Overview
Modifier 95 is a CPT (Level I) modifier, so the AMA's descriptor is not reproduced here. In plain terms it reports that a service was furnished synchronously, with the patient and the practitioner interacting in real time over audio and video. The AMA introduced it for 2017, together with a list of codes it considers suitable for that kind of delivery, and it became the most widely used telehealth modifier across commercial plans and Medicaid programs.
Medicare's use of 95 has changed with its telehealth rules. Before 2017 Medicare relied on the HCPCS modifier GT, and from 2018 on place of service code 02 alone. During the COVID-19 public health emergency CMS asked practitioners to report the place of service that would have applied in person and append 95, so that telehealth visits were paid at in-person rates. Since calendar year 2024, chapter 26, section 10.5 of the Medicare Claims Processing Manual has set the current rule: place of service 02 or 10, depending on whether the patient is at home, paired with 95 for audio and video or 93 for audio only. POS 02 is paid at the facility rate and POS 10 at the non-facility rate, and the manual is explicit that the modifier does not change the rate.
Two limits matter. First, 95 does not make a code payable as telehealth. Medicare pays only for services on the Medicare telehealth services list, furnished to an eligible beneficiary at an eligible originating site by a practitioner allowed to bill them; by billing a telehealth place of service with a covered code, the distant-site practitioner certifies that the beneficiary was at an eligible originating site. The AMA's list of codes suitable for 95 and Medicare's list are different documents. Second, critical access hospitals billing distant-site services under method II still use GT on their institutional claims, not 95.
For other payers, 95 is usually the expected telehealth modifier on professional claims, but plans differ on the place of service they want with it, whether they still accept GT and which codes they cover. Documentation should show that video was used, where the patient and practitioner were, and the content of the service, since those facts support the modifier, the place of service and the code together. Because Medicare's telehealth instructions changed in 2017, 2018, 2020 and 2024, a claim that is reviewed or appealed should be checked against the rules for its date of service rather than today's.
Worked example
A family physician sees an established patient over a video connection while the patient is at home. The claim carries the visit code, place of service 10 and modifier 95, and Medicare pays the non-facility rate. A week later the same patient joins a video visit from a rural clinic exam room with a nurse present, so the claim uses place of service 02 with modifier 95, and Medicare pays the facility rate for the physician's service.
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Frequently asked questions — Modifier 95 (Synchronous Audio-Video Telemedicine)
Does Medicare require modifier 95 on telehealth claims?
Yes, for audio-video services. Chapter 26, section 10.5 of the Claims Processing Manual says a telehealth place of service (02 or 10) must be paired with the appropriate telehealth modifier: 95 for audio and video, 93 for audio only.
What is the difference between modifier 95 and GT?
Both describe real-time audio and video. 95 is a CPT modifier used on Medicare professional claims with a telehealth place of service; GT is a HCPCS Level II modifier that Medicare now uses mainly for critical access hospital method II claims. Some other payers still ask for GT.
Does modifier 95 change the payment amount?
Not for Medicare. The place of service decides the rate: POS 02 is paid at the facility rate and POS 10 at the non-facility rate. The modifier only identifies the modality.
Which codes can be billed with modifier 95?
For Medicare, codes on the Medicare telehealth services list for the year, under its eligibility rules. The AMA publishes its own list of codes it considers appropriate for 95, and commercial plans set their own coverage, so the payer's list governs each claim.
Disclaimer
This glossary entry is operational reference for revenue-cycle and medical-billing professionals. It is not legal, clinical, or contractual advice. Industry benchmarks cite named public sources where available; always verify against the current guidance from the authority body before relying on a number in a contract, policy, or compliance filing.