Telehealth Modifiers: 95, 93, GT, GQ, FQ and FR Explained

By Awais Afzal, Healthcare Operations & Data Analyst · Published February 23, 2026 · Updated October 14, 2026

Telehealth modifiers are two-character codes added to a claim line to tell the payer how a visit was delivered: 95 for real-time audio and video, 93 for audio-only, GT and GQ for narrow Medicare cases, FQ for rural health clinics and FQHCs, and FR for virtual supervision. Which ones you need depends on the payer.

Search for this topic and you will find the same list repeated: GT, GQ, 95, CS. Some of it is out of date, and some of it was never meant for the claims a practice sends today. This guide sorts the modifiers by what they describe, shows where Medicare has changed its rules, and marks every point where a commercial plan or state Medicaid program may differ. It also explains the place-of-service codes that travel with them. For the wider billing picture, see our telehealth billing guide.

What do telehealth modifiers do on a claim?

A telehealth modifier is a short code added to a procedure line. It tells the payer the technology used for the visit, so the claim can be priced and checked against that payer’s telehealth policy. The visit itself is still reported with the usual CPT or HCPCS code.

Two ideas are worth holding onto. First, the modifier describes the service. It does not make a service payable that the payer does not cover, and it does not raise the amount. Second, modifiers are not universal. Medicare, each commercial plan and each state Medicaid program publish their own telehealth policies, and the same visit can need a different code string from each of them.

A practical way to organize the codes is by question. Was the visit audio and video, or audio-only? Was it live or recorded and sent later? Who is billing, a professional or a hospital or clinic? Was a supervisor watching by video? Each question points to a different modifier.

Which modifier goes with which type of telehealth visit?

Match the visit to the technology first, then check the payer. The table below uses the descriptions on a Medicare Administrative Contractor’s telehealth modifier page (First Coast Service Options, 2026) and the CMS transmittal that ended routine GT use (CMS Transmittal 3929, 2017). Payers other than Medicare may apply them differently.

Sources: First Coast Service Options, Telehealth service modifiers (2026); CMS Transmittal 3929 (2017); University of Washington Behavioral Health Institute, TeleBH 101 transcript (2025) for FR.

Read the third column as a Medicare snapshot. The same MAC page notes a few other uses, and the table is not a full list of every Medicare telehealth rule. Treat it as a starting point and confirm with your own MAC and each commercial payer.

When do you use modifier 95 or GT for audio and video visits?

Use 95 when the payer asks you to mark a real-time video visit. Use GT only where a payer or program still requires it, and not as a default.

Modifier 95 describes a synchronous service delivered over a real-time interactive audio and video system. On the First Coast Medicare page, the listed Medicare uses are narrow: physician telehealth to acute hospital care at home patients (reported with POS 21), hospital-employed outpatient therapy by telehealth, and opioid treatment program audio-video services (First Coast Service Options, 2026). That does not mean 95 is optional everywhere. Commercial plans and Medicaid programs set their own rules, and many publish a requirement for it.

GT is different. CMS told contractors in Transmittal 3929 that, from January 1, 2018, they would no longer require GT on professional telehealth claims when POS 02 certifies that the telehealth requirements are met. GT stays required on institutional claims from critical access hospitals that chose Method II (CMS, 2017). The First Coast page repeats that GT is allowed only on those institutional claims.

Older posts claim 95 and GT can be used interchangeably. That is not safe. A payer that wants 95 may reject GT, and a program that requires GT may reject 95. The only dependable source is the payer’s own billing policy for the plan on the claim.

How do audio-only visits change the modifier?

Audio-only visits use 93, or FQ for rural health clinics and FQHCs. Most older guides leave these out, even though phone-based visits are common in behavioral health and in follow-ups for patients with limited video access.

The First Coast page describes 93 as a service rendered by telephone or another real-time interactive audio-only system. It says rural health clinics and FQHCs may report either 93 or FQ, and that FQ is used only by those two clinic types (First Coast Service Options, 2026). A separate training transcript from the University of Washington Behavioral Health Institute makes the same distinction (UW BHI, 2025).

The coverage question matters as much as the code. A law firm memo on H.R. 7148 states that Congress passed the bill on February 3, 2026, and that it extends Medicare telehealth flexibilities, including audio-only services, through December 31, 2027 (Hobbs Straus Dickson & Boyd memo, 2026). This is a time-limited extension. Other payers set their own audio-only rules, so confirm them before you bill a phone visit.

For therapy and counseling practices, audio-only is often a daily question. Our behavioral and mental health billing page covers how the rest of the billing cycle works for those services.

Where do GQ, FR and CS fit?

GQ and FR are narrow, and CS is not a telehealth modifier at all. Treat each as an exception to confirm, not a routine add-on.

GQ: asynchronous services

GQ describes a service delivered through an asynchronous system, such as recorded video or images reviewed later. CMS Transmittal 3929 says contractors pay GQ-coded services only if the physician or practitioner is tied to a federal telemedicine demonstration in Alaska or Hawaii (CMS, 2017). Outside that setting, a Medicare practice should not expect GQ to apply. Some other payers may have their own store-and-forward policies.

FR: virtual supervision

FR is used when a supervising practitioner is virtually present by real-time audio and video. The UW BHI transcript gives the example of a teaching psychiatrist reporting an E/M with 25 and FR, with supervisor and trainee on separate devices (UW BHI, 2025). On the Medicare side, the CY 2026 fee schedule rule permanently defines virtual direct supervision as real-time audio and visual interactive telecommunications, excluding audio-only, for services that require direct supervision (CMS, CY 2026 PFS final rule summary). It does not extend that virtual presence to all teaching settings.

CS: not a telehealth modifier

Older posts list CS as a telehealth modifier because of its pandemic-era link to COVID-19 testing and cost-sharing. It does not describe how a visit was delivered, and it does not appear on the Medicare telehealth modifier page cited above. We could not confirm a current rule for it from a primary source, so check the payer before using it on any claim.

Modifier 25 and modifier 59 are also commonly mentioned alongside telehealth. They describe separate or distinct services, not delivery method. Our modifier 25 versus modifier 59 and modifier 59 essentials posts explain when each applies.

How do place of service codes 02 and 10 work with the modifier?

The place of service code tells the payer where the patient was. The modifier tells the payer how the visit was delivered. They answer different questions, and a telehealth claim often needs both.

A common source of confusion is whose location the code describes. In the UW BHI training, POS 10 is used when the patient is at home, and POS 02 when the patient is somewhere other than home, such as a hospital, a skilled nursing facility or another provider’s office (UW BHI, 2025). The code follows the patient, not the clinician’s desk.

Source: University of Washington Behavioral Health Institute, TeleBH 101 Part 3 transcript (2025); verify against the current CMS POS code set and your payer policy.

For the Q3014 originating site fee, CMS lists the CY 2026 payment as 80% of the lesser of the actual charge or $31.85, with the patient owing any unmet deductible and Medicare coinsurance (CMS, CY 2026 PFS final rule summary). Our POS 10 telehealth code guide goes deeper on home-based visits.

What has changed in Medicare telehealth rules, and what is still open?

Medicare’s modifier rules changed slowly, but its coverage rules changed often. Check the date on any guide, including this one.

Sources: CMS Transmittal 3929 (2017); CMS CY 2026 Physician Fee Schedule final rule summary; Hobbs Straus Dickson & Boyd memo GM-26-005 (2026).

Two limits apply to this table. It covers Medicare only, and it reflects the sources we could read on the date of this update. A law that sets an end date also invites a new extension debate before that date, so build a calendar reminder to re-check the rules each quarter.

How can a practice get telehealth modifiers right on every claim?

Capture the visit type at scheduling, not at billing. By the time a biller sees the claim, nobody remembers whether the visit dropped to a phone call halfway through.

1. Record the technology used. Add a field for video, audio-only or recorded, filled in by the clinician or front desk.
2. Record where the patient was. The patient’s location drives the place of service. A home visit and a visit from another clinic use different codes.
3. Look up the plan. Match the plan on the patient’s card to a one-page rule sheet showing the modifier, POS and covered codes.
4. Check the code against the telehealth list. Not every procedure code can be billed for a telehealth visit under every payer.
5. Scrub before submitting. A claim with 93 on a plan that wants 95 should be caught before it goes out.

A good way to catch mistakes is a pre-submission check. Our clean claims guide explains what that check should look at. A a practice management system that tracks claims by stage can hold the claim at a stage and assign an owner when a required field is missing, which fits this kind of rule well.

What should the visit note say to support the modifier?

The note should show the technology, the patient’s location and the clinician’s location, along with the usual clinical content. The modifier on the claim must match what the note says.

• The type of connection: real-time audio and video, or audio-only.
• Where the patient was at the time of the visit, in plain words.
• Where the clinician was, since some payers ask about it.
• The platform used. For privacy rules on video tools, see our guide to HIPAA-compliant video conferencing.
• Whether a supervising practitioner joined by video, when FR applies.
• A clear record if the visit changed mid-call from video to audio-only.

Some payers also ask for patient consent to a telehealth visit, and requirements differ by state. Treat consent as a payer and state question, and document it the way your policy says.

What do telehealth modifier errors look like in denials?

Most modifier problems show up as a pattern, not a single claim. Group denials by payer, modifier and POS, and the cause is usually visible within a handful of rows.

• Modifier mismatch. The claim has 95 where the payer wants GT, or 93 where it wants 95.
• POS conflict. A POS that says the visit was in the office, on a claim billed as telehealth.
• Audio-only not covered. A phone visit billed with a code the payer does not accept by audio-only.
• Missing technology record. The note does not say how the visit was delivered.
• Wrong clinic modifier. A non-clinic practice using FQ, which is only for rural health clinics and FQHCs.

Each of these is fixable at the front of the process. Our denial management services team can review a denial sample by payer and modifier, and our medical billing services cover the claim side. The how telehealth affects the revenue cycle post shows where telehealth touches the other revenue cycle steps.

How do you measure whether telehealth claims are paid correctly?

Track telehealth denials as their own line, not inside the overall denial rate. A single blended number hides a modifier problem that affects only one payer or one visit type. If you want a rough sense of what a denial pattern costs, you can put your own volumes into our revenue calculator.

Start with three counts per month: telehealth claims sent, telehealth claims denied, and the top three denial reasons by payer. Review them with the clinicians who deliver the visits, since they often know why a call switched to audio-only.

Our recommendations

1. Build a one-page rule sheet per payer. We recommend one page per major plan showing the modifier, place of service and covered codes for video and audio-only visits, with the date it was last checked.
2. Capture technology and patient location at the visit. Add two fields to the visit workflow so the biller never has to guess whether a visit was video, audio-only or recorded.
3. Use GT and GQ only when a payer names them. For Medicare, GT is limited to critical access hospital Method II claims and GQ to the Alaska and Hawaii demonstration. Do not add them by habit.
4. Re-check Medicare dates each quarter. Telehealth flexibilities carry end dates. Put the current end date on the calendar and review it before it arrives.
5. Review denials by modifier and POS. A monthly look at the top denial reasons for telehealth claims is usually enough to find the rule that is wrong.

Bottom line

Telehealth modifiers describe the technology of the visit: 95 for audio and video, 93 for audio-only, FQ for rural health clinics and FQHCs, and GT, GQ and FR for narrow cases. Confirm each payer’s rule, capture the visit details at the time of care, and review denials by modifier. If telehealth claims keep coming back, our denial management services team can look at a sample, and you can talk to our team to start.

Frequently asked questions

What are modifiers in telehealth billing?

Modifiers are short codes added to a procedure line to tell the payer how a service was delivered. In telehealth they separate real-time audio and video (95), audio-only (93 or FQ) and a few narrow cases such as GT, GQ and FR. They describe the service and do not change what a payer will pay for it.

What is the difference between GT and GQ?

GT describes interactive audio and video and GQ describes an asynchronous, store-and-forward service. Under Medicare, GT is limited to critical access hospital Method II institutional claims, and GQ is paid only for providers tied to a federal telemedicine demonstration in Alaska or Hawaii. Other payers may differ.

Can modifier 95 be used in place of GT?

Not safely. Both describe audio and video visits, but a payer that requires one may reject the other. Medicare dropped the GT requirement for professional claims in 2018, while many commercial plans and Medicaid programs set their own rule. Check the payer’s published policy before choosing.

What is the difference between modifier 93 and FQ?

Both describe audio-only visits. Modifier 93 covers telephone or other real-time audio-only services. FQ is used only by rural health clinics and FQHCs, which may report either 93 or FQ on Medicare claims. A non-clinic practice should not use FQ.

Is the CS modifier a telehealth modifier?

No. CS is tied to COVID-19 testing and cost-sharing, not to how a visit was delivered, and it is not on the Medicare telehealth modifier page we reviewed. Check the payer’s current policy before using it, and do not add it to routine telehealth visits.

Do telehealth modifiers affect reimbursement?

Indirectly. A modifier does not raise the rate, but it tells the payer which telehealth policy and fee rules apply. A missing or mismatched modifier can lead to a rejection or a lower payment. The place of service code can also change the Medicare payment level, so confirm both.

Sources

1. Transmittal 3929, Pub. 100-04, Change Request 10152 — CMS (2017)
2. Telehealth service modifiers — First Coast Service Options (Medicare Administrative Contractor) (2026)
3. Medicare Physician Fee Schedule final rule summary, CY 2026 (MM14315) — CMS (2026)
4. Memo GM-26-005 on H.R. 7148 — Hobbs, Straus, Dickson & Boyd (2026)
5. TeleBH 101 Part 3: Telehealth Modifiers (transcript) — University of Washington Behavioral Health Institute (2025)