Telepsychiatry Billing — Modifier 93 vs 95 Guide 2026

Modifier 95 — Synchronous Telemedicine via Video + Audio

• Required for real-time video visits
• Applied to any CPT code delivered via video
• Reimbursement typically parity with in-person
• Standard for telepsych since COVID PHE

Modifier 93 — Synchronous Telemedicine via Audio Only

• Required for phone-only visits (no video)
• Post-2023 CMS acceptance for behavioral health
• Reimbursement often reduced 15-30% vs 95
• Not accepted by all commercial payers

Common Denial Patterns

1. Missing modifier entirely (payer denies as in-person mismatch)
2. Wrong modifier (audio-only billed as video)
3. POS code wrong (10 vs 02)
4. Payer-specific ban on audio-only

Payer-Specific Rules

• Medicare: accepts 93 for BH post-2023
• Medicaid: state-specific (most accept)
• Optum BH: accepts 93 for established patients
• Carelon: accepts 93 with documentation of patient inability to do video
• Aetna: video-only for new patients

Telepsych Billing Services

– KD, Revenant Care