Modifier 95 vs 93 vs GT vs GQ: Telehealth Modifiers Explained for 2026

Telehealth modifiers are small — two characters — but they decide whether a virtual visit is paid, denied, or paid at the wrong rate. The trouble is that payers don't agree on which ones to use. A visit billed perfectly for one commercial plan can deny at Medicare, and a modifier one Medicaid program requires may be rejected by another.

This guide explains each telehealth modifier, how it interacts with place-of-service codes, and how to build payer-specific rules so your practice stops guessing.

The telehealth modifiers at a glance

Modifier 95 — the workhorse

Modifier 95 is a CPT modifier that indicates a synchronous telemedicine service rendered through a real-time interactive audio and video system. It's meant for services that are listed in CPT Appendix P, the list of codes that may be used for synchronous telemedicine.

For OB/GYN practices, that includes office and outpatient E/M visits (99202–99215) and a range of counseling and other services. When a commercial or Medicaid plan asks for modifier 95, it typically wants:

• The E/M code that reflects the medical decision making or total time
• Modifier 95
• A place of service that the payer specifies — often 02 or 10, sometimes the POS where the visit would have occurred in person (usually 11)

Modifier 93 — audio-only visits

Modifier 93 (synchronous telemedicine via telephone or other real-time interactive audio-only system) was added to CPT for services listed in Appendix T. Use it only when no video was used for the visit.

When audio-only visits are covered, payers usually expect:

• Documentation that the patient was offered video or couldn't use it, or that audio-only was clinically appropriate
• The same medical documentation required for the visit level billed
• Modifier 93 instead of 95

Don't confuse modifier 93 with the old audio-only telephone codes 99441–99443, which were deleted in 2025.

Modifier GT — mostly retired

GT ("via interactive audio and video telecommunication systems") was the original Medicare telehealth modifier. CMS replaced it with POS 02 years ago, and it's now limited to:

• Medicare claims from critical access hospitals billing under method II
• Some state Medicaid programs that never updated their telehealth policy
• A handful of commercial plans with older policies

If a payer hasn't specifically asked for GT, use 95 instead.

Modifier GQ — store-and-forward

GQ identifies asynchronous telecommunication — for example, images or recorded information sent for later review. For Medicare, it's used in the federal telemedicine demonstration programs in Alaska and Hawaii. Outside those programs, a few payers use it for store-and-forward services. Most OB/GYN practices will rarely need it.

Modifier FQ — RHCs and FQHCs

FQ identifies audio-only services furnished by Medicare rural health clinics and federally qualified health centers. If your practice is part of an FQHC or RHC, Medicare's billing rules for those settings — including the specific G-codes they use for virtual communication and mental health visits — apply instead of the standard physician fee schedule rules.

How modifiers work with place of service

Modifiers tell the payer how the service was delivered. The place-of-service code tells the payer where the patient was:

For Medicare, POS 02 and 10 are the main identifiers of telehealth; POS 10 visits are paid at the non-facility rate. Medicare requires modifier 95 only in specific circumstances CMS has defined, and modifier 93 for audio-only services where applicable.

For commercial and Medicaid plans, rules vary widely. Common patterns include:

• POS 02/10 plus modifier 95
• POS 11 (as if in person) plus modifier 95
• POS 02 with no modifier
• GT instead of 95 (older Medicaid policies)

That's why a single "telehealth rule" in your billing system almost always produces denials somewhere.

Medicare telehealth status in 2026

The Consolidated Appropriations Act, 2026 extended the major Medicare telehealth flexibilities through December 31, 2027 — including telehealth to patients at home, removal of geographic restrictions, and coverage of audio-only services where appropriate. Watch for CMS updates as that date approaches.

Telemedicine E/M codes 98000–98016

CPT 2025 introduced dedicated telemedicine E/M codes: 98000–98007 for audio-video visits and 98008–98015 for audio-only visits, plus 98016 for brief virtual check-ins (replacing HCPCS G2012). These codes describe the telemedicine modality in the code itself, so they don't need modifier 95 or 93.

Payer adoption is mixed. Medicare generally hasn't paid most of these codes, continuing to use 99202–99215 with telehealth POS codes, while some commercial plans have adopted them. Check each payer's policy before switching.

Telehealth modifiers in OB/GYN: special considerations

• Routine prenatal visits inside a global package aren't billed separately, whether virtual or in person (through 2026). Don't add 95 to a visit that shouldn't be billed at all.
• Problem visits during pregnancy — managing hypertension or gestational diabetes between in-person visits — may be billed separately with the right O-code diagnosis.
• Postoperative telehealth visits within a 90-day surgical global period are included, unless they address something unrelated.
• From January 1, 2027, prenatal and postpartum visits will be reported per encounter with E/M codes, which means virtual prenatal visits will need the correct telehealth modifier and POS for every payer. See our 2027 maternity transition guide.

Build a payer-by-payer telehealth table

The most reliable fix for telehealth denials is a simple table for your top payers:

Fill in each row from the payer's current published telehealth policy, then build those rules into your claim scrubber. Review the table whenever a payer issues a policy update.

Documentation checklist

• Patient consent for telehealth, if required by state law or payer policy
• Modality — audio-video or audio-only — and the reason audio-only was used
• Patient location (home vs. other) and provider location
• Medical decision making or total time supporting the E/M level
• Start and end times when billing by time

Quick reference: which modifier when?

• Live video visit, commercial plan that requires a modifier → 95 (with the payer's required POS)
• Live video visit, Medicare → POS 02 or 10; add 95 only where CMS instructs
• Phone-only visit, payer covers audio-only → 93
• Medicaid program with an older policy → whatever the state manual specifies — sometimes GT
• Store-and-forward service → GQ where the payer recognizes it
• RHC/FQHC audio-only service to Medicare → FQ
• Telemedicine E/M code (98000–98015) → no telehealth modifier needed; the code describes the modality

Let us check your telehealth claims

Telehealth rules shift frequently and vary by payer. Our telehealth billing service maintains payer-specific rules for every client, and a free review of your recent virtual visits takes only a WhatsApp message to start.