Telehealth Modifiers: 95, GT, and Place of Service
Telehealth Modifier Overview
Modifier 95 is the primary modifier for synchronous audio-video telehealth services. It tells the payer the service was delivered via real-time video. Place of service (POS) code 10 (telehealth in patient's home) or 02 (telehealth other) determines the facility fee component. Incorrect modifier or POS code is the leading cause of telehealth claim denials, affecting an estimated 12-15% of all telehealth submissions.
Modifier and POS Code Rules
- Modifier 95: Required by Medicare and most commercial payers for real-time audio-video visits. Append to the E/M or therapy code (e.g., 99214-95).
- Modifier GT: Used by some legacy Medicaid systems and older payer platforms. Check your state Medicaid guidelines — some states have transitioned to modifier 95.
- POS 10: Patient is at home during the telehealth visit. Medicare reimburses at the non-facility rate (higher).
- POS 02: Patient is at a qualifying originating site (clinic, hospital, rural health clinic). Medicare reimburses at the facility rate (lower).
- Modifier 93: Audio-only telephone E/M services (99441-99443). Required by payers that distinguish audio-only from video visits.
Payer-Specific Requirements
| Payer | Modifier | POS Code | Notes |
|---|---|---|---|
| Medicare | 95 | 10 or 02 | POS 10 for home, POS 02 for originating site |
| UnitedHealthcare | 95 | 02 | Uses POS 02 for all telehealth regardless of patient location |
| Anthem | 95 | 02 or 10 | Varies by state plan |
| Aetna | 95 | 02 | Standard POS 02 |
| Medicaid | 95 or GT | 02 or 10 | State-specific — check your state Medicaid manual |
Common Denials
CO-16 is the top telehealth denial — POS code or modifier mismatch. Verify the payer's specific POS/modifier combination before submitting. CO-6 (incorrect place of service) occurs when POS 11 (office) is used instead of POS 02 or 10 for a telehealth visit. CO-50 flags services not covered via telehealth — check the payer's telehealth-eligible service list. See telehealth setup for complete configuration guidance.
Common Questions About Telehealth Modifiers
Do I use modifier 95 or GT?
Use modifier 95 for Medicare and most commercial payers. Use GT only if your specific state Medicaid program requires it. When in doubt, check the payer's provider manual. Modifier 95 is the current CMS standard.
Does the POS code affect reimbursement?
Yes. POS 10 (patient at home) reimburses at the non-facility rate, which is higher than POS 02 (originating site/facility rate). For Medicare, POS 10 can increase reimbursement by 15-30% compared to POS 02 for the same E/M code.
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This reference is for informational purposes. Always verify against current payer policies, CPT guidelines, and CMS documentation. Last updated: 2026-04-06.