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Telehealth Modifier 95 vs. GT: Which One Do You Need?

By Danielle Wagar, CPES | Upstate Healthcare Admin


If you bill for telehealth sessions, you have almost certainly encountered modifier 95 and modifier GT. You may have used them interchangeably. You may have used the wrong one without knowing it and had no idea why claims denied. This guide clarifies exactly when each modifier applies and why using the wrong one will get your claims denied.

What Telehealth Modifiers Do


Telehealth modifiers are codes appended to a CPT procedure code on a claim to indicate that the service was delivered via real-time interactive audiovisual communication rather than in person. Without the correct modifier, a payer may process the claim as an in-person service, deny it outright, or flag it for an audit.



Modifier GT: Interactive Telecommunications System


Modifier GT is a HCPCS Level II modifier indicating a service was delivered via interactive audio and video telecommunications systems. Use it for: Traditional Medicare (Fee-for-Service) services where CMS guidelines specify GT for your specific service type; Medicaid programs in states that specifically require GT; some older commercial payer contracts written before modifier 95 became widely adopted.



Modifier 95: Synchronous Telemedicine Service


Modifier 95 is a CPT modifier developed by the AMA indicating a service was rendered via synchronous real-time interactive audio and video telecommunications system. It is now the preferred telehealth modifier for most commercial payers. Use it for: most commercial insurance plans (Aetna, Cigna, UnitedHealthcare); Medicare services where CMS guidance specifies modifier 95; most BCBS plans (see our post on the BlueCard network for context on BCBS billing variation); and Medicare Advantage plans (see our breakdown of Medicare Advantage vs. Traditional Medicare for why MA follows commercial payer rules).



Which Modifier Does Each Payer Require?

  • Traditional Medicare (FFS): Primarily modifier 95; GT still used for some services - verify with current CMS telehealth CPT list

  • Medicare Advantage: Modifier 95 - MA plans follow commercial, not traditional Medicare, rules

  • Medicaid (varies by state): GT or 95 depending on state; check your state billing manual

  • Aetna: Modifier 95

  • UnitedHealthcare: Modifier 95

  • Cigna: Modifier 95

  • BCBS (varies by plan): Modifier 95 for most plans; confirm with your specific plan's provider manual

Place of Service Code Matters Too


Using the correct modifier is necessary but not sufficient. You also need the correct Place of Service (POS) code: POS 02 for telehealth provided other than in the patient's home; POS 10 for telehealth provided in the patient's home (introduced 2022 - correct for most mental health telehealth sessions). A claim with modifier 95 but POS 11 (office) will likely deny. Verify that your EHR or billing software is using the correct POS code for each claim.



Audio-Only Sessions: A Different Modifier Entirely


Audio-only sessions (phone calls without video) are NOT covered by modifier 95 or GT. For Medicare, audio-only behavioral health services may be billed with modifier FQ under specific circumstances. Commercial payers vary widely. Before billing audio-only, confirm your specific payer's current policy.



Telehealth Billing and Your Insurance Panels


Being credentialed with an insurance company does not automatically mean your telehealth services are covered. When updating your provider record, confirm telehealth capabilities are noted in your profile — see our guide on adding a new office location to your insurance contracts.



Summary: Modifier 95 vs. GT at a Glance

  • Modifier 95 is the standard for most commercial payers and Medicare Advantage. Use it by default for synchronous video sessions unless a specific payer tells you otherwise.

  • Modifier GT is primarily for traditional Medicare FFS and state Medicaid programs that require it.

  • Always pair your modifier with the correct Place of Service code - POS 10 for patient at home.

  • Verify current requirements with each payer at least annually. Telehealth billing rules continue to evolve.



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