Modifier 95 (synchronous telemedicine)
DefinitionA CPT modifier added to a service line to show it was delivered by real-time, two-way audio and video telemedicine instead of in person.
Modifier 95 flags a service line as delivered by real-time audio-video telemedicine. On an MNT claim it goes on the 97802, 97803 or 97804 line.
Whether you need it depends on the payer:
- Medicare professional claims: CMS's current telehealth guidance identifies telehealth through POS 02 or POS 10, and the MLN booklet lists modifier 95 for hospital outpatient therapy billed on institutional claims, not as a general requirement for professional claims (MLN901705). Check your MAC's current instructions.
- Commercial plans: many still ask for modifier 95, some accept GT, some rely on POS alone, and some want the office POS plus 95. The only reliable answer is the payer's own telehealth policy or a verification call.
Two mistakes to avoid: adding 95 to an in-person visit, and sending a telehealth claim with neither the telehealth POS nor the modifier the payer expects. Both tend to come back as place-of-service or modifier rejections, which are fixable, but they cost weeks.