3 Telehealth Modifiers You’ll Need to Collect Max Revenue

Not every code you submit to Medicare requires a modifier, which is why it can sometimes be easy to forget them. Unfortunately, leaving telehealth modifiers off of some claims can cause instant denials, which is why it’s essential to iron out the rules of when you need them and when you don’t.

Check out three important telehealth modifiers that will keep your reimbursement flowing throughout 2025

1. Modifier 93

If you submit a telehealth claim for a service performed as audio-only communication, then you’ll want to append modifier 93 (Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system) to the code. Part B payers will reimburse the service if the patient doesn’t have the ability or technical capacity for real-time audio and video interactive technology. This code also applies if the patient has the ability and capacity for audio-visual technology but doesn’t consent to using it.

For example, suppose your physician performs a level-two E/M service over audio-only communication for an established patient who’s in her home at the time and doesn’t have access to audio/video technology. For this service, you’ll report 99212-93.

2. Modifier FQ

When you first read the descriptor for modifier FQ (The service was furnished using audio-only communication technology), you may wonder if it’s a duplicate of modifier 93, since both describe a telehealth service provided without video. But there’s one subtle difference between the two telehealth modifiers. Modifier FQ is only applicable to federally qualified health centers (FHQs) and rural health clinics (RHCs).

That’s why it’s essential to know your place of service before submitting audio-only claims. The decision of which telehealth modifiers to use comes down to whether the patient is in an FHQ, RHC, or elsewhere.

3. Modifier 95

In the past, modifier 95 (Telehealth modifier defined as synchronous telemedicine service rendered via real-time Interactive audio and video telecommunications system) was required for every audio-video telehealth claim you submitted to Medicare, but that’s no longer the case.

Now, you’ll use modifier 95 for physical therapists, occupational therapists or speech-language pathologists employed by hospitals who perform audio-visual telehealth services — but only when the clinician is in the hospital and the patient is at home.

Watch for Guidance on Telehealth Modifiers

Above are the guidelines that CMS has been using in 2025, but keep an eye on them, as things may change in the coming years as telehealth rules continue to evolve.

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