What is the modifier 95 for telephone visits?
Asked by: Rose Turcotte | Last update: December 23, 2025Score: 4.6/5 (47 votes)
When should modifier 95 be used?
In addition, providers need to use either modifier 95 for services or benefits provided via synchronous, interactive audio visual telecommunication systems or modifier GQ for services or benefits provided via asynchronous store and forward.
What is the modifier for telephone visits?
Use modifier -93 for the reporting of medical services that are provided via real-time interaction between the physician or other qualified health care professional (QHP) and a patient through audio-only technology.
Is modifier 95 required for telehealth services in 2024?
Therapy providers, including SLPs, will continue to use modifier “95” to indicate telehealth services and will not use one of the POS codes for telehealth services, regardless of settings. SLPs should continue to report the POS code that best reflects where services would have been provided in person.
Does UHC require a 95 modifier for telehealth?
UnitedHealthcare requires one of the telehealth-associated modifiers (GT, GQ, G0 or 95) to be reported when performing a service via Telehealth to indicate the type of technology used and to identify the service as Telehealth.
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How to code a telehealth visit?
- 99202-99205: Office/outpatient E/M visit, new patient.
- 99211-99215: Office/outpatient E/M visit, established patient.
- G0425-G0427: Consultations, emergency department or initial inpatient (Medicare only)
Does modifier 25 or 95 go first?
Since both modifier 25 and 95 can impact payment, list modifier 25 first.
How to bill telehealth visits in 2024?
Coding for Audio-video Visits
Use the POS that aligns with the patient's location. As of January 1, 2024, Medicare pays telehealth services provided in the patient's home (POS 10) at the non-facility rate. Telehealth services provided at an originating site (POS 02) are paid at the facility rate.
What is modifier 95 or GT Aetna?
When a provider reports modifier GT or 95, it certifies the patient received services via an audiovisual telecommunications system. • GT: Telehealth service rendered via interactive audio and. video telecommunications system. • 95: Synchronous telemedicine service rendered via real-time.
What is the difference between telehealth and telemedicine?
While telemedicine refers specifically to remote clinical services, telehealth can refer to remote non-clinical services, such as provider training, administrative meetings, and continuing medical education, in addition to clinical services. There are several other ways to define telehealth.
How do I document a telephone visit?
- Verbal consent obtained.
- Statement that the service was provided via telephone.
- Time-in and Time-out.
- Reason for the visit.
- Synopsis of the conversation.
- Outcomes (i.e. prescription, care instructions, recommendations, etc.)
Is a phone call considered telehealth?
A real-time interaction between a patient and health care provider that is conducted solely via audio (e.g., telephone, internet call without video).
What is the POS for telephone visits?
Place of Service codes: When billing telehealth claims, it is important to understand the place of service (POS) codes as it affects reimbursement. POS 02 refers to telehealth provided other than in patient's home and POS 10 refers to telehealth provided in patient's home.
What is the modifier for telephone only visit?
Modifier 93 descriptor
Synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located away at a distant site from the physician or other qualified health care professional.
Will Medicare pay for telehealth in 2025?
Medicare patients can receive telehealth services for non-behavioral/mental health care in their home through March 31, 2025. There are no geographic restrictions for originating site for Medicare non-behavioral/mental telehealth services through March 31, 2025.
Can you bill a preventive visit via telehealth?
Yes, billable providers may utilize a telehealth modality to provide FQHC, RHC, or Tribal 638 covered services via synchronous telehealth (audio-visual, two-way communication) to “established” patients. Please see the Provider Manuals provided by telehealth.
When should you use modifier 95?
The modifier may depend on the type of service. -95: Synchronous telemedicine service rendered via a real-time interactive audio and video communications system.
Is Aetna no longer covering telehealth?
Aetna recently announced it was excluding fully insured commercial plans in all 50 states from its new telehealth policy that took effect December 1, 2023, eliminating coverage for audio-only and asynchronous telehealth services.
Does UHC require 95 modifier for telehealth?
Modifiers 95, GT, GQ and G0 are not required to identify Telehealth services but are accepted as informational if reported on claims with eligible Telehealth services.
What is the CMS modifier 95 for 2024?
In 2024, CMS is no longer requiring modifier 95 on claims, but is requiring using POS 02 or POS 10. Modifier 95 is for use with real-time, audio/visual visits.
Does Medicare cover telephone only visits?
Additionally, Medicare will pay for audio-only (i.e. telephone services) for specific services (telephone evaluation and management, behavioral health counseling, or educational services). A list of these audio-only services is included in the Appendix at the end of this document.
How do I know which modifier to use?
The correct modifier to use is determined by payor preference. There can be instances where a CPT code is further defined by an HCPCS modifier, for example, to describe the side of the body the procedure is performed on, such as left (modifier -LT) or right (modifier -RT).
What is the 25 modifier for telehealth?
Modifier 25 indicates that a patient's condition requires a distinct and substantial evaluation and management (E/M) service, separate from any other procedures or services performed on the same day by the same physician or healthcare provider.