Crystal's Coder Hub📡 Modifier -GQ — Via an Asynchronous Telecommunications System
Quick Reference
Modifier: -GQ | Type: HCPCS Level II Modifier | Used With: CPT / HCPCS Service Codes | Telehealth Type: Asynchronous (Store-and-Forward) | Real-Time Interaction Required: ❌ No | Billable: ✅ Yes (payer/program restrictions apply)
📋 Modifier Description
Modifier -GQ — “Via an asynchronous telecommunications system” — is a HCPCS Level II modifier appended to a CPT or HCPCS procedure/service code to indicate that the service was delivered through store-and-forward technology. In this model, patient data (images, videos, medical history, lab results) is collected at the originating site and electronically transmitted to a distant-site provider for evaluation at a later time — without a real-time, face-to-face interaction between patient and provider.
Asynchronous telemedicine differs from synchronous telemedicine (real-time audio/video, reported with Modifier -95 or Modifier -GT) in that the provider and patient are not present simultaneously. The provider reviews the transmitted data and makes a clinical decision — this model is particularly common in dermatology, radiology, and ophthalmology, where visual data can be evaluated independently of a live encounter.
⚠️ Medicare Limitation — Critical to Know
For Medicare, Modifier -GQ is not a general-use telehealth modifier. As of 2025–2026, CMS limits -GQ reimbursement to services furnished under Federal telemedicine demonstration projects in Alaska and Hawaii only. For all other Medicare telehealth, use Modifier -95 (synchronous audio/video) or Modifier -93 (audio-only). Verify Medicaid and commercial payer policies independently — coverage varies significantly.
🔬 Modifier vs. Other Telehealth Modifiers
| Modifier | Full Name | Interaction Type | CMS Medicare Use (2025–2026) | Common Specialties |
|---|---|---|---|---|
| -GQ | Via an Asynchronous Telecommunications System | Asynchronous (Store-and-Forward) | ⚠️ Limited — AK/HI Federal Demo Projects only | Dermatology, Radiology, Ophthalmology |
| -95 | Synchronous Telemedicine Service Rendered Via Real-Time Interactive Audio and Video Telecommunications System | Synchronous (Live Audio + Video) | ✅ Primary Medicare telehealth modifier | All specialties |
| -93 | Synchronous Telemedicine Service Rendered Via Telephone or Other Real-Time Interactive Audio-Only Telecommunications System | Synchronous (Audio-Only) | ✅ Medicare audio-only visits | Primary Care, Behavioral Health |
| -GT | Via Interactive Audio and Video Telecommunications Systems | Synchronous (Live Audio + Video) | ⚠️ Institutional claims only (e.g., Critical Access Hospitals); retired from routine professional use | CAHs, institutional billing |
| -FQ | Service Furnished Using Audio-Only Communication Technology | Synchronous (Audio-Only) | ✅ FQHC/RHC audio-only visits | FQHCs, RHCs |
Clinical Pearl
The single most common audit error with -GQ is using it for general Medicare telehealth outside of the Alaska/Hawaii demonstration programs. If you’re billing professional telehealth for a standard Medicare patient, -GQ will deny — use Modifier -95 (live video) or -93 (audio-only) instead. Always verify the payer-specific telehealth modifier matrix before appending -GQ to any claim.
✅ When to Use Modifier -GQ
- Federal Telemedicine Demonstration Projects (Alaska & Hawaii): The provider is located at the distant site and receives asynchronously transmitted patient data from the originating site in a qualifying CMS demonstration program
- Store-and-Forward Specialty Services: Clinical data (photos, video clips, diagnostic images) is collected and sent for provider review at a later time — not during a live encounter — in a payer-approved asynchronous program
- Medicaid Asynchronous Programs: Some state Medicaid programs reimburse store-and-forward services; -GQ may be required — confirm state-specific guidelines
- Commercial Payer Contracts: Some commercial payers recognize -GQ for asynchronous telehealth; verify individual payer policy and contract language before use
- FQHC/RHC Context: -GQ has appeared in certain FQHC/RHC asynchronous billing contexts — verify current CMS guidance as this area evolves
❌ When NOT to Use Modifier -GQ
| Scenario | Correct Modifier |
|---|---|
| Real-time audio + video telehealth (any payer, any specialty) | -95 |
| Audio-only telehealth (Medicare, no video) | -93 |
| General Medicare telehealth (outside AK/HI demo) | -95 or -93 — NOT -GQ |
| FQHC/RHC audio-only services | -FQ (with -93 if applicable) |
| Critical Access Hospital institutional telehealth | -GT |
| In-person service billed with POS 11 | No telehealth modifier needed |
Bundling / Denial Alert
Do not append -GQ to a service code that does not support asynchronous delivery. CMS and most payers require that the CPT/HCPCS code itself be eligible for telehealth and specifically for store-and-forward delivery. Using -GQ on an ineligible code will result in a denial. CPT Appendix P lists codes approved for synchronous telehealth (Modifier -95); there is no equivalent published list for -GQ — confirm eligibility with the specific payer or program.
🏷️ Modifier Placement & Claim Submission
| Field | Guidance |
|---|---|
| Where Appended | Appended directly to the CPT or HCPCS service code (e.g., [[99213]]--GQ) |
| Place of Service | POS 02 (telehealth outside patient’s home) or POS 10 (telehealth in patient’s home) |
| Claim Type | Professional (CMS-1500 / 837P) |
| Billing Provider | Distant-site provider — the provider reviewing the transmitted data |
| Originating Site | Site where patient data was collected and transmitted |
| Documentation Required | Confirm asynchronous transmission; describe data reviewed; clinical findings and plan; date of data collection vs. date of provider review |
📝 Coding Examples
Example 1 — Alaska Federal Demo Project: Dermatology Store-and-Forward Consult
Clinical Scenario: A 52-year-old female patient presents at a rural originating site clinic in Alaska. High-resolution photographs of a suspicious pigmented lesion on her left forearm are captured and transmitted to a distant-site dermatologist participating in the CMS Federal Telemedicine Demonstration Project. The dermatologist reviews the images asynchronously the following day, documents clinical findings, and recommends a biopsy. No real-time interaction between the patient and dermatologist occurred.
| Field | Code | Rationale |
|---|---|---|
| CPT + Modifier | 99242--GQ | Office consultation, new patient, low complexity — -GQ appended to certify asynchronous store-and-forward delivery under the Alaska Federal Demo Project |
| POS | 02 | Telehealth provided other than in patient’s home |
| PDx | L81.4 | Other melanin hyperpigmentation — primary reason for consult; most specific code supported by documentation |
Note
The dermatologist must document that services were provided under a qualifying Federal telemedicine demonstration program in Alaska or Hawaii. Without this documentation, -GQ is not supported for Medicare reimbursement and the claim will deny.
Example 2 — Commercial Payer: Ophthalmology Teleretinal Imaging Asynchronous Read
Clinical Scenario: A 67-year-old male diabetic patient has teleretinal images captured at his primary care physician’s office and transmitted to an ophthalmologist for asynchronous interpretation. The commercial payer contract explicitly recognizes -GQ for store-and-forward ophthalmology reads. The ophthalmologist documents the interpretation the next morning, noting no diabetic retinopathy.
| Field | Code | Rationale |
|---|---|---|
| CPT + Modifier | 92250-GQ | Fundus photography with interpretation and report — -GQ documents asynchronous store-and-forward delivery per commercial payer contract |
| POS | 02 | Telehealth — distant site |
| PDx | E11.9 | Type 2 diabetes mellitus without complications — underlying condition driving the retinal screening |
Warning
Always verify the payer contract before appending -GQ to a commercial claim. Never assume commercial payer acceptance — some payers require Modifier -95 even for store-and-forward services, or may require a proprietary modifier. A denial for incorrect modifier use can be difficult to appeal retroactively.
⚠️ Common Coding Pitfalls
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Using -GQ for General Medicare Telehealth: -GQ is not a general-purpose Medicare telehealth modifier. Outside of the Alaska/Hawaii federal demonstration programs, Medicare will deny claims with Modifier -GQ. The correct modifier for standard Medicare synchronous telehealth is Modifier -95; for audio-only, use Modifier -93.
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Missing or Incorrect POS Code: Telehealth claims — including those with -GQ — require POS 02 (outside patient’s home) or POS 10 (patient’s home). Using POS 11 (Office) on a telehealth claim signals an in-person encounter and will create a conflict with the -GQ modifier, triggering a denial or audit flag.
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Appending -GQ to an Ineligible CPT Code: Not every CPT code supports asynchronous delivery. Using -GQ on a code that requires real-time interaction (e.g., interactive psychotherapy codes) is a misuse of the modifier and will deny. Verify CPT code eligibility with the specific payer or program before billing.
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Inadequate Documentation of Asynchronous Delivery: The medical record must clearly document: (1) that the service was provided via store-and-forward technology; (2) the date the data was collected at the originating site; (3) the date the provider reviewed the data at the distant site; and (4) the clinical findings and plan. Without this, -GQ cannot be supported on audit.
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Confusing -GQ with GT or -95: These three modifiers are NOT interchangeable. -GT = legacy interactive audio/video (now largely limited to institutional/CAH use); -95 = current standard synchronous audio/video; -GQ = asynchronous store-and-forward. Swapping them creates claim errors and compliance exposure.
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Assuming Uniform Commercial Payer Coverage: Commercial payer acceptance of -GQ is contract-specific. Some payers use -GQ; others use proprietary codes or require Modifier -95 for all telehealth regardless of synchronicity. Always pull the payer’s current telehealth billing guidelines before submitting.
📎 Sources
1 AMA CPT 2025 Professional Edition — Appendix P (Telehealth Services) and Modifier definitions 2 CMS Program Memorandum Intermediaries/Carriers — AB-01-69: Telemedicine Modifier GQ (Store-and-Forward, Alaska/Hawaii) 3 CMS Telehealth FAQ Calendar Year 2025 (CMS.gov, January 2025) 4 CMS Medicare Physician Fee Schedule Final Rule 2025 (CMS-1807-F) 5 ICD-10-CM Official Guidelines for Coding and Reporting FY2025 6 Center for Connected Health Policy (CCHP) — Store-and-Forward Telehealth Policy Tracker (2026) 7 Mend — “2026 Telemedicine Billing: GT, -95 & GQ Modifier Differences” (January 2026) 8 247MedicalBillingServices — “2026 Telemedicine Billing: GT, -95 & GQ Modifier Differences” (February 2026) 9 AAPC Knowledge Center — “Telehealth Modifiers GT and GQ” (2017; foundational reference) 10 Novitas Solutions Medicare JH — Telehealth Service Modifiers Policy (2026)