Telehealth Modifiers (95 and 93)

What telehealth modifiers 95 and 93 mean

Modifier 95 tells the payer that a covered service was provided via synchronous, real-time audio and video. Think of a standard video session: 90834-95 for individual therapy, or 90791-95 for a diagnostic evaluation over Zoom.

Modifier 93 tells the payer the service was delivered via synchronous audio-only communication. That is typically a phone visit or other real-time audio when video is not used, such as 90832-93 when a patient cannot connect by video.

Current CPT guidance recognizes both 95 and 93 for telehealth, but coverage is payer-specific. Medicare, state Medicaid programs, and commercial and behavioral health carve-out vendors all publish their own lists of which codes can be billed with 95 or 93, at what rates, and under what conditions.

Why telehealth modifiers matter operationally

Telehealth modifiers drive coverage, rate, and audit risk. Use the wrong modifier, or skip it when the payer requires it, and clean claims can flip into avoidable denials. For example, a payer that only covers audio-video for 90837 may deny a 90837-93 as non-covered, or may deny a 90837 with no modifier as "setting inconsistent with POS." That is lost revenue and at least one extra billing cycle.

Rates can also change based on the modifier. Some plans reimburse 95 telehealth visits at the same rate as in-person, but pay less for 93 audio-only, or exclude audio-only entirely. If you mislabel an audio-only visit as 95, you may get paid at a higher rate in the short term, but you are also stacking audit risk if the plan audits call logs or platform data against claims.

On the compliance side, regulators and plans use modifiers to track telehealth utilization. Misuse can show up in a focused audit, especially in behavioral health where telehealth volumes are high. Getting 95 and 93 right protects both cash flow and your exposure if a state Medicaid agency or Medicare contractor reviews your telehealth patterns.

How telehealth modifiers are used and read on claims

On professional claims (CMS-1500 / 837P), 95 or 93 is appended at the line level to the CPT or HCPCS code. For example:

• 90834-95 with POS 10 (patient's home) for a video therapy session
• 90853-95 with POS 02 for a telehealth IOP group session, if the payer allows tele-IOP
• 99443-93 with POS 10 for an audio-only E/M follow up

The same base CPT code is used for the service, but the modifier and place of service tell the payer how the service occurred and where the patient was located. Medicare currently uses POS 02 (telehealth provided other than home) and POS 10 (patient's home) for most telehealth; some commercial and behavioral carve-out plans still require POS 11 (office) with modifier 95 instead. GT modifier was retired for Medicare in 2018, but some Medicaid programs and private plans still use GT or other telehealth indicators, so payer policy review is mandatory.

On facility claims (UB-04 / 837I), the use of 95 and 93 is less consistent. Many payers prefer telehealth-specific HCPCS codes, revenue codes, or condition codes instead of modifiers, especially for partial hospitalization, IOP, or hospital outpatient clinics. Behavioral health programs that bill per diem codes (for example H0015 or H0035) need payer-specific rules on whether to append 95/93, use a different code set, or restrict telehealth to certain group or individual services only.

On remittance advice, you will typically see the original CPT with the modifier reflected as billed. If the modifier is invalid or not required, you may see line-level denials or reductions tied to CO-4, CO-16, or informational codes like N130 and MA130. Those denial patterns are your feedback loop for whether your telehealth billing configuration actually matches the payer's rules.

• Billing 90834 with no modifier for a video visit when the payer requires modifier 95, leading to CO-16 or CO-4 denials for "inconsistent with POS" and pushing payment into the next cycle while your team rebills.
• Using modifier 95 for audio-only therapy calls because the clinician charted "telehealth" generically, which can trigger recoupments in a post-payment review once the plan compares call logs or platform data against billed modality.
• Appending 93 or 95 to every behavioral health line on a UB-04 PHP/IOP claim when the Medicaid MCO only wants telehealth reflected on certain HCPCS codes, causing partial denials and messy recoupments mid-episode.
• Continuing to bill GT on 90791 and 90837 for Medicare patients after 2018, instead of 95 with the correct POS, which converts clean claims into avoidable CO-16 denials and delays cash 30 to 60 days.
• Not updating authorization records when a residential or IOP episode switches from in-person to telehealth, so later dates of service with 95 or 93 deny under CO-197 because the auth on file only covers in-person services.

Telehealth is the default access channel for many behavioral health patients, so 95 and 93 show up on a large share of your volume. That amplifies the impact of even small configuration errors. If your EHR maps all tele-visits to 95, for example, but a state Medicaid plan only covers audio-only via 93 for substance use counseling, you can quietly bleed revenue and face recoupments when they reconcile claim data with policy.

Carve-out mental health and substance use benefits add another layer. A commercial medical plan may cover both 95 and 93 for therapy, while its behavioral health vendor only covers 95 for certain CPT codes and bans telehealth group sessions. If your practice management system does not differentiate by payer and modifier, you will see different CO-4, CO-16, or CO-50 denials for the same code across plans, which is confusing for staff and hard on cash.

Long behavioral episodes and per-diem care complicate telehealth rules further. Some Medicaid MCOs allow tele-PHP or tele-IOP with 95 appended to group therapy HCPCS codes, but not to the per-diem H-code. Others prohibit telehealth for residential per-diem but allow telehealth add-on therapy. If your team uses a blanket rule like "all remote sessions get 95," you can jeopardize whole weeks of residential or IOP revenue.

Concurrent authorization also interacts with modifiers. Payers may treat telehealth as a different modality for UM purposes. If a patient starts PHP in person, then transitions to virtual PHP, the plan may require a new auth or a modifier-specific note on the existing auth. If claims start carrying 95 without that update, you can get CO-197 denials for days that were clinically appropriate but not authorized in the payer's system as telehealth days.

AI can offload the grunt work of managing telehealth modifier rules across payers. An AI agent can read and store each payer's telehealth policies, crosswalk which CPT or HCPCS codes are allowed with 95 or 93, and then scrub outbound claims to catch mismatches, such as audio-only notes billed with 95 or payers that require POS 11 plus 95 instead of POS 10. It can also monitor remittance files for patterns of CO-4, CO-16, N130, and MA130 tied to modifiers, then suggest rule updates before denial patterns grow.

Supabill's claims-scrubbing agent can hold payer-specific telehealth rules in state, compare scheduled visit modality, POS, and documented tech (audio-only vs video) to the billed line, and flag which encounters need 95, 93, a different POS, or no telehealth modifier at all. A denials agent can read every 835, cluster telehealth-related denials, and push concrete worklists back to operators. Humans still need to interpret grey-zone payer rules, negotiate exceptions with medical directors, and decide when to appeal or accept recoupments, but the AI can keep the day-to-day modifier work consistent and fast.

What is the difference between modifier 95 and modifier 93 for behavioral health claims?

Modifier 95 is used when a covered service is delivered via real-time audio and video, such as a video therapy or psychiatric medication visit. Modifier 93 is used when the service is delivered via synchronous audio-only communication, such as a phone visit where no video is used. Behavioral health payers often pay 95 and 93 differently, or limit which CPT codes can be billed with 93, so using the wrong modifier can result in denials or recoupments. Medicare and many state Medicaid programs publish specific telehealth modifier policies that providers should follow, including when 93 is allowed. Source

Do all payers accept telehealth modifiers 95 and 93 the same way?

No. Medicare, Medicaid programs, and commercial or carve-out behavioral health plans all have their own telehealth rules. Some payers accept 95 but not 93, some still use GT or telehealth-specific HCPCS codes, and some limit telehealth entirely for certain services such as residential per-diem. You should treat each payer's telehealth policy as its own rulebook and configure your billing system accordingly, especially for high-volume codes like 90791, 90834, 90837, and 90853. Source

How do telehealth modifiers interact with place of service codes on behavioral health claims?

Payers typically require both a telehealth-appropriate place of service and a telehealth modifier to identify the service correctly. For Medicare, POS 02 (telehealth provided other than home) or POS 10 (patient's home) are paired with telehealth services; some commercial or behavioral health vendors still want POS 11 (office) plus modifier 95 to indicate telehealth. Using a telehealth POS with no modifier, or 95/93 with an in-person POS that the payer does not accept, is a common cause of CO-4 and CO-16 denials. Always check each payer's guidance on acceptable POS and modifier combinations for telehealth. Source

Should behavioral health facilities use modifiers 95 and 93 on UB-04 claims for PHP or IOP?

Policies vary by payer. Some Medicaid MCOs and commercial plans allow telehealth PHP or IOP and want 95 on specific group therapy or individual therapy HCPCS codes, while others require different revenue codes or condition codes instead of standard CPT modifiers. In some cases, per-diem codes like H0015 or H0035 cannot be billed as telehealth at all, even if some programming occurs virtually. Review each plan's facility telehealth policy and do not assume that professional-claim rules for 95 and 93 carry over to UB-04 billing. Source

What happens if the wrong telehealth modifier is used on a behavioral health claim?

If you bill a video visit with 93, or an audio-only visit with 95, the claim may still pay, but you risk future recoupments if the payer compares documentation or platform logs to billing. If you omit a required modifier entirely, you are more likely to see immediate CO-4 or CO-16 denials related to inconsistent modifier or missing information. In either case, the fix usually involves correcting the claim with the appropriate modifier or POS, and in some situations submitting an appeal or reconsideration with records that clarify the actual modality used. Source

• CMS, Telehealth
• Medicaid.gov, Telehealth
• SAMHSA, Telehealth for Behavioral Health