Modifier 95- Synchronous Audio-Video Telemedicine

Identifies a synchronous telemedicine service provided through a real-time interactive audio and video telecommunications system.

What Is Modifier 95?

Modifier 95 identifies a healthcare service furnished through a real-time, interactive audio and video telecommunications system.

The patient and practitioner communicate simultaneously using technology that allows them to see and hear one another during the encounter. This distinguishes Modifier 95 from Modifier 93, which identifies qualifying synchronous audio-only services.

Modifier 95 remains active in 2026 and continues to play an important role in Medicare telehealth reporting. CMS's CY 2026 telehealth policies continue to evaluate telehealth services based on whether they can be furnished through an interactive, two-way audio-video telecommunications system.

Modifier 95 communicates how the service was delivered. It does not, by itself, establish that the underlying CPT or HCPCS service is covered by Medicare, medically necessary, or eligible for telehealth payment.

When to Use Modifier 95

Real-Time Audio and Video: The patient and practitioner communicate simultaneously using interactive telecommunications technology with both audio and video capabilities.

Qualifying Telehealth Service: The underlying CPT or HCPCS service is eligible to be furnished through telehealth under the applicable Medicare or payer policy.

Distant-Site Practitioner: The practitioner furnishes the service remotely while the patient is at a different location.

Required Claim Identification: Modifier 95 is appended when Medicare or another payer requires the claim to identify synchronous audio-video delivery.

Applicable Place of Service: For Medicare professional telehealth claims, the appropriate telehealth POS should also be reported when required.

Service Requirements Met: The practitioner performs and documents the same applicable elements required by the CPT or HCPCS code being reported.

RHC or FQHC Telehealth: Beginning October 1, 2026, CMS requires RHCs and FQHCs furnishing applicable distant-site telehealth services to report individual CPT or HCPCS codes and Modifier 95 for audio-video services instead of reporting G2025 for those services.

When NOT to Use Modifier 95

Audio-Only Encounter: Modifier 93 identifies qualifying synchronous telemedicine furnished through real-time audio-only technology.

Asynchronous Service: Modifier 95 does not describe store-and-forward communications, recorded information, portal messages, or other asynchronous interactions.

In-Person Encounter: Do not append Modifier 95 when the practitioner and patient are physically together for the reported service.

Service Not Telehealth Eligible: Modifier 95 does not convert an otherwise ineligible CPT or HCPCS service into a Medicare-covered telehealth service.

Technology Does Not Meet Requirements: Do not report Modifier 95 when the encounter does not involve qualifying real-time interactive audio-video communication.

Remote Monitoring Alone: Remote patient monitoring and remote therapeutic monitoring have their own coding requirements and should not automatically be reported with Modifier 95 simply because technology is involved.

Payer Requires Different Reporting: Medicaid programs and commercial insurers may have telehealth billing requirements that differ from Medicare.

Billing Example

A physician conducts a qualifying follow-up visit with a Medicare patient through a live video platform.

The physician and patient can see and hear each other throughout the encounter. The physician performs and documents the elements necessary for the reported service.

Because the encounter was furnished through synchronous audio-video telecommunications, the physician reports the appropriate eligible service code with Modifier 95 and the applicable Medicare place of service.

Example with Patient at Home: If the patient receives the qualifying Medicare telehealth service in their home, POS 10 identifies telehealth provided in the patient's home.

Example Outside the Patient's Home: If the patient receives the qualifying telehealth service somewhere other than their home, POS 02 identifies telehealth provided other than in the patient's home. CMS defines POS 02 and POS 10 specifically for these circumstances.

Documentation Requirements

Communication Method: Document that the encounter occurred through real-time interactive audio and video telecommunications.

Service Provided: Record the clinical services furnished during the encounter.

Medical Necessity: Documentation should establish why the underlying healthcare service was medically reasonable and necessary.

Patient Location: Record the patient's location when relevant to Medicare or payer telehealth requirements.

Practitioner Location: Maintain practitioner location information when required by applicable billing or licensing rules.

Service Elements: Document the history, examination, medical decision-making, time, or other elements required by the specific CPT or HCPCS service.

Consent: Document patient consent when required for the particular telehealth service or payer.

Technology: The record should make clear that the encounter was synchronous audio-video rather than audio-only when Modifier 95 is reported.

Billing and Claim Considerations

Modifier 95 is only one component of a correctly reported Medicare telehealth claim.

Providers should first verify that the underlying service qualifies for Medicare telehealth. CMS maintains its Medicare Telehealth Services List and makes additions or deletions through the annual Physician Fee Schedule process.

For Medicare professional telehealth reporting, POS 02 and POS 10 serve different purposes:

POS 02: Telehealth provided other than in the patient's home.

POS 10: Telehealth provided in the patient's home.

CMS guidance pairs the appropriate telehealth POS with Modifier 95 for audio-video services and Modifier 93 for audio-only services. CMS has also distinguished payment based on POS: POS 02 receives the facility rate while POS 10 receives the non-facility rate under the applicable PFS telehealth methodology.

The modifier itself does not determine the payment rate. The underlying service, place of service, coverage requirements, provider type, and other Medicare rules must also be considered.

Medicare Telehealth Service Eligibility

Reporting Modifier 95 does not mean that every CPT or HCPCS service can be billed through telehealth.

The underlying service must qualify under current Medicare rules. CMS maintains and updates the Medicare Telehealth Services List as part of its Physician Fee Schedule policies.

For CY 2026, CMS streamlined its process for considering services for the Medicare Telehealth Services List and focuses its clinical review on whether a service can be furnished using an interactive, two-way audio-video telecommunications system.

Because the list and applicable requirements can change, providers should verify eligibility for the specific date of service rather than assuming a service qualifies because it was successfully performed remotely.

RHC and FQHC Billing in 2026

Rural Health Clinics and Federally Qualified Health Centers have special Medicare telehealth billing requirements.

For dates of service beginning October 1, 2026, CMS instructs RHCs and FQHCs to report the individual CPT or HCPCS code describing an applicable distant-site telehealth service instead of G2025 and append:

Modifier 93: Audio-only service.

Modifier 95: Audio-video service.

CMS's implementation guidance specifically defines Modifier 95 as the modifier for synchronous telemedicine furnished through a real-time interactive audio-video telecommunications system.

This makes it particularly important to verify the date of service and provider setting when determining the appropriate Medicare telehealth billing method.

Common Billing Mistakes

Confusing 95 With 93: Modifier 95 identifies audio-video communication. Modifier 93 identifies qualifying synchronous audio-only communication.

Incorrect Place of Service: Reporting POS 02 when the patient is at home, or POS 10 when the patient is somewhere other than home, can result in incorrect claim reporting.

Assuming Modifier 95 Establishes Coverage: The underlying CPT or HCPCS service must independently qualify for telehealth.

Using 95 for Asynchronous Communication: Portal messages, recorded information, and other asynchronous interactions do not satisfy Modifier 95's synchronous audio-video definition.

Reporting 95 Because Video Was Used: The mere use of video technology does not make a service Medicare-covered telehealth.

Ignoring Provider-Specific Rules: Telehealth requirements may differ for physicians, therapists, RHCs, FQHCs, and other provider types.

Using Outdated Telehealth Rules: Medicare telehealth policies have changed substantially over time. Claims should be based on requirements applicable to the actual date of service.

Ignoring Other Payers: A commercial insurer or Medicaid program may require different modifiers, POS codes, or telehealth reporting procedures.

Common Denial Reasons

Service Not Eligible for Telehealth: The underlying CPT or HCPCS service does not qualify under the applicable payer's telehealth policy.

Incorrect Place of Service: The POS reported does not correspond to where the patient received the telehealth service.

Incorrect Telehealth Modifier: Modifier 93 or another reporting method better represents how the service was furnished.

Audio-Video Requirement Not Supported: Documentation does not establish synchronous interactive audio-video communication.

Medical Necessity Not Supported: The record does not demonstrate why the underlying service was medically necessary.

Service Requirements Not Met: Documentation fails to support the requirements of the CPT or HCPCS code reported.

Provider Eligibility Issue: The practitioner or facility does not satisfy applicable requirements for the particular telehealth service.

Payer-Specific Rule Not Met: The claim does not comply with the insurer's telehealth coverage or billing policy.

Modifier 95 vs. Modifier 93

Modifier 95: Synchronous telemedicine furnished through a real-time interactive audio and video telecommunications system.

Modifier 93: Synchronous telemedicine furnished through telephone or another real-time interactive audio-only telecommunications system.

The distinction is based primarily on the technology used during the encounter.

If the qualifying encounter includes both live audio and video, Modifier 95 may apply. If it qualifies for audio-only reporting and no video is used, Modifier 93 may apply.

CMS continues to make this distinction explicitly in its 2026 telehealth guidance, including its new RHC and FQHC billing instructions effective October 1, 2026.

Modifier 95 vs. Modifier GT

Modifier 95: Current modifier identifying synchronous telemedicine furnished through real-time interactive audio-video telecommunications.

Modifier GT: Historically used to identify services furnished through interactive audio and video telecommunications and still relevant in certain limited payer or Medicare-specific circumstances.

Modifier GT should not automatically be substituted for Modifier 95. Providers should follow the requirements of the payer and service setting involved.

For ModifierLookup, this distinction is important because the modifiers may sound similar but their current billing applications are not interchangeable.

Frequently Asked Questions

Does Modifier 95 mean the patient must be at home?
No. Modifier 95 identifies the audio-video telecommunications method. For Medicare professional telehealth claims, POS 10 identifies a patient receiving telehealth in their home, while POS 02 identifies telehealth received somewhere other than the patient's home.

Can Modifier 95 make a service eligible for Medicare telehealth?
No. Modifier 95 identifies how an eligible service was furnished. The underlying service must independently satisfy Medicare's telehealth coverage and billing requirements.