Modifier 95: Telehealth Billing Rules for 2026

Modifier 95 marks a service as delivered by live audio and video. On a Medicare claim it goes on the telehealth line together with place of service 02 or 10. A session held by phone only takes modifier 93 instead.

The modifier does not change what Medicare pays. The place of service code does: POS 10 pays the non facility rate and POS 02 the facility rate. For a 60 minute 90837 in 2026 that is USD 167.00 against USD 135.27 nationally.

What is modifier 95?

Medicare contractor Noridian prints the CPT descriptor: "synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system." Noridian's instruction is one line: "Append this modifier when performing telemedicine services using real-time audio and video communications."

Synchronous means the patient and the clinician are connected at the same moment. A recorded message reviewed later is asynchronous and does not qualify. A phone call is synchronous but has no video, which is why Medicare gives it its own modifier.

Modifier 95 at a glance

How do you use modifier 95 on Medicare claims?

Chapter 26 of the Medicare Claims Processing Manual sets the rule. Under it, POS 02 or POS 10 "must be paired with the appropriate telehealth modifier (modifier 93 for audio-only and modifier 95 for audio/video)." The same paragraph says the choice of 93 or 95 "does not change rate of payment, only the POS code determines the non-facility or facility payment rate."

CMS put that wording in with Transmittal 12671 in June 2024, effective for services from January 1, 2024. The current chapter, revision 14466 issued May 27, 2026, still carries it word for word.

Pick the POS from where the patient is, then the modifier from the technology used:

The rate gap is real money on time based codes. National 2026 amounts from the CMS relative value file, before locality adjustment:

Our place of service codes guide covers how to confirm the patient's location before the visit.

Modifier 95 or 93: video or audio only?

Use 95 when the session had live video for the whole service. Use 93 when it was audio only. The CMS telehealth booklet (MLN901705, December 2025) allows audio only for behavioral and mental health telehealth when the patient is at home.

When a video visit drops to a phone call partway through, document when it switched and why, and code by what actually happened. Payers differ on how to code a visit that switched partway, so read the payer's audio only rule first.

Is the GT modifier still used?

For Medicare, only in one case. It applies to distant site practitioners who bill under the critical access hospital optional payment Method II. The CMS booklet says they "must submit institutional claims using the GT modifier." Professional claims from a clinic or practice use POS 02 or 10 with 95 or 93.

GQ, asynchronous store and forward, is paid only for federal telemedicine demonstrations in Alaska and Hawaii. A behavioral health group outside those programs has no use for it on Medicare claims. Some Medicaid and commercial plans kept GT in their own policies, so a payer can still ask for it.

Which behavioral health codes take modifier 95?

Any code on the CY 2026 Medicare telehealth list that you deliver by video. The common behavioral health codes are all on it:

Modifiers sit on each claim line. An E/M visit with a psychotherapy add-on by video is two lines, for example 99214 and 90836. Each line delivered by video carries POS 10 or 02 and modifier 95. An add-on line without it does not tell the payer that part of the visit was telehealth.

When a line needs modifier 25 as well, list 25 first and 95 after it. Modifier 95 does not change Medicare payment, so it sits after modifiers that affect payment or processing. Check your contractor's own sequencing guidance, since it is the one that reads the claim.

What should the note say for a video visit?

The note has to support every part of the claim line: the code, the place of service and the modifier. For a telehealth visit that means a few lines an in person note does not need.

The CMS booklet also lists an in-person rule for Medicare behavioral health telehealth. The patient needs a visit in person within 6 months of the first telehealth visit and every year after, with exceptions in 42 CFR 410.78. Congress has pushed back the start of this rule more than once. Check the CMS telehealth page for the date in force before you build it into scheduling.

Do Medicaid and commercial payers follow the same rules?

Not always. The Medicare manual binds Medicare contractors. Medicaid programs and commercial plans publish their own telehealth policies. They differ on whether they take POS 10, which modifier they want (95, GT or none) and whether they pay for audio only. Medicare Advantage plans can also set their own claim rules.

Keep one row per payer and update it when a policy changes:

Why do modifier 95 claims get denied?

These mismatches send telehealth claims back. Each is a gap between the claim line and the visit, or between the claim and the payer's policy:

Our guides to claim scrubbing and denial management cover how to catch these before submission and work the ones that come back.

Sources

• CMS, Medicare Claims Processing Manual, chapter 26, Rev. 14466, issued May 27, 2026
• CMS, Transmittal 12671, Change Request 13582, June 6, 2024
• CMS, MLN901705 Telehealth and Remote Monitoring, December 2025
• Noridian JE Part B, Modifier 95, updated May 14, 2025
• CMS CY 2026 Medicare telehealth services list and 2026 physician fee schedule relative value file

Get telehealth claims right the first time

A telehealth claim is right when the code, the place of service and the modifier all match the note. mdhub's billing agent, Eric, checks eligibility first. Then it scrubs each claim against the rules your clinic sets for modifiers and add-on codes before it goes out. See mdhub billing, or book a demo if you run a clinic with 10 or more clinicians. Solo clinicians can start a free trial.

Modifier 95 FAQ