The 95 modifier for telehealth is an essential billing tool for healthcare providers delivering virtual care services via live audio and video. As telehealth remains widely reimbursable in 2025, using modifier 95 accurately ensures proper claim processing and payment, especially when billing r or commercial payers. Yet, many providers still face confusion about how and when to use it, what CPT codes it applies to, and how it interacts with Place of Service (POS) codes. This guide clarifies these points so your billing remains accurate and compliant.
What Is Modifier 95 in Telehealth Billing?
Modifier 95 is used to report synchronous telehealth services, meaning those provided in real time via interactive audio and video technology. By appending this modifier to a CPT® code, providers indicate that the service was delivered remotely through a virtual platform, not in person. Note that modifier 95 applies only to CPT codes approved for telehealth use, and only when audio and video were both used during the encounter. This modifier helps payers differentiate between in-office and virtual care services, which is critical for claim processing, compliance, and reimbursement.
How to Use Modifier 95 for Telehealth Billing
Here’s when to use modifier 95 for telehealth:
- The service is delivered through real-time audio and video, not pre-recorded communication.
- The CPT code is on the payer’s approved telehealth code list.
- The payer’s billing policy requires modifier 95 (most commercial insurers and Medicare do).
- The POS code used does not already imply telehealth delivery.
For audio-only telehealth visits (e.g., phone calls), Medicare and some other payers now require modifier 93, not 95.
Modifier 95 vs GT Modifier: What’s the Difference?
If you’re asking, “Do I use 95 or GT modifier for telehealth?” you’re not alone. Here’s a simple comparison:
- Modifier 95: The current standard for most real-time telehealth services billed to Medicare, Medicaid, and commercial payers.
- Modifier GT: An older modifier, once used heavily by Medicare before 2018. Some state Medicaid programs and legacy payers may still request GT.
Best practice is: default to modifier 95 unless a payer’s guidelines explicitly request GT.
What CPT Codes Can Be Used with Modifier 95?
Only CPT codes that are approved by Medicare or a specific payer for telehealth are eligible for modifier 95. Examples of eligible service types:
- Office and outpatient E/M visits
- Behavioral health sessions
- Physical therapy and occupational therapy check-ins
- Transitional care and chronic care management
- Annual wellness visits
Disclaimer: CPT® codes are copyrighted by the American Medical Association. We recommend reviewing your payer’s published telehealth code list or consulting your billing team for specifics.
Modifier 95 and Place of Service (POS) Codes: Key Rules
Correctly pairing modifier 95 with the right Place of Service (POS) code is crucial.
- POS 02: Used when the patient receives telehealth outside their home. Modifier 95 should be appended to eligible CPT codes.
- POS 10: Used when the patient receives telehealth from home. Modifier 95 still applies here.
- POS 11 (Office): This was allowed by some payers during the pandemic to reflect “temporary” virtual visits from in-office providers. As of 2025, only use POS 11 with modifier 95 if the payer’s policy specifically allows it.
If the wrong POS-modifier combo is used, the claim could be denied or paid incorrectly.
Is Modifier 95 Still Required for Telehealth in 2025?
Yes, modifier 95 is still required for most telehealth services in 2025.
- Medicare: Still uses modifier 95 for real-time virtual care when billed with POS 02 or POS 10.
- UnitedHealthcare (UHC), Aetna, and other commercial payers: Continue to require modifier 95, though policies may vary slightly by plan.
- Audio-only visits: Require modifier 93, not 95.
Always verify your top payers’ 2025 telehealth policies; some are still evolving post-pandemic.
Does Modifier 95 Affect Payment?
Absolutely. Using modifier 95 correctly:
- Ensures the payer recognizes the virtual nature of the service
- Helps the claim get routed to the appropriate reimbursement logic
- Prevents delays, underpayments, or denials due to coding mismatches
Incorrect or missing modifiers can flag a claim for medical review, or worse, result in full denials.
Best Practices for Telehealth Billing with Modifier 95
To stay compliant and maximize reimbursement, follow these best practices:
- Use modifier 95 only with audio-video services
- Match it with approved CPT codes and correct POS codes
- Train billing staff on modifier 95 vs GT vs 93
- Monitor payer-specific changes annually
- Audit denied claims for modifier-related errors
Conclusion
The 95 modifier for telehealth is a small detail with a big impact. When used correctly, it ensures faster payment, better compliance, and fewer denials. But telehealth billing is complex and changes frequently across payers. If modifier errors, coding confusion, or claim rejections are eating into your revenue, it’s time to get expert help. A billing partner with deep telehealth experience can ensure every service is coded and paid correctly the first time.
About Medisys
At Medisys, we specialize in telehealth billing and coding for healthcare providers nationwide. From modifier accuracy to payer compliance, we ensure your virtual visits are reimbursed correctly and efficiently. Whether you’re a solo provider or multi-site group, we help you navigate the evolving landscape of telemedicine reimbursement. Contact us to learn more about how we can support your practice.
