Two little characters on a claim form can decide whether your telehealth session gets paid or denied. Bill a virtual therapy visit to one payer with the GT modifier, and it sails through. Send the same claim to another payer, and it bounces back because they wanted modifier 95 instead. Nothing about the session changed. Only the modifier did.
This is the daily reality of telehealth billing, and behavioral health practices feel it more than anyone because so much of their care now happens over video.
This guide explains what the GT modifier actually is, how it differs from modifier 95 and GQ, where each one still applies, what Medicare and Medicaid expect, and the documentation that keeps virtual claims clean. By the end, your team will know exactly which modifier belongs on which claim.
What Is the GT Modifier?
The GT modifier is an HCPCS Level II modifier created by CMS that indicates a service was delivered via interactive audio and video telecommunications systems. In plain English, it tells the payer that the visit took place via a live, real-time video connection rather than in person.
GT was the original telehealth modifier. For years, it was the standard way to flag virtual visits on claims, appended directly to the CPT code, such as 90837 GT for a 60-minute psychotherapy session delivered by video. The underlying service and fee schedule stay the same; the modifier describes how the care was delivered.
Also Read: ICD-10 Codes For Depression: Complete Billing Guide
Two things GT does not cover: it is not for audio-only phone sessions, and it is not for asynchronous services where the provider reviews information later. GT specifically means live, two-way, synchronous audio and video.
GT vs Modifier 95: The Core Difference
Here is the part that confuses almost everyone. GT and modifier 95 describe the same clinical scenario. Both mean synchronous telemedicine delivered through real-time interactive audio and video. The difference is origin and payer preference, not meaning.
| Feature | GT Modifier | Modifier 95 |
| Created By | CMS (HCPCS Level II) | AMA (CPT, introduced 2017) |
| Meaning | Interactive audio and video telecommunications | Synchronous telemedicine, real-time audio and video |
| Code Limits | Historically broad, now payer-specific | Only CPT codes listed in Appendix P |
| Medicare Professional Claims | No longer required, POS codes are used instead | Optional, POS codes drive processing |
| Medicare Institutional Claims | Still required for CAH Method II providers | Not used in that scenario |
| Medicaid | Required by some state programs | Required by many others |
| Commercial Payers | A shrinking group still requires it | The dominant standard today |
The practical takeaway: neither modifier is universally right. The payer decides. Some Medicaid programs still deny claims without GT. Many commercial plans deny claims without 95. Billing teams that use them interchangeably without checking payer policy generate denials in both directions.
A Short History: Why Two Modifiers Exist
GT came first, built by CMS in the early days of federal telehealth billing. For a long time, it was the only game in town. In January 2017, the AMA introduced modifier 95 in the CPT manual along with Appendix P, a list of codes approved for synchronous telemedicine. Shortly after, CMS stopped requiring GT on most professional claims, shifting instead to place of service codes to identify telehealth.
Then, telehealth exploded in 2020, commercial payers rushed to formalize their policies, and most standardized on modifier 95. GT never fully retired, though. It survives in specific corners of the billing world, which is exactly why it still matters in 2026.
Where the GT Modifier Still Applies
Despite the shift toward 95, GT remains the correct choice in a few defined situations:
- Critical Access Hospitals bill under Method II, where Medicare still requires GT on institutional telehealth claims
- Certain state Medicaid programs continue to require GT on professional telehealth claims
- Legacy commercial contracts that were written around GT and never updated
- Payers that accept both GT and 95, where either will process cleanly
The only reliable way to know is a payer-by-payer check. Building a simple telehealth modifier grid for your top ten payers, and updating it once or twice a year, prevents the vast majority of modifier-related denials.
When to Use Modifier 95
Modifier 95 is now the default for most professional telehealth claims. Use it when:
- The service was delivered through live, synchronous audio and video
- The CPT code appears in Appendix P of the CPT manual, which includes psychotherapy codes, psychiatric diagnostic evaluations, and standard E/M visits.
- The payer’s policy lists 95 as its telehealth modifier
For behavioral health, that covers the everyday codes: 90791 for intakes, 90832, 90834, and 90837 for individual therapy, 90846 and 90847 for family sessions, all billed with modifier 95 when delivered by video to a payer that follows the AMA standard.
The Other Telehealth Modifiers Worth Knowing
GT and 95 get most of the attention, but a complete telehealth billing picture includes a few more codes.
| Modifier | Meaning | Typical Use |
| GQ | Asynchronous telecommunications, store-and-forward | Provider reviews transmitted images or recordings later; Medicare use is limited to federal demonstration programs in Alaska and Hawaii |
| 93 | Synchronous audio-only service | Phone sessions without video, where the payer covers them |
| FQ | Audio-only behavioral health service | Medicare behavioral health visits delivered by phone |
| G0 | Telehealth for acute stroke | Diagnosis and treatment of acute stroke symptoms |
The GQ modifier deserves a special note because it is the true asynchronous modifier. If a patient sends recorded information and the provider evaluates it later without a live interaction, that is GQ territory, not GT and not 95. Mixing up synchronous and asynchronous modifiers is a quiet but consistent source of claim rejections.
Place of Service Codes: The Other Half of the Story
Modifiers describe how the service was delivered. Place of service codes describe where the patient was. Both must align for the claim to process correctly.
- POS 02 indicates telehealth provided somewhere other than the patient’s home, such as a clinic or facility
- POS 10 indicates telehealth provided while the patient is in their home
- POS 11 remains the code for regular in-office visits
Medicare leans heavily on POS codes to identify telehealth on professional claims, which is why it dropped the GT requirement. A common denial pattern is a mismatch, such as POS 11 combined with a telehealth modifier, or POS 10 with no modifier for a payer that requires one. The modifier and the POS code need to tell the same story.
What This Looks Like in Behavioral Health
At Zee Medical Billing LLC, we often see the same telehealth claim built three different ways depending on the payer, and all three are correct:
- A video therapy session billed to a commercial plan: 90834 with modifier 95 and POS 10
- The same session was billed to a state Medicaid program that kept GT: 90834 with GT and POS 10
- The same session billed to Medicare: 90834 with POS 10, modifier optional under current professional claim rules
Same service, same documentation, three claim formats. That is the entire GT versus 95 question in a single example. The clinical work never changes. The payer’s rulebook does.
Also Read: ICD-10 Codes For MDD And Depression: Billing Guide
Documentation That Supports Telehealth Modifiers
Whichever modifier the payer wants, the chart has to back it up. A clean telehealth note includes:
- Documented patient consent for telehealth, obtained before services begin
- The platform used, confirming it was a real-time audio and video connection
- Start and stop times with total session duration
- The locations of both the provider and the patient during the session
- The clinical content, interventions, and treatment plan are just like an in-person note
- Provider signature with credentials
For audio-only sessions, the note should state clearly that the visit was telephone-based and why, since that changes the modifier to 93 or FQ depending on the payer.
Common Telehealth Modifier Mistakes
The denial patterns around telehealth modifiers are remarkably consistent:
- Sending GT to a payer that requires 95, or 95 to a payer that requires GT
- Appending a video modifier to an audio-only phone session
- Using GT or 95 on an asynchronous service that belongs under GQ
- Pairing a telehealth modifier with POS 11
- Forgetting the modifier entirely for commercial payers that require one
- Applying telehealth modifiers to CPT codes, the payer never approved for virtual delivery
- Assuming all payers follow Medicare’s rules, when Medicaid and commercial plans each go their own way
Every one of these is preventable with a current payer grid and a claim scrubber rule that flags telehealth claims missing the expected modifier and POS combination.
FAQs
What is the difference between the GT and 95 modifiers?
Both modifiers describe the same thing: a synchronous telehealth service delivered through real-time interactive audio and video. The difference is who created them and who requires them. GT is an HCPCS Level II modifier created by CMS and was the original telehealth standard. Modifier 95 is an AMA CPT modifier introduced in 2017 and limited to codes in Appendix P of the CPT manual. Today, most commercial payers and Medicaid programs prefer 95, while GT survives in certain state Medicaid programs and institutional billing. The payer’s policy, not the definition, decides which one goes on the claim.
Is the GT modifier still valid in 2026?
Yes, but its use is narrow and payer-specific. Medicare no longer requires GT on professional claims, relying on place of service codes 02 and 10 instead, though it still requires GT on institutional claims from Critical Access Hospitals billing under Method II. Several state Medicaid programs and some older commercial contracts also still require GT. The safest approach is to verify each payer’s current telehealth policy rather than assuming GT is either dead or universally accepted, because both assumptions produce denials.
Do I use GT or 95 for Medicare telehealth claims?
For standard professional claims, Medicare generally does not require either modifier. It identifies telehealth through the place of service code, POS 02, when the patient is outside the home, and POS 10 when the patient is at home. Including modifier 95 usually does not hurt, but the POS code is what drives processing. The exceptions are audio-only behavioral health visits, which need modifier FQ or 93, and institutional claims from CAH Method II providers, which still require GT. Medicare Advantage plans can set their own rules, so verify those separately.
What is the GQ modifier, and how is it different from GT?
GQ indicates an asynchronous telehealth service, often called store-and-forward, where patient information, such as images or recorded video, is transmitted and the provider reviews it later. There is no live interaction happening in real time. GT, by contrast, means a live synchronous audio and video session. Under Medicare, GQ is mostly limited to federal telehealth demonstration programs in Alaska and Hawaii, though some state Medicaid programs use it for services like teledermatology. Using GQ on a live video session or GT on a delayed review misrepresents the service and invites denials or audit findings.
Which modifier do I use for phone-only therapy sessions?
Audio-only sessions never take GT or 95, because both of those modifiers require video. The correct modifier is 93, which indicates a synchronous audio-only service, or FQ for Medicare behavioral health visits delivered by phone. Coverage for audio-only care varies more than video coverage, with some commercial payers restricting it to behavioral health or specific situations, so verify the payer’s audio-only policy before the session. The documentation should clearly state that the visit was telephone-based and note why video was not used when relevant.
Conclusion
The GT modifier story is really a story about payer variation. GT and modifier 95 mean the same thing, a live audio and video telehealth session, but different payers demand different labels, and Medicare mostly ignores both in favor of place of service codes. The essentials to remember: GT is the legacy CMS modifier still required by some Medicaid programs and CAH Method II institutional claims, 95 is the AMA standard for most commercial claims, GQ covers asynchronous services, 93, and FQ covers audio-only, and the POS code must always match the modifier’s story.
Build a payer-specific modifier grid, keep it current, align every telehealth claim’s modifier and POS code, and document consent, platform, times, and locations in every note. Do that consistently, and telehealth billing stops being a denial generator and becomes as routine as in-person claims.
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