Understanding the Differences Between Modifier 93 and Modifier 95 in Telehealth Billing

Telehealth has become a critical part of healthcare delivery, especially after recent shifts in how care is accessed. With this growth, accurate billing for telehealth services is essential to avoid claim denials and compliance issues. Two common modifiers used in telehealth billing are Modifier 93 and Modifier 95. Although they may seem similar, they serve different purposes and apply to different types of services. Misusing these modifiers can lead to billing errors, delayed payments, or audits.

This post explains the key differences between Modifier 93 and Modifier 95, when to use each, and practical tips to avoid telehealth billing mistakes.

What Are Modifier 93 and Modifier 95?

Modifiers are two-digit codes added to CPT or HCPCS codes to provide additional information about a service performed. They help payers understand the context of the service and determine appropriate reimbursement.

• Modifier 93 indicates a synchronous telemedicine service rendered via a real-time interactive audio-only telephone or other real-time audio-only telecommunications system.

• Modifier 95 indicates a synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system.

  
  

Both modifiers signal that the service was delivered remotely, but the technology used differs.

When to Use Modifier 93

Modifier 93 applies specifically to telehealth services provided using audio-only technology. This means the patient and provider communicate through a telephone or similar device without video.

Common scenarios for Modifier 93

• A patient calls a healthcare provider for a consultation, and the provider delivers care over the phone.

• The patient does not have access to video technology or internet bandwidth is insufficient for video.

• The service is a real-time evaluation or management (E/M) visit conducted solely by audio.

  
  

Important points about Modifier 93

• It applies only to services that are normally covered when delivered in person.

• The service must be synchronous, meaning it happens live and in real time.

• Modifier 93 is often used for specific CPT codes that allow audio-only telehealth, such as certain E/M codes.

• Not all payers accept Modifier 93; some may require Modifier 95 or have different rules for audio-only visits.

  
  

When to Use Modifier 95

Modifier 95 applies to telehealth services delivered using both audio and video technology. This means the provider and patient interact through a live audiovisual connection.

Common scenarios for Modifier 95

• A video visit between a patient and provider using a telehealth platform.

• Remote patient monitoring sessions that include live video interaction.

• Behavioral health or therapy sessions conducted via video conferencing.

  
  

Important points about Modifier 95

• It signals that the service was provided through an interactive audiovisual system.

• Modifier 95 is widely accepted by Medicare and many commercial payers for telehealth visits.

• It applies to a broad range of CPT codes, including office visits, consultations, and therapy services.

• The service must be synchronous and live.

  
  

Key Differences Between Modifier 93 and Modifier 95

| Feature | Modifier 93 | Modifier 95 |

|-------------------------|------------------------------------|------------------------------------|

| Technology Used | Audio-only (telephone or similar) | Audio and video (teleconferencing) |

| Type of Interaction | Synchronous, real-time audio | Synchronous, real-time audio and video |

| Common CPT Codes | Limited to codes allowing audio-only | Broad range of telehealth-eligible codes |

| Payer Acceptance | Varies, some payers do not accept | Widely accepted by Medicare and commercial payers |

| Typical Use Cases | Phone consultations, triage calls | Video visits, therapy sessions |

Understanding these differences helps providers select the correct modifier and avoid claim denials.

Practical Tips to Avoid Telehealth Billing Errors

Billing errors related to Modifier 93 and Modifier 95 often happen because of confusion about technology used or payer requirements. Here are some tips to improve accuracy:

• Verify payer policies before submitting claims. Some payers may not reimburse for audio-only visits or may require specific documentation.

• Document the technology used during the visit clearly in the medical record. Note if the visit was audio-only or included video.

• Use Modifier 93 only when no video is available and the service is allowed by the payer.

• Apply Modifier 95 for all video-based telehealth services unless payer instructions say otherwise.

• Stay updated on telehealth billing rules, as policies can change frequently, especially during public health emergencies.

• Train billing staff and providers on the correct use of modifiers and telehealth documentation requirements.

• Audit telehealth claims regularly to catch and correct modifier errors before submission.

  
  

Examples of Correct Modifier Use

Example 1: Audio-only telephone visit

A patient calls their primary care provider with flu symptoms. The provider evaluates the patient over the phone and documents the visit. The provider bills CPT code 99441 (telephone E/M service) with Modifier 93 to indicate audio-only telehealth.

Example 2: Video visit for behavioral health

A patient attends a scheduled therapy session via a secure video platform. The provider bills CPT code 90834 (psychotherapy) with Modifier 95 to indicate the service was delivered through live audio and video.

Example 3: In-person visit mistakenly billed with Modifier 95

A provider sees a patient in the office but accidentally adds Modifier 95 on the claim. This can cause claim denial because Modifier 95 is only for telehealth services. The claim should be corrected by removing the modifier.

Final Thoughts on Modifier 93 and Modifier 95

Choosing the right modifier for telehealth billing is essential to ensure claims are processed smoothly and providers receive timely payment. Modifier 93 is for audio-only telehealth services, while Modifier 95 applies to services delivered via audio and video.

Providers should always check payer guidelines and document the type of telehealth technology used. Clear understanding and correct use of these modifiers reduce billing errors and support compliance with telehealth regulations.

As telehealth continues to evolve, staying informed about billing requirements will help healthcare providers deliver care remotely without financial setbacks. Review your telehealth billing processes regularly and train your team to apply Modifier 93 and Modifier 95 correctly.

If you want to improve your telehealth billing accuracy, start by reviewing recent claims and payer policies today. This simple step can prevent costly errors and keep your revenue cycle healthy.