Telehealth visits are easy. But billing them correctly? Not always.
If you’ve ever had a telehealth claim denied because of the wrong modifier or POS code, you know how frustrating it feels. The visit happened. The documentation is there. The care was delivered. But one small billing detail can delay payment for weeks.
With major CMS flexibilities ending on September 30, 2025, 2026 billing rules look different again. Rural limits are returning for many services. Some specialties keep expanded access, while others don’t. That means modifiers matter more than ever.
Let’s break this down clearly so your claims don’t get stuck.
Why Telehealth Billing Modifiers Matter
A telehealth modifier tells the payer how the service was delivered. Was it a video? Audio-only? Store-and-forward? Because each format affects reimbursement.
Without the correct modifier, the claim may process incorrectly or get denied. That’s why billing teams must match three things every time:
- The CPT code
The modifier - The place of service (POS) code
When those three line up correctly, reimbursement moves smoothly. When they don’t, delays begin.
Now let’s go step by step.
Step 1: Understand the Core Telehealth Modifiers
There are four main modifiers you need to know in 2026.
Modifier 95: Synchronous Audio-Video Visits
Modifier 95 indicates a real-time telehealth visit using both audio and video. You attach it to CPT codes such as 99202-99215 for office or outpatient E/M visits.
As of 2026, some insurance companies do not require the use of Modifier 95 for certain video visits, but it is still required by most. It remains especially important for therapy services and behavioral health. If the visit used live video interaction, this is usually your go-to modifier.
Modifier 93: Audio-Only Telehealth
Modifier 93 applies when the visit was conducted by audio only. No video.
This modifier is required for telephone-based evaluation and management services when allowed by payer rules. It must be paired with POS 02 or POS 10, depending on the patient’s location. Audio-only services are still permitted for behavioral health beyond September 2025, but other specialties may face tighter rules. Always confirm coverage before submitting.
Modifier GT: Interactive Telehealth (Legacy)
Modifier GT was widely used before Modifier 95 became standard. Some Medicare Administrative Contractors and certain commercial payers still accept or require it. It shows a live interactive telehealth service, like 95, but for older billing systems. In 2026, GT is used less often, but it may still appear depending on the payer’s policies.
Modifier GQ: Asynchronous Telehealth
Modifier GQ is used for store-and-forward telehealth. This means that the patient data is transmitted and then viewed at a later date, not in real-time. This modifier is still used only in certain programs or in rural configurations. It is not used in routine outpatient billing but is used in certain Medicare environments.
Step 2: Match the Correct POS Code
Modifiers alone aren’t enough. Place of Service codes must also align.
- POS 02 indicates telehealth provided other than in the patient’s home.
- POS 10 indicates telehealth provided in the patient’s home.
This distinction now affects reimbursement rates. Some payers reimburse differently based on where the patient was located during the visit. Always confirm the patient’s location at the time of service and document it clearly.
Step 3: Know the 2026 CMS Reimbursement Changes
The Public Health Emergency allowed broad telehealth flexibility. Those rules change after September 30, 2025.
Here’s what that means for 2026:
- Many services return to rural-only geographic limits.
- Behavioral health keeps broader telehealth access through December 31, 2026.
- FQHCs and RHCs retain expanded telehealth billing in certain cases.
- Certain therapists continue to provide order access temporarily.
For E/M billing, most providers still use CPT codes 99202–99215. Some payers may recognize newer telehealth-focused codes like 98000–98016, but usage varies. Because policies differ, verify payer requirements before submitting high-volume claims.
Step 4: Document Properly Every Time
Modifiers won’t protect you if documentation is weak. For telehealth claims in 2026, you must document:
- Patient consent for telehealth
- Type of technology used (audio-video or audio-only)
- Patient location
- Provider location
- Medical necessity
If audited, this information supports reimbursement. Without it, even correctly coded claims can be recouped later. Keep documentation consistent and clear.
Step 5: Understand Commercial and Medicaid Differences
CMS rules guide Medicare, but commercial payers like BCBS and UnitedHealthcare don’t always follow the same structure. Some require Modifier 95. Others prefer GT. Some waive modifiers but require specific POS codes. Policies change frequently.
Medicaid rules depend on state guidelines, and those can vary widely. Because of this variation, your billing team should maintain a payer policy tracker. Submitting telehealth claims without checking payer rules increases denial risk.
Common Telehealth Billing Mistakes to Avoid
Even experienced billing teams make small errors that cause big delays.
Here are common ones:
- Using Modifier 95 for audio-only visits
- Forgetting to append Modifier 93
- Pairing the wrong POS code
- Failing to document consent
- Assuming all payers follow Medicare rules
Each mistake may seem minor, but it can lead to denials or underpayments.
How Telehealth Modifiers Impact Revenue
When used correctly, telehealth billing modifiers protect reimbursement. They signal compliance, support medical necessity, and reduce payer confusion.
When used incorrectly, they slow cash flow and increase rework. The difference between clean claims and repeat submissions often comes down to details like these.
Telehealth is here to stay. But billing rules are tightening again, which means accuracy matters more than ever.
Final Thoughts
Telehealth billing in 2026 requires attention to detail. Modifier 95 for video. Modifier 93 for audio-only. GT in select cases. GQ for asynchronous setups. Match them with POS 02 or 10. Document clearly. Confirm payer policies.
That’s the formula.
If your team wants support navigating modifier changes and reimbursement rules, Rapid RCM Solutions helps US practices stay compliant while keeping revenue steady.
Because delivering care should be your focus. Getting paid for it shouldn’t feel this complicated.
