Telehealth has rapidly evolved from an emergency solution during the COVID-19 pandemic to a cornerstone of modern healthcare delivery. Patients can now consult providers remotely, access follow-up care, and engage in chronic disease management—all without leaving their homes. As telehealth becomes an essential service, understanding telehealth billing and modifiers is crucial for healthcare providers aiming to ensure accurate reimbursement and compliance.
What Are Telehealth Modifiers?
In medical billing, modifiers are two-character codes appended to CPT or HCPCS codes to provide additional information about a procedure or service. For telehealth services, modifiers indicate that a healthcare service was delivered via telecommunication technology rather than in-person. These modifiers ensure that payers correctly recognize and reimburse telehealth services.
Telehealth modifiers are vital because they clarify the nature of the visit, the mode of service delivery, and sometimes the location of the patient, which can directly impact reimbursement.
Common Telehealth Modifiers
1. Modifier 95 – Synchronous Telemedicine Service
Modifier 95 is one of the most widely used telehealth modifiers. It indicates that a service was delivered via real-time, interactive audio and video communication. This modifier is applied to evaluation and management (E/M) codes, psychotherapy, and other CPT codes suitable for virtual delivery.
Example:
- CPT Code 99213 – Office visit for an established patient
- With telehealth: 99213-95
This signals that the visit occurred remotely and meets payer requirements for telehealth reimbursement.
2. Modifier GT – Via Interactive Audio and Video
Modifier GT is another telehealth-specific code, primarily used by Medicare and some commercial payers. It indicates that the service was provided using an interactive audio and video telecommunications system. While similar to 95, GT is often used in legacy billing systems and specific payer scenarios.
Example:
- CPT Code 99214-GT – Telehealth visit with interactive video
3. Modifier GQ – Asynchronous Telehealth (Store and Forward)
Modifier GQ applies to services delivered using store-and-forward technology, where patient data is collected and sent to a provider for evaluation at a later time. This approach is common in specialties like dermatology, radiology, and ophthalmology.
Example:
- CPT Code 99244-GQ – Telehealth consult where clinical data is reviewed asynchronously
4. Modifier FQ – Telehealth for Distant Site in Home
Modifier FQ is used to indicate a telehealth service provided to a patient at home (distant site) rather than a clinical facility. This is essential for programs focusing on homebound patients or those in rural areas.
Example:
- CPT Code 99441-FQ – Telehealth E/M service for a patient in their home
5. Modifier CR – Catastrophe/Disaster Related
During public health emergencies, some payers may require CR modifiers to indicate services provided under special conditions, such as pandemic-related telehealth expansion. While less common in routine billing, it remains relevant in certain emergency scenarios.
How Telehealth Modifiers Affect Reimbursement
Telehealth modifiers are not just administrative tools—they directly impact claim approval and payment amounts. Incorrect or missing modifiers can lead to:
- Claim denials: Payers may deny a claim if they cannot identify the service as telehealth.
- Reduced reimbursement: Some services reimbursed at a lower rate if modifiers are incorrect.
- Compliance issues: Telehealth has strict regulatory guidelines, and modifiers help demonstrate adherence to rules.
Key Tip: Always document the mode of service, patient location, and technology used, as many payers require detailed records when telehealth modifiers are applied.
Telehealth Modifier Guidelines by Payer
Medicare
- Modifier 95 is the standard for synchronous telehealth visits.
- Modifier GQ is required for store-and-forward telehealth in certain specialties.
- Modifier GT is still recognized for some legacy systems.
Commercial Payers
- Policies vary widely. Always verify each payer’s telehealth billing requirements.
- Many commercial insurers accept 95 for virtual visits.
State Medicaid Programs
- Some states require additional codes to indicate telehealth services delivered at home vs. a clinic.
- Modifier usage may differ based on state regulations, so always check local Medicaid telehealth guidance.
Best Practices for Using Telehealth Modifiers
- Verify payer requirements: Each insurer may have different modifier policies.
- Use correct CPT codes: Not all procedures are eligible for telehealth.
- Document everything: Record the patient’s location, type of visit, and technology used.
- Stay updated: Telehealth policies evolve regularly, especially after public health emergencies.
- Educate staff: Ensure billing teams are trained to apply modifiers correctly to prevent denials.
Common Challenges in Telehealth Billing
- Modifier confusion: GT, 95, and GQ can be mixed up if staff are unfamiliar with their applications.
- Non-covered services: Some procedures are ineligible for telehealth reimbursement.
- Duplicate claims: Incorrect modifiers can trigger payer audits or duplicate claim rejections.
- State-specific rules: Cross-state telehealth billing adds complexity regarding patient location and licensing.
How Allzone Helps Providers With Telehealth Billing
At Allzone, we understand that telehealth billing can be challenging. Our experienced medical billing team helps healthcare providers:
- Identify which CPT codes qualify for telehealth.
- Apply the correct modifiers (95, GT, GQ, FQ) for accurate reimbursement.
- Avoid claim denials and delays through meticulous documentation and compliance checks.
- Stay up-to-date with evolving telehealth regulations and payer policies.
By partnering with Allzone, providers can focus on delivering high-quality virtual care while leaving the complex billing and reimbursement process to experts.
Conclusion
Telehealth is more than a temporary trend—it’s a permanent evolution in healthcare delivery. As the industry shifts toward digital care, understanding and correctly using telehealth modifiers is essential for providers to secure accurate reimbursement and maintain compliance.
Modifiers like 95, GT, GQ, and FQ help differentiate between synchronous, asynchronous, and home-based services, ensuring payers recognize the nature of the service. Proper documentation, adherence to payer policies, and expert billing support are key to maximizing revenue and minimizing claim denials.
At Allzone, we specialize in telehealth billing, offering tailored solutions to help healthcare providers navigate the complexities of virtual care reimbursement. Let us handle your telehealth billing so you can focus on what matters most—delivering exceptional care to your patients.