If you are billing a standard E/M code (like 99213) but the service was performed virtually via Zoom or Doxy.me, you must properly indicate it on the claim using Modifier 95.
When to Use Modifier 95
Modifier 95 is defined as a "Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system." It MUST be real-time, and it MUST include both audio and video. If the video fails and the call becomes audio-only, you cannot use Modifier 95 (you must switch to audio-only codes like 99441).
Medical Necessity & E/M Requirements
A telehealth visit billed with Modifier 95 must meet the exact same documentation requirements (Time or Medical Decision Making) as an in-person visit. You cannot cut corners on MDM just because it is on video.
NCCI Edits and POS Matching
If you use Modifier 95, your Place of Service (POS) must logically match a telehealth setting (POS 02 or 10). Using POS 11 (Office) with Modifier 95 will often trigger automated payer denials depending on current CMS waivers.