Modifier 95 vs 93: Choosing the Telehealth Modifier and Place of Service

Modifier 95 tells a payer that a service on the telehealth list was furnished by real-time, two-way audio and video. Its sibling, modifier 93, says the same service was furnished audio-only. Neither is a payment lever, and neither is interchangeable with the other at the biller’s discretion — and that second point is the one most guidance skips. Under 42 CFR 410.78, modifier 93 is an attestation that specific factual conditions were met, not simply a description of the technology that happened to be used.

Selecting them correctly is a three-part decision: the modifier describes the modality, the place-of-service code describes where the patient was, and the two carry different consequences. This guide works from the primary sources — 42 CFR 410.78 as codified on 1 August 2026, the Medicare Claims Processing Manual Pub. 100-04 Chapter 26 (place-of-service codes) and Chapter 12 §190 (telehealth payment) — and flags explicitly where the current position is set by short-term legislation that no manual or regulation reliably reflects.

Modifier 95 vs Modifier 93: What Separates Them

CMS states the pairing directly in Pub. 100-04 Chapter 26, under Special Considerations for Telehealth Claims (Codes 02, 10):

As appropriate, POS 02 or POS 10 may be used and must be paired with the appropriate telehealth modifier (modifier 93 for audio-only and modifier 95 for audio/video). … Use of audio-only (93) or audio-video (95) does not change rate of payment, only the POS code determines the non-facility or facility payment rate.

So the modifier does not move money. It describes modality, and it is required alongside the place-of-service code rather than optional. But that sentence understates what modifier 93 does, because the regulation attaches conditions to it that modifier 95 does not carry.

42 CFR 410.78(a)(3) defines an interactive telecommunications system as, at minimum, multimedia communications equipment including audio and video equipment permitting two-way, real-time interactive communication between the patient and the distant-site practitioner. That is the default, and it is what modifier 95 describes. The regulation then permits audio-only in one narrow circumstance:

Interactive telecommunications system may also include two-way, real-time audio-only communication technology for any telehealth service furnished to a patient in their home if the distant site physician or practitioner is technically capable of using an interactive telecommunications system as defined in the previous sentence, but the patient is not capable of, or does not consent to, the use of video technology.

Four conditions, all of which must hold: the patient is in their home; the practitioner is technically capable of audio and video; and the patient is either not capable of video or does not consent to it. The regulation then says what the modifier is for: the following modifiers must be appended to a claim for telehealth services furnished using two-way, real-time audio-only communication technology to verify that the conditions set forth in the prior sentence have been met — CPT modifier 93, and for rural health clinics and federally qualified health centers, Medicare modifier FQ in addition.

The practical consequence: modifier 93 is an attestation, not a description. Appending it asserts that a video-capable practitioner offered video and the patient could not or would not use it. A practice that simply does not offer video, or that uses telephone for convenience, has not met the regulatory condition — and the modifier says otherwise on the claim. Document the reason (incapacity or declined consent) in the record at the time, not retrospectively. Modifier 95, by contrast, carries no equivalent conditional structure; it describes a service furnished the default way.

POS 02 vs POS 10 vs POS 11

The place-of-service code answers a different question — where the patient was — and it is the field that determines the payment rate. From the Pub. 100-04 Chapter 26 code set:

• POS 02 — Telehealth Provided Other than in Patient’s Home (effective 1 January 2017). The location where services are provided or received through telecommunication technology, where the patient is not located in their home. Pays at the facility rate.
• POS 10 — Telehealth Provided in Patient’s Home (effective 1 January 2022). Same, where the patient is in their home — a location other than a hospital or other facility where the patient receives care in a private residence. Pays at the non-facility rate.
• POS 11 — Office. The in-person code. CMS states that the only two valid POS codes for Medicare telehealth billing… are POS 02 and POS 10, so POS 11 is not a Medicare telehealth code. There is one narrow exception in the manual’s own text, and it runs the other way: a physician’s or practitioner’s office serving as the originating site — where the patient is — should use POS 11 to ensure appropriate payment, because that office is billing the originating-site facility fee, not the distant-site professional service.

Because POS 10 pays the non-facility rate and POS 02 pays the facility rate, and because the non-facility rate is generally the higher of the two for office-type services, the POS choice is where the money is. It follows a fact — the patient’s physical location — not a preference. Note also that POS is not the only place a home-versus-not distinction bites: the audio-only permission in 410.78(a)(3) is itself limited to services furnished to a patient in their home, so a POS 02 claim carrying modifier 93 is internally inconsistent on its face.

Two edits are worth knowing because they explain most denials in this area, both set out in Pub. 100-04 Chapter 12 §190.7. If a service is billed with POS 02 or 10 and the procedure code is not designated a covered telehealth service, the contractor denies it (Group Code CO, CARC 96, RARC N776, MSN 9.4). If the distant-site practitioner is not eligible to bill for telehealth, the claim is denied separately (CARC 185, MSN 21.18). Contractors are also instructed to install edits ensuring only practitioners properly licensed under State law to furnish the specific service are paid — the manual’s own example is a nurse practitioner not licensed to provide individual psychotherapy under State law.

Who May Be the Distant-Site Practitioner

42 CFR 410.78(b)(2) enumerates the practitioners who may furnish and bill a Medicare telehealth service from the distant site: a physician; a physician assistant; a nurse practitioner; a clinical nurse specialist; a nurse-midwife; a clinical psychologist; a clinical social worker; a registered dietitian or nutrition professional; a certified registered nurse anesthetist; a marriage and family therapist; and a mental health counselor. Any distant-site practitioner who can appropriately bill for diabetes self-management training may do so on behalf of others who personally furnish the service as part of the DSMT entity.

The regulation adds a limitation that catches people: a clinical psychologist, clinical social worker, marriage and family therapist or mental health counselor may bill for individual psychotherapy via telecommunications but may not seek payment for medical evaluation and management services. And a telepresenter is not required as a condition of payment unless the distant-site practitioner determines one is medically necessary.

Originating Site and Geography — the Part That Keeps Moving

This is where a page written with confidence goes out of date fastest, so read the following as the codified permanent baseline rather than as the operative rule for any given month.

42 CFR 410.78(b)(3) lists eligible originating sites: a physician’s or practitioner’s office; a critical access hospital; a rural health clinic; a federally qualified health center; a hospital; a hospital-based or CAH-based renal dialysis center; a skilled nursing facility; a community mental health center; a renal dialysis facility (for the home-dialysis monthly ESRD assessment only); the individual’s home (for that same ESRD assessment); a mobile stroke unit (for acute stroke only); the individual’s home for treatment of a substance use disorder or co-occurring mental health disorder on or after 1 July 2019; and a rural emergency hospital for services on or after 1 January 2023.

Paragraph (b)(4) then imposes the geographic test: originating sites must generally be in a health professional shortage area outside a Metropolitan Statistical Area or within a rural census tract of one, in a non-MSA county, or an entity in a Federal telemedicine demonstration project approved or funded by the Secretary as of 31 December 2000. Four categories are carved out of that geographic requirement entirely:

• Home-dialysis monthly ESRD-related clinical assessments on or after 1 January 2019.
• Diagnosis, evaluation or treatment of symptoms of an acute stroke, on or after 1 January 2019.
• Treatment of a substance use disorder or co-occurring mental health disorder for an individual with an SUD diagnosis, on or after 1 July 2019.
• Diagnosis, evaluation and/or treatment of a mental health disorder, for services furnished on or after 1 January 2025 — conditioned on the practitioner having furnished an in-person, non-telehealth item or service within 6 months prior to the initial telehealth service and within 6 months of any subsequent telehealth service.

What this text does not tell you is what is in force today. The broad suspension of the geographic and originating-site limits — the reason a Medicare patient in a suburb has been able to receive telehealth at home for services well beyond the four carve-outs above — has been carried by statute through a sequence of short-term extensions rather than by amendment to this regulation, and the codified text still contains vestigial provisions (a mental-health paragraph ending 31 December 2024, and references to the COVID-19 Public Health Emergency) that the extensions have overtaken. This guide does not state a current expiration date, because that date has changed repeatedly and was not verified against a primary legislative source at the time of writing (23 August 2026). Before relying on a flexibility for a specific date of service, check the CMS telehealth page and your MAC’s current article — not a summary, and not this page.

Two things that have not been moving are worth holding onto as fixed points: the list of covered telehealth services is maintained by CMS and changed through annual Physician Fee Schedule rulemaking (42 CFR 410.78(f)); and asynchronous store-and-forward remains payable only for Federal telemedicine demonstration programs conducted in Alaska or Hawaii, billed with modifier GQ, under which the distant-site practitioner certifies the asynchronous medical file was collected and transmitted from such a demonstration.

A Decision Order That Works

Sequence the questions rather than reaching for a modifier first:

1. Is the code on the Medicare telehealth list for this date of service? If not, POS 02 or 10 will trigger the CARC 96 denial regardless of modifier.
2. Is the distant-site practitioner one of the eligible types, and licensed under State law for this specific service? Two separate tests, and the second is State-specific.
3. Where was the patient physically located? Home → POS 10 (non-facility rate). Anywhere else → POS 02 (facility rate). Not a judgment call.
4. Was it audio and video, or audio only? Audio and video → modifier 95. Audio only → modifier 93, but only if all four regulatory conditions held and the reason is documented; add modifier FQ if the biller is an RHC or FQHC.
5. Do the originating-site and geographic rules permit it for this date of service? Verify against current CMS guidance rather than assumption.
6. Is this a non-Medicare payer? Then start again: commercial and Medicaid telehealth policies are set payer by payer and State by State, and some require different modifier or POS combinations than Medicare does. Do not carry a Medicare answer across without checking the payer’s own policy.

How 95 Differs From the Other Modifiers You Might Reach For

Most CPT and HCPCS modifiers answer a question about the relationship between services — whether an evaluation and management service was separate from a procedure, whether a second procedure was distinct, which component of a service is being billed. Modifiers 95 and 93 answer a completely different question: how was this service delivered, and where was the patient. They therefore coexist with the relational modifiers rather than substituting for them, and a telehealth claim can legitimately carry both kinds.

• Modifier 25 — whether an E/M on the same day as a procedure was significant and separately identifiable.
• Modifier 59 and the X{EPSU} modifiers — whether a service was a distinct procedural service.
• Modifiers 26 and TC — which component of a diagnostic service is being billed.
• Modifier 24 — whether a post-operative E/M was unrelated to the surgery.

The adjacent question — when a service furnished by someone other than the billing practitioner can be billed under that practitioner’s number at all — is a coverage test rather than a coding one, and is covered separately in incident-to billing. Note in particular that the virtual-presence provision permitting direct supervision by real-time audio/video is a supervision rule in 42 CFR 410.26 and 410.32, not a telehealth rule: it governs where the supervisor may be, and it does not make the supervised service a telehealth service or attract modifier 95.

Frequently Asked Questions

Is modifier 95 required in 2026?

For Medicare telehealth claims, Pub. 100-04 Chapter 26 states that POS 02 or POS 10 must be paired with the appropriate telehealth modifier — 93 for audio-only, 95 for audio/video — so on a Medicare claim the modifier is required rather than optional. What has repeatedly changed is not that requirement but the underlying scope of what may be furnished by telehealth at all, which rests on short-term statutory extensions. Confirm the current position for your date of service against CMS and your MAC before billing.

What is the difference between modifier 93 and modifier 95?

Modality. Modifier 95 denotes real-time audio and video; modifier 93 denotes real-time audio-only. But modifier 93 also functions as an attestation under 42 CFR 410.78(a)(3) that the patient was at home, the practitioner was capable of video, and the patient was either incapable of or unwilling to use video. Modifier 95 carries no equivalent condition.

Does modifier 93 or 95 change how much is paid?

No. CMS states plainly that use of audio-only (93) or audio-video (95) does not change the rate of payment; only the POS code determines the facility or non-facility rate. POS 02 pays the facility rate, POS 10 the non-facility rate.

Should I use POS 02, POS 10, or POS 11?

POS 10 if the patient was at home; POS 02 if the patient was somewhere other than their home. POS 11 is the in-person office code and is not a Medicare telehealth POS — with one exception in the other direction: a physician’s office acting as the originating site and billing the originating-site facility fee uses POS 11.

What is modifier FQ, and when is it needed?

42 CFR 410.78(a)(3)(ii) requires rural health clinics and federally qualified health centers to append Medicare modifier FQ, in addition to CPT modifier 93, on claims for telehealth services furnished by two-way real-time audio-only technology.

Can a telephone visit be billed with modifier 95?

No. A telephone-only encounter is not audio and video. If the audio-only conditions in 42 CFR 410.78(a)(3) were met it is modifier 93; if they were not met, it may not be a payable Medicare telehealth service at all, and the answer runs to whether a separate non-telehealth code fits rather than to a different modifier.

Do commercial payers follow these rules?

Not necessarily. Everything above is Medicare policy drawn from 42 CFR 410.78 and Pub. 100-04. Commercial plans and State Medicaid programmes set their own telehealth modifier and place-of-service requirements, and MAC-level guidance itself varies by jurisdiction on documentation expectations. Check the specific payer’s current policy rather than generalising from Medicare.

This guide summarises 42 CFR 410.78 as codified on 1 August 2026 and CMS Medicare Claims Processing Manual Pub. 100-04, Chapters 12 (§190) and 26, as published by CMS. It is general reference material, not billing advice for a specific claim. The statutory telehealth flexibilities that extend beyond the permanent regulatory baseline described here have been repeatedly extended by short-term legislation and their current expiration was not verified against a primary source at the time of writing — verify the current position and your own MAC’s guidance before applying any of this to a live claim.

The older telehealth modifiers are covered separately: modifiers GT and G0 sets out what survived the 2018 elimination of GT, the critical access hospital Method II claim that still requires it, and the acute stroke modifier G0.

Related: see the Laboratory Compliance & Quality hub and the NCD and LCD guide for how a service becomes covered in the first place, before any modifier question arises.