A Complete Guide to Modifier 93 vs 95

Medical billing has many small details that can make a big difference. One of the most important areas is telehealth billing, where two codes are often confused. These are Modifier 93 vs 95. Both are used for remote healthcare visits, but they serve very different purposes.

Understanding each one helps providers get paid correctly and avoid claim problems. This guide explains both modifiers in simple terms so that anyone can follow along easily.

What Is a Billing Modifier?

A billing modifier is a short two-character code added to a CPT code. CPT stands for Current Procedural Terminology. These codes describe the medical services a provider gives to a patient. The modifier does not change what the service is. Instead, it gives the insurance payer /more details about how the service was provided.

Think of a CPT code as the main subject of a sentence. The modifier is the part that adds useful context. For example, a modifier might indicate that the visit was by phone or video. Payers like Medicare, Medicaid, and private insurers use this information to process claims properly.

In telehealth, modifiers are especially important. They help separate remote visits from in-person appointments. Without the right modifier, a claim may be denied or delayed in processing.

The Rise of Telehealth and Why These Modifiers Matter

Before 2020, telehealth was used by a small number of providers. The COVID-19 pandemic changed everything very quickly. Millions of patients began receiving care via phone and video calls. Clinics had to adapt fast to this new way of delivering medical billing services.

As telehealth grew, insurers needed better ways to track remote visits. They wanted to know:

1. Where the patient was located during the appointment
2. What type of technology was used for the visit
3. Whether the visit met the requirements for coverage

Modifier 93 and Modifier 95 were created to provide exactly this information. Using the wrong modifier on a claim can lead to a denial or an audit. Skipping the modifier altogether is also a common billing error. Getting the right modifier on the right claim is a simple but very important step.

What Is Modifier 95 for Telehealth?

95 Modifier description is: when a medical visit is conducted via live Audio and video. This type of visit is called synchronous telemedicine. The patient and the provider can see and hear each other in real time. The visit happens over a video platform, not just a phone call.

Key Characteristics of 95 Modifier for Telehealth

1. The visit must include both Audio and video at the same time
2. The provider and patient are in two different locations
3. The communication happens live with no delays
4. Medicare and most commercial insurance plans accept it
5. The American Medical Association (AMA) officially recognizes this modifier

When to Use Modifier 95

Telehealth Modifier 95 should be added to a CPT code in the following situations:

1. The visit used a live video platform such as Zoom for Healthcare, Doxy.me, or another HIPAA-compliant tool
2. Both the provider and patient could see and hear each other clearly
3. The patient was at an approved originating site, such as a clinic, hospital, or their own home
4. The CPT code appears on the payer’s approved telehealth services list

Common CPT Codes Used with Modifier 93

CPT Code	Description
99202 to 99215	Office or outpatient evaluation and management visits
90832 to 90838	Psychotherapy services
99421 to 99423	Online digital evaluation and management services
96116	Neurobehavioral status exam

Example of Modifier 95 in Use

A psychiatrist in New York conducts a 45-minute video therapy session with a patient at home. The patient and doctor can see and hear each other the whole time. The correct billing code for this visit would be:

90834-95 (Individual psychotherapy, 45 minutes, via synchronous telemedicine)

What Is Modifier 93?

Modifier 93 description is: when a medical visit takes place entirely by telephone. No video is involved in this type of visit. The provider and patient communicate only by phone. This modifier was created to cover situations where video is unavailable or not feasible.

Key Characteristics of Modifier 93

1. The visit uses Audio only, with no video component
2. The call happens in real time between the provider and patient
3. It is designed for patients who do not have access to video technology
4. The AMA includes this modifier in its official telehealth billing guidelines
5. It is very helpful for serving elderly, rural, and low-income patients

When to Use Modifier 93

Modifier 93 is the right choice in the following situations:

1. The visit was done entirely by phone with no video at any point
2. The video was either not available or not accessible to the patient
3. The patient gave informed consent for an audio-only telehealth visit
4. The service is listed on the payer’s approved telephone visit list
5. The call was live and real-time, not a voicemail or recorded message

Common CPT Codes Used with Modifier 93

CPT Code	Description
99441 to 99443	Telephone evaluation and management services
98966 to 98968	Telephone services by qualified non-physician practitioners
90832	Psychotherapy by phone, if the payer allows audio-only visits

Example of Modifier 93 in Use

A primary care physician calls a patient to go over new lab results. The doctor and patient talk by phone for 20 minutes and adjust the patient’s medication plan. The correct billing code for this visit would be:

99442-93 (Telephone evaluation and management service, 11 to 20 minutes, audio-only)

Difference Between Modifier 93 and 95

The difference between modifier 95 vs 93 primarily comes down to whether the encounter included video communication.

Feature	Modifier 93	Modifier 95
Type of communication	Audio only, by telephone	Audio and video, live and real-time
Video required?	No	Yes
Real-time visit?	Yes	Yes
Recognized by	AMA	AMA
Common payers	Medicare, select commercial plans	Medicare, most commercial plans
Typical visit type	Phone call appointment	Video telehealth appointment
Technology needed	A telephone	Video-capable device and internet
Documentation needed	Audio-only note and patient consent	Video platform name and patient consent

Documentation Requirements for Each Modifier

Good documentation is the foundation of a clean claim. Payers are reviewing telehealth claims more carefully than ever before. Incomplete records are among the top reasons telehealth claims are flagged for review.

Documentation for Modifier 95

Your medical records must clearly include the following details:

1. The name of the video platform used for the visit, such as Doxy.me or Zoom for Healthcare
2. A note confirming the session was live with both Audio and video active
3. The location of the patient at the time of the appointment
4. The location of the provider during the visit
5. Written confirmation that the patient gave informed consent for telehealth
6. Standard clinical notes, including the chief complaint, history, assessment, and plan

Documentation for Modifier 93

For phone-only visits, your records should clearly show:

1. A statement that the visit was done by telephone with no video
2. The reason the video was not used was that the patient lacked the right device or internet access
3. The patient’s verbal consent for an audio-only telehealth visit
4. The total length of the phone call in minutes
5. Clinical notes covering the assessment, plan, and medical decision-making

Pro Tip: Some Medicare Administrative Contractors (MACs) ask providers to specify why audio-only technology was used. A short statement such as “Patient does not have access to a video-capable device” is sufficient in most cases.

Payer-Specific Rules: Medicare, Medicaid, and Commercial Insurance

Different payers follow different rules for these two modifiers. Knowing the guidelines for your most common payers can significantly reduce claim errors.

Medicare

Medicare has clear and specific rules for telehealth billing. Here is what providers should know:

1. Modifier 95 is accepted for Medicare telehealth visits when live video is used, and the patient is at an approved originating site.
2. Medicare formally accepted modifier 93 during the COVID-19 Public Health Emergency (PHE). Many audio-only coverage rules have been extended through new legislation. Always confirm the current rules with CMS or your Medicare Administrative Contractor.
3. The CPT code must appear on Medicare’s approved telehealth services list for either modifier to be valid.
4. Place of service code 02 is used when the patient is not at home, and code 10 is used when the patient receives care at their own home.

Medicaid

Medicaid is managed at the state level, so rules differ from state to state:

1. Some states cover audio-only visits and accept Modifier 93, while others do not.
2. Many state Medicaid programs kept their expanded telehealth rules after the PHE ended.
3. Always check your specific state’s Medicaid telehealth policy before submitting a claim.

Commercial Insurers

Private insurance companies each write their own telehealth rules:

1. Major payers like Aetna, Cigna, UnitedHealthcare, and Blue Cross Blue Shield generally accept Modifier 95 for live video visits.
2. Coverage for Modifier 93 phone-only visits varies across commercial plans.
3. Review each payer’s provider manual or telehealth coverage document at least once a year, since policies update regularly.

Common Billing Mistakes to Avoid

Billing errors with these two modifiers happen more often than many providers realize. Knowing the most common mistakes helps your team avoid them before they become a problem.

1. Using Modifier 95 for a Phone-Only Visit

It is one of the most flagged errors in telehealth billing audits. If no video was used during the visit, Modifier 95 cannot be applied. Submitting this modifier without a video being present is a misrepresentation of services. It can lead to payment recoupment if discovered during a review.

2. Forgetting to Verify the Approved Services List

Not every CPT code qualifies for telehealth reimbursement. If the code is not on the payer’s approved list, the claim will be denied. It is true even if the modifier itself is used correctly. Always confirm CPT code eligibility before billing.

3. Missing the Place of Service Code

The modifier alone is not enough for a complete telehealth claim. The correct Place of Service (POS) code must also appear on the claim form. POS codes 02 and 10 are the two most commonly used for telehealth visits. A missing or wrong POS code is a very common reason for claim rejections.

4. Not Including Patient Consent Documentation

Many payers require proof that the patient agreed to receive telehealth services. Without this documentation in the record, a claim can be questioned during an audit. Always note written or verbal consent in the clinical notes before or during the visit.

5. Treating Old Rules as Current Rules

Telehealth billing rules have shifted greatly since 2020. CMS and individual payers regularly update their telehealth policies. What was covered last year may no longer be covered today. Staying up to date through CMS bulletins and payer newsletters is a smart practice.

The Importance of Getting Modifiers Right

Using the wrong modifier is not just a paperwork problem. It can have real consequences for your practice and your patients. Consistent billing errors can lead to:

1. Claim denials that slow down your revenue cycle
2. Payment recoupment, where the payer asks for money back after an audit
3. Compliance risks if billing patterns suggest intentional errors
4. Unexpected patient bills that damage trust and satisfaction

On the other hand, practices that train their teams well and document carefully see real benefits. Fewer denials, faster approvals, and a smoother revenue cycle are the rewards of getting modifier billing right from the start.

Tips for Staying Compliant and Up to Date with Billing

Telehealth billing is one of the most frequently updated areas in healthcare. Here are some practical steps to help your practice keep up:

1. Subscribe to CMS newsletters and the Medicare Learning Network (MLN) to get policy updates first.
2. Attend webinars and training sessions offered by your specialty’s professional association each year.
3. Run quarterly internal billing audits to catch modifier errors before they pile up.
4. Train your full clinical team, including providers and front-desk staff, not just your billing department.
5. Use billing software that includes checks for the telehealth modifier and validation tools.
6. Work with a compliance officer or healthcare attorney if you are unsure whether a service qualifies for telehealth coverage.

Final Thoughts

The difference between Modifier 93 and Modifier 95 comes down to one key question: Was there video? Modifier 95 is for live audio and video visits. Modifier 93 is for phone-only visits with no video. Both modifiers cover real-time remote care. They reflect different tools used to deliver that care.

Applying these modifiers correctly keeps your practice safe from audits and helps patients avoid billing surprises. It also supports the long-term growth of telehealth as a trusted care option. With good documentation, a clear selection process, and updated knowledge of payer rules, any provider or biller can handle these codes with full confidence.

Telehealth is a lasting and growing part of modern healthcare. Billing it accurately is one of the best ways to make sure it keeps working well for everyone involved.

FAQs About Modifier 93 vs 95