Modifier 95: Telehealth Billing Rules for 2026
Modifier 95 marks a telehealth service done by live audio and video. How Medicare uses POS 02 or 10 instead, what each pays, and what other payers expect.
Modifier 95 is a billing modifier that marks a service as delivered by synchronous telemedicine: a real-time, two-way audio and video connection between the practitioner and the patient. It doesn't change the rate. For Medicare professional claims, the place of service code (02 or 10) is what identifies telehealth and sets the payment.
Key takeaways
- Modifier 95 means live audio and video. Audio-only uses modifier 93.
- On Medicare professional claims since January 1, 2024, CMS identifies telehealth with POS 02 (patient not at home) or POS 10 (patient at home).
- POS 10 pays the non-facility rate; POS 02 pays the facility rate. The modifier has no payment effect.
- CMS lists 95 for hospital institutional claims for outpatient therapy by hospital-employed therapists.
- Medicare's expanded telehealth rules (any location, including the home) run through December 31, 2027.
Modifier 95 · payment effect
With and without the modifier
99214 without 95 · national office
$135.61
Office visit
99214-95 · No change to the rate
$135.61
Marks a synchronous audio-video telehealth service. Payment follows the place of service, not the modifier.
What modifier 95 means
Modifier 95 flags services furnished over a real-time audio-video link that would otherwise have been done face to face. Code-set guidance identifies services appropriate for this modifier, but Medicare maintains its own list: Medicare pays telehealth only for codes on the Medicare Telehealth Services List, and a code billed as telehealth that isn't on the list is denied (Pub. 100-04, ch. 12, §190.7).
Medicare: POS drives telehealth, not the modifier
For professional claims, CMS's current instructions identify telehealth through the place of service code:
- POS 02, Telehealth Provided Other than in Patient's Home. The patient is somewhere other than home, such as a clinic or a hospital. Paid at the facility rate.
- POS 10, Telehealth Provided in Patient's Home. Paid at the non-facility rate since January 1, 2024.
By billing POS 02 or 10 with a covered telehealth code, the practitioner certifies the patient was at an eligible originating site (Pub. 100-04, ch. 12, §190.6.1). CMS's telehealth booklet (MLN901705, December 2025) lists modifier 95 under institutional billing, for outpatient physical, occupational and speech therapy furnished via telehealth by therapists employed by hospitals. It lists the other telehealth modifiers by setting: GT for critical access hospitals billing under Method II, GQ for asynchronous services in the Alaska and Hawaii demonstrations, and FQ for audio-only services at rural health clinics and FQHCs.
Place of service · 99214
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
Non-facility (office) rate · national
$135.61
The facility rate would be $84.50 (+$51.11). In a facility, the facility bills its own costs separately.
When to use modifier 95
- Commercial and Medicaid plans that require it. Many private payers and state Medicaid programs still identify telehealth with 95, sometimes together with POS 02 or 10 and sometimes with the in-person POS. Their policy decides.
- Hospital outpatient therapy furnished by telehealth, on institutional claims, per CMS.
- Any payer's instruction to report 95 on a Medicare Advantage plan or other plan that publishes its own telehealth rules.
The service has to be real-time audio and video for the whole encounter. If the video drops and you finish by phone, the payer's audio-only rules apply (modifier 93).
When not to use modifier 95
Also don't use 95:
- For audio-only visits. Use 93, or FQ at rural health clinics and FQHCs.
- For services that aren't telehealth by nature, such as remote patient monitoring, chronic care management and other non-face-to-face codes. CMS says those aren't subject to telehealth rules.
- For store-and-forward (asynchronous) services. 95 means synchronous.
How modifier 95 affects payment
Modifier 95 carries no payment adjustment with any payer that follows the fee schedule. Under Medicare, the rate comes from the code and the POS: POS 10 at the non-facility amount, POS 02 at the facility amount. The difference for an office visit code is the practice expense the practitioner's office would have carried in person.
Under current law, Medicare beneficiaries can receive telehealth anywhere in the U.S., including at home, through December 31, 2027, and audio-only is allowed in the home through the same date. Starting January 1, 2028, non-behavioral telehealth generally returns to rural, facility-based originating sites (CMS Telehealth FAQ, updated February 26, 2026).
Telehealth modifiers compared
| Modifier | Meaning | Where it's used |
|---|---|---|
| 95 | Live audio and video | Commercial and Medicaid plans; Medicare institutional therapy claims |
| 93 | Audio only | Audio-only services where the payer allows them |
| GT | Live audio and video | Medicare: only institutional claims from Method II critical access hospitals |
| FQ | Audio only | Medicare: rural health clinics and FQHCs only |
| GQ | Asynchronous | Medicare: Alaska and Hawaii demonstration programs |
FAQ
What is a 95 modifier used for?
To mark a service furnished by real-time audio and video telehealth. Payers that use it rely on it to separate virtual visits from in-person ones.
Is modifier 95 required for telehealth services in 2026?
It depends on the payer. Medicare's professional claim instructions identify telehealth with POS 02 or 10, and CMS's telehealth booklet lists 95 for hospital institutional therapy claims. Many commercial and Medicaid plans still require 95; check each plan's telehealth policy.
Can you bill 99214 with modifier 95?
Yes. 99214 is on the Medicare Telehealth Services List, and payers that use 95 accept it on office E/M codes. For Medicare, bill it with POS 10 or 02.
Which modifier goes first, 25 or 95?
Neither changes the price, so the order rarely matters for payment. Convention puts pricing modifiers first and informational ones after; with two informational modifiers, follow the payer's published order if it has one.
Does POS 10 pay more than POS 02?
Under Medicare, yes for most codes. POS 10 is paid at the non-facility rate, which includes office practice expense, and POS 02 at the lower facility rate.
Keep reading
- Modifier 93 for audio-only services.
- Modifier 25 when a telehealth visit happens on the same day as another service.
- Codes on this page: 99214 99213 90837
Sources: CMS MLN901705, Telehealth & Remote Patient Monitoring (December 2025); CMS Telehealth FAQ (updated February 26, 2026); Medicare Claims Processing Manual, Pub. 100-04, ch. 12, §20.4.2, §190.6.1 and §190.7; CMS MLN Matters MM14315 (CY 2026 PFS final rule). Verified October 6, 2026.
