Modifier GQ- Via Asynchronous Telecommunications System

Identifies Medicare telehealth services furnished through an asynchronous, store-and-forward telecommunications system under a qualifying federal telemedicine demonstration in Alaska or Hawaii.

What Is Modifier GQ?

Modifier GQ is a HCPCS Level II telehealth modifier defined as “via asynchronous telecommunications system.”

Unlike synchronous telehealth, asynchronous telehealth does not require the patient and practitioner to communicate in real time. Clinical information—such as medical images, records, or other relevant data—is collected and transmitted so the distant-site practitioner can review it later.

For Medicare, GQ has a very narrow application. Current CMS 2026 guidance states that GQ is used for asynchronous Medicare telehealth when the medical file is collected and transmitted from a federal telemedicine demonstration conducted in Alaska or Hawaii.

GQ therefore should not be treated as a general-purpose modifier for every store-and-forward or asynchronous service.

When to Use Modifier GQ

Asynchronous Telehealth: The covered telehealth service is furnished through qualifying asynchronous, store-and-forward technology.

Alaska or Hawaii Demonstration: The service meets Medicare requirements involving a federal telemedicine demonstration conducted in Alaska or Hawaii.

Medical File Transmitted: The necessary medical information is collected and transmitted to the distant-site practitioner for review.

Covered Telehealth Service: The underlying CPT or HCPCS service satisfies applicable Medicare telehealth coverage requirements.

Qualified Practitioner: The distant-site physician or practitioner meets Medicare requirements for furnishing and billing the service.

Demonstration Participation Supported: Documentation supports the practitioner's participation in the applicable federal telemedicine demonstration when required.

When NOT to Use Modifier GQ

Standard Video Telehealth: GQ is not the general modifier for synchronous, real-time audio-video telemedicine.

Audio-Only Telemedicine: Modifier 93 identifies qualifying synchronous audio-only telemedicine services; GQ describes asynchronous telecommunications.

Ordinary Store-and-Forward Service: Do not use GQ merely because information was electronically transmitted. Medicare restricts GQ telehealth payment to the qualifying Alaska or Hawaii federal demonstration circumstances.

Service Not on Medicare Telehealth List: GQ does not convert an otherwise ineligible service into a covered Medicare telehealth service.

Nonqualifying Geographic Circumstance: Do not apply GQ to an ordinary asynchronous service outside the specific Medicare demonstration framework.

Remote Monitoring Alone: Do not assume remote patient monitoring or remote therapeutic monitoring qualifies for GQ simply because data is transmitted electronically.

Billing Example

A qualifying practitioner participates in a federal telemedicine demonstration in Alaska.

Clinical information needed for an eligible Medicare telehealth service is collected and transmitted asynchronously to the distant-site practitioner rather than reviewed during a live interaction.

The practitioner reviews the transmitted medical file and furnishes the qualifying service.

The applicable professional service CPT or HCPCS code is reported with Modifier GQ to identify that the service was delivered through the qualifying asynchronous telecommunications system.

CMS states that reporting GQ certifies that the asynchronous medical file was collected and transmitted to the distant site from a federal telemedicine demonstration conducted in Alaska or Hawaii.

Documentation Requirements

Asynchronous Delivery: Document that the service was furnished using store-and-forward rather than synchronous communication.

Medical Information Transmitted: Maintain documentation of the clinical information collected and transmitted for practitioner review.

Demonstration Eligibility: Documentation should support participation in the qualifying federal telemedicine demonstration in Alaska or Hawaii.

Service Performed: Clearly document the professional service furnished after reviewing the transmitted information.

Practitioner Information: Identify the qualified distant-site practitioner who reviewed the information and furnished the service.

Medical Necessity: The medical record should support the necessity of the underlying service independently of the telehealth delivery method.

CMS permits Medicare contractors to require documentation demonstrating the distant-site practitioner's participation in the qualifying Alaska or Hawaii federal demonstration before paying GQ telehealth claims.

Billing and Claim Considerations

Modifier GQ describes the method of telehealth delivery. It does not independently establish Medicare coverage.

The underlying CPT or HCPCS service must still satisfy applicable Medicare telehealth requirements. CMS maintains a Medicare telehealth services list and updates additions or deletions through the Physician Fee Schedule process.

For CY 2026, CMS continues to specifically instruct practitioners furnishing qualifying asynchronous telehealth to append GQ to the professional service code.

This narrow Medicare rule is especially important for billing accuracy. A provider should not see the phrase “asynchronous telecommunications system” and assume GQ applies to every modern store-and-forward encounter.

The Alaska/Hawaii federal demonstration requirement remains central to Medicare's use of GQ.

Understanding Asynchronous Telehealth

Asynchronous telehealth is often called store-and-forward telehealth.

Instead of requiring the patient and practitioner to interact simultaneously, relevant clinical information is captured and transmitted for later review.

This differs from:

Synchronous Audio-Video: The patient and practitioner communicate in real time using audio and video.

Synchronous Audio-Only: The patient and practitioner communicate in real time without video.

Asynchronous Telehealth: Clinical information is transmitted and reviewed at different times.

For Medicare GQ billing, however, the delivery method alone is insufficient. CMS ties GQ payment to the qualifying federal telemedicine demonstration circumstances in Alaska or Hawaii.

Medicare Requirements for GQ

Current CMS guidance makes the Medicare limitation explicit.

When asynchronous telehealth is reported with GQ, the practitioner is certifying that the asynchronous medical file was collected and transmitted to the distant site from a federal telemedicine demonstration conducted in Alaska or Hawaii.

Medicare contractors may request evidence that the physician or practitioner participates in the applicable demonstration before paying the service.

Providers should therefore verify all applicable eligibility and telehealth requirements rather than treating GQ as a broadly available asynchronous-service modifier.

Modifier GQ vs. Modifier 95

Modifier GQ: Asynchronous, store-and-forward telehealth under Medicare's qualifying Alaska or Hawaii federal demonstration rules.

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

The primary distinction is asynchronous versus synchronous communication.

CMS's 2026 guidance continues to recognize GQ specifically for qualifying asynchronous Medicare telehealth.

Modifier GQ vs. Modifier 93

Modifier GQ: Asynchronous telecommunications; the practitioner and patient do not need to interact in real time.

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

Both can involve care without live video, but they represent fundamentally different communication methods. GQ should not be substituted for 93 simply because a service does not use video.

Common Billing Mistakes

Using GQ Nationwide: Medicare's GQ rule is not a general nationwide store-and-forward billing pathway. It is tied to qualifying federal demonstrations in Alaska or Hawaii.

Confusing Asynchronous With Audio-Only: Audio-only telemedicine can still be synchronous. GQ specifically represents asynchronous communication.

Using GQ for Standard Video Visits: Real-time audio-video telemedicine is not asynchronous store-and-forward care.

Ignoring Underlying Service Eligibility: Adding GQ does not make an otherwise ineligible service a Medicare-covered telehealth service.

Insufficient Demonstration Documentation: A Medicare contractor may require evidence of participation in the qualifying federal demonstration.

Using GQ for Remote Monitoring: Electronic transmission of health information alone does not automatically make a service eligible for GQ.

Common Denial Reasons

Demonstration Requirements Not Met: The service is not connected to a qualifying federal telemedicine demonstration in Alaska or Hawaii.

Ineligible Telehealth Service: The underlying CPT or HCPCS code does not satisfy applicable Medicare telehealth requirements.

Incorrect Telehealth Modifier: The service was synchronous rather than asynchronous.

Practitioner Requirements Not Met: The billing practitioner does not satisfy applicable Medicare telehealth requirements.

Insufficient Documentation: The record does not establish asynchronous delivery or qualifying demonstration participation.

Claim Information Incorrect: The procedure code, modifier, or other claim information does not support Medicare telehealth payment.

Frequently Asked Questions

Can Modifier GQ be used for any asynchronous telehealth service?
No. For Medicare, current CMS guidance restricts GQ telehealth payment to qualifying asynchronous services associated with a federal telemedicine demonstration conducted in Alaska or Hawaii.

Is Modifier GQ still active in 2026?
Yes. CMS's current 2026 Medicare telehealth guidance continues to instruct practitioners to append GQ when qualifying asynchronous telehealth is furnished under the applicable Alaska or Hawaii federal demonstration requirements.