Glossary · Coding

Telehealth modifier (95 / GT / GQ)

Telehealth modifiers 95, GT, and GQ are two-character codes appended to CPT or HCPCS codes to identify the technology and setting through which a service was delivered remotely; selecting the wrong modifier is one of the most common reasons telehealth claims are denied or down-coded.

Verified May 8, 2026 · 7 sources ↓

Drawn from CMSNoridianNovitasMend247medicalbillingservices

Definition

Source · Editorial summary grounded in 7 cited references ↓

Modifier 95 designates a synchronous telehealth service delivered via real-time, interactive audio and video. For most professional billing scenarios since January 1, 2024, it is the default Medicare telehealth modifier—appended when a clinician in a hospital provides care to a patient at home, and required for outpatient therapy services billed by physical therapists, occupational therapists, or speech-language pathologists employed by hospitals. It works in tandem with Place of Service (POS) codes 02 (patient not at home) or 10 (patient at home) on professional claims.

Modifier GT also signals synchronous audio-video delivery but is now narrowly scoped: Medicare limits it to institutional claims submitted by Critical Access Hospital (CAH) Method II distant-site providers. Outside that specific CAH context, GT is generally not accepted on professional claims and its use by commercial payers varies—many have replaced it entirely with modifier 95.

Modifier GQ covers asynchronous 'store-and-forward' telehealth, where a medical file is collected and transmitted to a provider for later review rather than in real time. CMS restricts GQ to the federal telemedicine demonstration programs operating in Alaska and Hawaii. Orthopedic providers outside those states have essentially no Medicare indication to append GQ. A fourth modifier worth knowing is 93, which flags synchronous audio-only services when a patient either requests telephone-only care or does not consent to video.

Why it matters

Using the wrong modifier triggers immediate claim denial or an automated audit flag: a professional claim submitted with GT instead of 95 will be rejected by most MACs because GT is reserved for CAH institutional billing; a claim with GQ outside Alaska or Hawaii signals geographic ineligibility and will deny; and omitting modifier 95 when a hospital-based therapist delivers outpatient telehealth removes the required telehealth identifier, causing the MAC to treat the service as if it were delivered in person—potentially triggering a place-of-service mismatch denial or an overpayment recoupment. Getting the modifier right also determines whether CMS reimburses at the facility or non-facility Physician Fee Schedule rate, which can meaningfully affect net payment.

Common mistakes

Where people most often go wrong with this concept.

Source · Editorial brief grounded in cited references ↓

Appending GT on a professional (non-CAH) claim—GT is valid only on institutional CAH Method II claims; use modifier 95 for professional telehealth instead.
Using GQ for any telehealth service outside the Alaska or Hawaii federal demonstration programs; it has no reimbursable application elsewhere under Medicare.
Omitting modifier 95 when a hospital-employed PT, OT, or SLP bills outpatient therapy via telehealth—CMS requires it in this specific scenario even when POS 02 or 10 is used.
Pairing the wrong POS code with modifier 95—POS 02 applies when the patient is outside their home (e.g., a clinic or workplace), while POS 10 applies when the patient receives care from home, including temporary lodging or their car.
Assuming modifier 95 is universally required on all professional telehealth claims; as of 2024 most standard telehealth visits are identified by POS 02 or 10 alone, and modifier 95 is only mandated in the hospital-clinician-to-patient-at-home and outpatient therapy scenarios.
Applying telehealth modifiers to audio-only services—modifier 93 is the correct designator for synchronous telephone-only visits; using 95 on an audio-only claim misrepresents the technology used.
Neglecting to verify commercial payer policies annually—many non-Medicare payers have their own modifier requirements that diverge from CMS rules and change year to year.

Related codes

Codes commonly involved when this concept appears in practice.

CPT

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01Do I still need modifier 95 on every professional telehealth claim after January 1, 2024?

No. Since January 1, 2024, most standard professional telehealth visits are identified by POS 02 or POS 10 alone. Modifier 95 is specifically required when a hospital-based clinician provides care to a patient who is at home, and when hospital-employed PTs, OTs, or SLPs bill outpatient therapy via telehealth. Verify your MAC's current guidance before assuming universal applicability.

02Can an orthopedic surgeon in a private practice use modifier GT for a telehealth follow-up visit?

No. Under current Medicare rules, GT is limited to institutional claims filed by CAH Method II distant-site providers. A private-practice orthopedic surgeon should use POS 02 or POS 10 with modifier 95 (where required) for professional telehealth claims.

03When would an orthopedic practice ever use modifier GQ?

Almost never. GQ is restricted to asynchronous store-and-forward services provided under the federal telemedicine demonstration programs in Alaska and Hawaii. An orthopedic practice outside those states has no Medicare basis for appending GQ.

04What modifier applies when a patient calls in and refuses video for their telehealth visit?

Use modifier 93 to designate a synchronous audio-only service. Note that Medicare does not reimburse audio-only E/M visits under its standard telehealth benefit, so the claim may deny; check whether the service qualifies under a specific audio-only policy before submitting.

05How does modifier selection affect reimbursement rates?

Place of service and modifier together determine whether CMS pays at the facility or non-facility Physician Fee Schedule rate. Services billed with POS 10 (patient at home) are paid at the non-facility rate, which is generally higher than the facility rate used for POS 02 visits. An incorrect POS-modifier pairing can result in payment at a lower rate or a denial.

06Do commercial payers follow the same modifier rules as Medicare?

Not always. Many commercial and Medicaid managed-care plans have their own telehealth modifier policies—some still require GT, others use proprietary modifiers, and a few have adopted Medicare's 95/POS framework. Always verify each payer's current telehealth billing policy before submitting claims.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

Mira flags telehealth encounters at documentation close and prompts the coder to confirm the correct modifier before claim submission. The scribe layer checks three variables: (1) billing entity type—if the claim originates from a CAH Method II institutional file, Mira pre-populates GT; for all other professional claims it defaults to modifier 95 when telehealth is detected; (2) patient location at time of service—Mira maps POS 10 when the patient's documented location is their home, temporary lodging, or vehicle, and POS 02 for all other non-facility telehealth sites; (3) technology modality—if the visit note or consent documentation indicates audio-only delivery, Mira substitutes modifier 93 and surfaces a warning that Medicare audio-only E/M claims may deny. GQ is surfaced as an option only when the rendering provider's practice address is in Alaska or Hawaii. Mira does not auto-submit; it presents the recommended modifier with a one-line rationale so the billing team can confirm or override before the claim leaves the queue. Payer-specific override rules (e.g., a commercial plan that still requires GT) can be configured in Mira's payer rules table and will supersede the Medicare default logic.

See Mira's approach