system.”
It is the main telehealth modifier used by Medicare and most commercial payers. It is used with POS 10 or POS 02 depending on where the patient was located. Modifier 95 cannot be used for phone-only visits. In those cases, modifier 93 is required instead.
When to Use Modifier 95?
Use modifier 95 only when:
- The visit is done through live video and audio
- The CPT code is covered for telehealth by the payer
- The patient is located at home (POS 10) or another approved site (POS 02)
- The provider is licensed in the patient’s state at the time of service
If any one of these is missing, modifier 95 should not be used.
How to Document for Modifier 95?
The clinical note must confirm 3 facts:
- The name or type of the video platform used
- The patient’s physical location during the session
- The provider’s physical location during the session
Payers often review these details during audits. Missing this information can lead to claim denial.
What Is the GT Modifier for Telehealth?
Modifier GT is used for live telehealth visits done through real-time audio and video. It describes the same type of service as modifier 95, but it is now used in very limited cases.
Modifier GT is no longer used for most Medicare Part B professional claims. In 2026, it is mainly limited to certain hospital settings, such as Critical Access Hospital (CAH) Method II claims.
When Is Modifier GT Still Used?
- Some commercial insurance plans still accept GT for live video visits
- Some state Medicaid programs still require GT instead of 95
- It must always be checked with the payer before billing
Do not use modifier GT and modifier 95 together. This often leads to claim denials.
What Is Modifier 93 for Telehealth?
Modifier 93 is used for audio-only telehealth visits. It means the service was delivered through a phone call without video.
It replaced the older telephone visit codes. 99441, 99442, and 99443 were removed from the CPT code set in 2025. They are no longer accepted for billing.
How to Bill Audio-Only Visits in 2026
Billing depends on the payer type:
- Medicare (Seniors): Use regular visit codes (99202–99215) but add Modifier 93 to show it was phone-only.
- Commercial (Private Insurance): Do not use regular codes. Use 98008–98015.
- Medicaid: Every state has its rules.
Documentation Requirements for Modifier 93
Clinical notes must have these 3 elements:
- Audio-only visit was used because video was not possible or not chosen
- Verbal consent was obtained from the patient
- Time or medical decision-making supports the E/M level billed
This documentation proves the visit was appropriate and not downgraded from video for convenience.
What Are Place of Service Codes 02 and 10?
POS codes 02 and 10 show where the patient was during a telehealth visit. They do not describe the provider’s location.
- POS 02 = Patient is at a non-home location (clinic, hospital, SNF)
- POS 10 = Patient is at home
| Code | Name | Patient Location | Fee Schedule | Pairs With |
| POS 02 | Telehealth – Other than Home | Clinic, hospital, SNF, or any non-home site | Facility rate | 95, 93, GT (CAH only) |
| POS 10 | Telehealth – Patient’s Home | Patient’s private residence | Non-facility rate | 95, 93 |
CMS updated these codes to separate home-based telehealth from other settings. POS 10 is now often paid at a higher non-facility rate, while POS 02 follows a facility-based rate.
Where POS Codes Go on the CMS-1500 and 837P
POS codes are reported in two places depending on claim type:
- CMS-1500 (paper form): Box 24B, per service line
- Electronic 837P claims:
- Loop 2300 (claim level)
- Loop 2400 (service line level)
Telehealth Modifier and POS Code Pairing
These are the 6 valid combinations for 2026:
- 99202–99215 + modifier 95 + POS 10: synchronous video, patient at home, Medicare or commercial
- 99202–99215 + modifier 95 + POS 02: synchronous video, patient at non-home site, Medicare or commercial
- 99202–99215 + modifier 93 + POS 10: audio-only, patient at home, Medicare
- 99202–99215 + modifier 93 + POS 02: audio-only, patient at non-home site, Medicare
- 98008–98015 + modifier 93 + POS 10 or 02: audio-only, commercial payers that adopted the 2025 AMA code set
- CAH institutional claim + modifier GT: synchronous video, Critical Access Hospital Method II only
Any combination outside these produces a denial.
5 Telehealth Billing Errors That Generate Denials in 2026
These are not edge cases. They appear on submitted claims every day.
- Modifier GT on Medicare Part B professional claims
GT was retired from these claims in 2018. Every submission produces a denial.
- Modifier 95 on audio-only visits
Modifier 95 can’t be used on audio-only visits. It requires video.
- Using CPT codes 99441-99443
These codes are not used any more. The claim auto-denies.
- POS 11 (office) paired with telehealth modifiers on Medicare claims
POS 11 tells Medicare the visit was in-person. Pairing it with modifier 95 or 93 creates a logical conflict the claim system rejects.
- POS 02 when the patient was at home
POS 02 applies when the patient is at a non-home site. Using it for a home-based visit produces the wrong fee schedule and can trigger a demand for repayment on post-payment audit.
Stop Telehealth Denials at the Source
One wrong modifier costs you that claim. A pattern of wrong modifiers costs you a payer audit.
At Minnesota Medical Billing, we verify modifier and POS code accuracy on every telehealth claim we process. Our billing team works with the most current CMS guidelines and payer-specific rules so your claims are clean before they leave the practice.
Our team checks every code combination before submission, modifier, POS code, CPT, and documentation, so your telehealth revenue cycle stays clean.
Request a Free Telehealth Billing Review
Frequently Asked Questions
1.What is the most common telehealth billing mistake?
One of the most common mistakes is using the wrong modifier or POS code combination.
2. Can modifier 95 be used for phone calls?
No. Modifier 95 is only for real-time audio-video visits. Audio-only services should be billed with modifier 93 when payer rules allow.
3. Which POS code should be used for home telehealth?
Use POS 10 when the patient receives telehealth services from their home. POS 02 is used when the patient is at another approved location.