2026 Telemedicine Billing: GT, 95 & GQ Modifier Differences

Are your telehealth claims being paid smoothly or quietly denied due to a simple modifier error? As virtual care becomes a permanent part of healthcare delivery, the difference between GT, 95, and GQ modifiers is no longer a minor technical detail. Instead, it can directly influence reimbursement accuracy, compliance exposure, and revenue predictability.

Keeping this in mind, this blog will break down the core differences between GT, 95, and GQ modifiers.

• Mode of Communication

The GT modifier indicates that a service was delivered through real-time interactive audio and video communication. It historically identified virtual visits replacing in-person care. However, its technical requirement still depends strictly on live, synchronous interaction between provider and patient.

Modifier 95 represents synchronous telemedicine delivered via real-time audio and video systems. Unlike GT, it is formally defined by the AMA and widely adopted by payers. It applies only when both parties communicate simultaneously through interactive technology.

The GQ modifier applies to asynchronous telemedicine services. In this setting, patient information such as images or recorded data is reviewed later by the provider. Since interaction is not simultaneous, it reflects store-and-forward clinical evaluation.

• Current Payer Acceptance

In 2026, the GT modifier has limited payer acceptance and is mainly restricted to certain institutional billing scenarios. Many commercial insurers no longer require it. Therefore, checking individual payer policies remains essential before submission.

Modifier 95 is broadly accepted by Medicare, Medicaid, and most commercial payers. It has become the preferred identifier for synchronous telehealth services. Consequently, it is commonly used for routine real-time virtual encounters.

The GQ modifier is primarily recognized for Medicare-approved asynchronous services. Commercial payer acceptance may differ depending on contract terms. As a result, billing teams must confirm coverage requirements prior to claim submission.

• Claim Type Application

The GT modifier is generally associated with institutional claims, particularly under certain facility-based reimbursement methods. Its relevance in professional claims has decreased considerably. Therefore, it is most applicable within defined hospital billing contexts.

Modifier 95 is mainly appended to professional claims submitted by physicians and qualified healthcare providers. It integrates into standard outpatient and office-based billing workflows. This makes it practical for everyday telehealth services.

The GQ modifier is used on professional claims involving asynchronous services. It identifies delayed provider evaluation without changing the underlying CPT code. Its use depends on meeting telehealth eligibility requirements.

• CPT Code Eligibility

Historically, GT was appended to many telehealth-eligible CPT codes. In 2026, its use is increasingly payer-specific and limited. Therefore, verifying code eligibility before attaching this modifier is necessary to avoid denials.

Modifier 95 may only be used with CPT codes listed in Appendix P of the CPT manual. This limitation ensures appropriate application to synchronous services. Using it outside approved codes may lead to claim rejection.

The GQ modifier applies only to CPT codes that support asynchronous service delivery. Not every procedure qualifies for store-and-forward evaluation. Clear documentation must justify that delayed review was clinically appropriate.

• Documentation Expectations

Claims billed with GT must clearly state that the service occurred through live audio and video communication. The medical record should describe the virtual format and medical necessity. Accurate documentation reduces compliance exposure.

When using modifier 95, documentation must confirm real-time interactive audio and video communication. The clinical note should specify synchronous telemedicine delivery. Proper recordkeeping strengthens reimbursement integrity.

The documentation must demonstrate that the provider reviewed transmitted information later and made clinical decisions accordingly for GQ. The note should indicate asynchronous service delivery. Therefore, detailed documentation supports claim validity.

• Reimbursement Implications

Reimbursement for GT varies significantly based on payer policy and billing context. Some insurers may no longer recognize it outside institutional settings. Therefore, incorrect application may result in payment delays or denials.

Modifier 95 generally supports reimbursement comparable to in-person visits when used correctly. Many payers recognize it for approved synchronous services. Accurate use promotes smoother payment processing.

Payment for GQ services may be more restricted compared to synchronous encounters. Reimbursement depends on whether the payer allows asynchronous care in that scenario. Careful billing helps minimize underpayment risk.

• Compliance Risk Considerations

Using GT incorrectly can increase denial risk due to its limited relevance in 2026. Payers may reject claims if policy conditions are unmet. As a result, verifying requirements before billing is advisable.

Modifier 95 presents lower compliance risk when appended only to eligible CPT codes and supported by proper documentation. In fact, following official guidelines reduces audit concerns and strengthens billing accuracy.

The GQ modifier carries moderate compliance risk if asynchronous criteria are not clearly documented. Improper pairing with unsupported codes may trigger denials. Comprehensive clinical notes help justify appropriate use.

• Technology Requirements

The GT modifier requires real-time, two-way interactive audio and video technology. Both provider and patient must communicate simultaneously during the encounter. If video capability is absent, the service typically does not qualify under GT billing requirements.

Modifier 95 also mandates synchronous audio and video communication through secure, HIPAA-compliant platforms. The interaction must occur live without delay. Audio-only services generally do not qualify unless specifically allowed by payer policy.

The GQ modifier supports store-and-forward technology, where clinical data such as images or recordings are transmitted for later review. Live interaction is not required. Instead, technology must allow secure electronic transmission and documentation of delayed provider evaluation.

• Geographic Restrictions

Historically, GT usage was influenced by geographic restrictions, especially in rural or designated originating sites. Although many limitations have evolved, certain institutional claims may still follow location-based criteria depending on payer policy.

Modifier 95 is generally not restricted by geographic location under current telehealth flexibilities. Many payers allow services regardless of rural or urban status. However, ongoing regulatory changes may affect location eligibility.

The GQ modifier was traditionally associated with federal demonstration programs in specific states or regions. Geographic eligibility may still apply depending on Medicare guidelines. Therefore, verifying regional requirements remains important before claim submission.

• Place of Service (POS) Reporting

When billing with GT, the place of service may vary depending on institutional billing rules. Facilities often follow specific Medicare guidance. Accurate POS reporting is necessary to prevent claim rejection.

Modifier 95 is commonly billed using the POS code that reflects where the service would have occurred in person, combined with required telehealth indicators. Proper POS selection directly impacts reimbursement rates.

POS coding must align with payer-specific telehealth instructions for GQ billing. As services are asynchronous, the POS may differ from synchronous encounters. Correct reporting ensures appropriate adjudication and payment.

• Future Relevance and Regulatory Trends

The GT modifier’s relevance continues to decline as payer systems standardize telehealth billing practices. Many organizations transition toward modifier 95 for synchronous services. Therefore, GT may remain limited to specific institutional circumstances.

Modifier 95 is expected to remain the dominant telehealth modifier for synchronous services due to widespread payer acceptance. Regulatory updates increasingly reference it as the primary telemedicine identifier in professional billing.

The GQ modifier may retain importance in specialized asynchronous programs and emerging digital health models. As remote diagnostics expand, store-and-forward billing could grow, provided regulatory frameworks continue supporting delayed provider evaluations.

Conclusion

Telehealth billing in 2026 demands precision, adaptability, and proactive oversight. As virtual care continues to evolve, modifier selection plays a critical role in protecting revenue integrity and maintaining regulatory alignment. In fact, even small inaccuracies can quietly impact reimbursement timelines and overall financial performance.

Instead of approaching modifier usage as a routine coding step, healthcare organizations benefit from structured internal controls, regular payer policy reviews, and ongoing staff education. A forward-thinking billing strategy ensures smoother claims processing and long-term operational stability in a digitally driven care environment.

As a result, outsourcing telehealth billing and coding services to 24/7 Medical Billing Services can provide dedicated compliance monitoring, payer-specific guidance, and consistent quality checks. Thereby, this will help organizations maintain financial confidence while focusing on patient care.

FAQs

Can multiple telehealth modifiers be used on the same claim?

Only one telehealth modifier should be appended unless specific payer instructions require otherwise.

Can telehealth modifiers impact value-based care reporting?

Accurate modifier use supports proper encounter classification and performance tracking.

Are telehealth modifiers relevant for bundled payment models?

They may be required for reporting purposes even when reimbursement is bundled.