CPT Modifier 95

What modifier 95 means

Modifier 95 identifies that a service on the payer's telehealth-eligible list was furnished via a real-time, interactive audio-AND-video connection. It marks the encounter as synchronous telemedicine, distinguishing it from in-person and from audio-only care.

When to use it

A live, two-way audio-and-video visit is conducted for a code that appears on the payer's telehealth list (e.g., an established-patient E/M or a psychotherapy session delivered by video).

Documentation checklist

The record should support every item below before you append modifier 95.

• That real-time, interactive audio AND video were both used
• The patient's location and consent to telehealth
• Total time and/or medical decision making supporting the E/M level

Do NOT use modifier 95 when

• The encounter was audio-only (telephone) — a different code/modifier (e.g., 93) applies
• The visit was in person
• The service is not on the payer's telehealth-eligible list

Common denial reasons

• Code billed is not telehealth-eligible for that payer
• Place-of-service / modifier mismatch (e.g., POS 02/10 vs. modifier 95 conventions)
• Audio-only service incorrectly billed with 95

How to appeal a modifier 95 denial

On denial, confirm the code was on the payer's telehealth list for the date of service and resubmit with the correct POS plus modifier 95, attaching a note documenting the real-time audio-and-video encounter, patient location, and consent.

Payer notes

Telehealth place-of-service and modifier conventions change over time and vary by payer. Medicare has used POS 02/10 with telehealth lists; some payers require 95, others GT. Verify the current telehealth policy and whether 95, GT, or a POS code is expected.

Related & commonly confused modifiers

Where modifier 95 is used

• Office/outpatient E/M (99202–99215)
• Behavioral health (90791, 90832, 90834, 90837)
• Other telehealth-listed services