Modifier GQ is a HCPCS Level II telehealth modifier that identifies healthcare services furnished via an asynchronous telecommunications system, also known as store-and-forward telemedicine.

Unlike Modifier 95 and Modifier GT, which identify live, real-time audio and video telehealth services, Modifier GQ identifies situations where clinical information is captured, stored, and transmitted electronically to another healthcare professional for later review.

Under current Medicare rules, Modifier GQ has extremely limited applicability. Medicare only recognizes Modifier GQ for providers participating in Federal telemedicine demonstration programs conducted in Alaska or Hawaii. It is not appropriate for routine Medicare telehealth claims.

Modifier

Modifier Name

Via Asynchronous Telecommunications System

Plain English Explanation

Modifier GQ tells the payer:

“This service was performed using store-and-forward technology instead of a live audio-video interaction.”

The provider reviews medical information that was transmitted electronically after it was collected rather than interacting with the patient in real time.

Purpose of Modifier GQ

Modifier GQ is used to:

Identify asynchronous telemedicine services.
Distinguish store-and-forward technology from live telehealth.
Support billing under Medicare’s Alaska and Hawaii Federal telemedicine demonstration projects.
Identify services reviewed after electronic transmission of clinical information.
Comply with payer-specific telemedicine policies.

Understanding Modifier GQ

“Asynchronous” means the patient and provider are not communicating simultaneously.

Instead:

Clinical information is collected.
Images, videos, ECGs, pathology slides, radiology studies, or other medical data are electronically transmitted.
The distant-site practitioner reviews the information later.
Recommendations or interpretations are communicated afterward.

Examples include:

Dermatology image review
Retinal image interpretation
Radiology consultation
Digital pathology review
Wound photograph evaluation

Unlike synchronous telehealth, there is no live two-way audio-video encounter.

When to Use Modifier GQ

Append Modifier GQ only when:

The payer specifically requires Modifier GQ.
The service qualifies as asynchronous telemedicine.
The provider participates in a Medicare-approved Federal telemedicine demonstration program in Alaska or Hawaii.
State Medicaid or a commercial payer specifically recognizes asynchronous telemedicine with Modifier GQ.

Common CPT/HCPCS Codes

Modifier GQ may be appended, when allowed by payer policy, to eligible professional services such as:

CPT/HCPCS Code	Description
99202–99215	Office or outpatient E/M services (payer-specific)
G0425–G0427	Telehealth consultation services
Consultation codes or specialty interpretation services	When specifically permitted by payer policy

Important: Medicare generally limits GQ billing to the Alaska and Hawaii Federal demonstration projects. Routine Medicare telehealth services should not be billed with Modifier GQ.

When NOT to Use Modifier GQ

Do not use Modifier GQ when:

The encounter uses live audio and video (use Modifier 95 or GT if required by the payer).
The visit is conducted in person.
The service is audio-only.
The payer does not recognize asynchronous telemedicine.
Billing routine Medicare telehealth services outside the approved demonstration programs.

Medicare Rules

Current Medicare policy provides:

Modifier GQ is reserved for Federal telemedicine demonstration programs conducted in Alaska and Hawaii.
It certifies that the service was furnished using store-and-forward telecommunications technology.
Medicare contractors generally deny GQ claims when the provider is not participating in one of these demonstration programs.
Routine Medicare telehealth services use standard telehealth billing policies, including POS 02 or POS 10 where applicable, rather than Modifier GQ.

Commercial Insurance Rules

Commercial payer policies vary considerably.

Some payers:

Recognize asynchronous telemedicine.
Require Modifier GQ.
Require proprietary telehealth modifiers.
Require no modifier at all.
Require prior authorization.

Always verify payer-specific billing instructions before claim submission.

Documentation Requirements

Documentation should include:

Patient consent (if required).
Description of the asynchronous technology used.
Date and time clinical information was received.
Date and time physician review occurred.
Medical necessity.
Clinical findings.
Assessment and recommendations.
Provider signature and credentials.

Real Billing Examples

Example 1 – Dermatology Consultation

A primary care physician uploads photographs of a suspicious skin lesion. A dermatologist reviews the images the following day and provides treatment recommendations.

Billing

Appropriate consultation or E/M code
Modifier GQ (only if permitted by payer policy)

Example 2 – Retinal Image Review

A diabetic retinal image is electronically transmitted to an ophthalmologist for interpretation.

Billing

Appropriate interpretation code
Modifier GQ (payer-specific)

Example 3 – Alaska Demonstration Project

A provider participating in a Federal telemedicine demonstration program in Alaska reviews electronically transmitted patient data.

Billing

Appropriate CPT/HCPCS code
Modifier GQ

Example 4 – Hawaii Demonstration Project

A physician reviews wound photographs submitted electronically through an approved Federal demonstration project.

Billing

Appropriate CPT/HCPCS code
Modifier GQ

Example 5 – Incorrect Use

A physician conducts a live video telehealth visit and reports:

CPT 99214
Modifier GQ

This is incorrect because the encounter was synchronous. Modifier GQ applies only to asynchronous telecommunication systems.

CMS-1500 Claim Example

Field	Example
CPT	99213 (payer-specific example)
Modifier	GQ
POS	Payer-specific
Diagnosis Pointer	L98.9 (Example)
Units	1

Common Denial Reasons

Modifier GQ used for routine Medicare telehealth.
Provider not participating in an approved Federal demonstration project.
Incorrect telehealth modifier.
Service not eligible for asynchronous telemedicine.
Missing documentation.
Incorrect Place of Service.
Payer does not recognize Modifier GQ.

How to Correct the Denial

Verify whether the payer recognizes Modifier GQ.
Confirm the service was asynchronous.
Verify provider eligibility for the Medicare demonstration project, if applicable.
Replace the modifier if the service was actually synchronous.
Submit a corrected claim.
Appeal with supporting documentation when appropriate.

Coding Tips

Remember that GQ means asynchronous, not live telehealth.
Do not confuse GQ with Modifier 95 or GT.
Verify payer-specific requirements before billing.
Medicare rarely accepts Modifier GQ outside Alaska and Hawaii demonstration programs.
Thoroughly document the electronic transmission and delayed clinical review.

Modifier GQ vs Modifier 95

Modifier	Description
GQ	Asynchronous (store-and-forward) telemedicine
95	Live, real-time audio and video telehealth

Modifier GQ vs Modifier GT

Modifier	Description
GQ	Asynchronous telecommunication
GT	Interactive real-time audio and video telecommunication

Modifier GQ vs Modifier 93

Modifier	Description
GQ	Store-and-forward telemedicine
93	Audio-only synchronous telehealth

Modifier GQ vs POS 02

Code	Purpose
GQ	Identifies asynchronous telemedicine
POS 02	Indicates telehealth furnished when the patient is located somewhere other than home

Frequently Asked Questions (FAQs)

Q1. What does Modifier GQ mean?

Answer: It identifies services furnished through an asynchronous (store-and-forward) telecommunications system.

Q2. Does Medicare routinely accept Modifier GQ?

Answer: No. Medicare generally limits Modifier GQ to Federal telemedicine demonstration programs in Alaska and Hawaii. Routine Medicare telehealth services should not be billed with Modifier GQ.

Q3. What is the difference between Modifier GQ and Modifier 95?

Answer: Modifier GQ is used for asynchronous (store-and-forward) services, while Modifier 95 identifies live, real-time audio and video telehealth.

Q4. Can commercial insurance require Modifier GQ?

Answer: Yes. Some commercial insurers and state Medicaid programs recognize asynchronous telemedicine and may require Modifier GQ. Requirements vary by payer.

Q5. Can Modifier GQ be used for audio-only services?

Answer: No. Modifier GQ is for store-and-forward technology, not telephone-only or live audio encounters.

AR Caller Tips

When following up on claims billed with Modifier GQ:

Verify whether the payer recognizes Modifier GQ.
Confirm the service was asynchronous.
Determine whether the payer requires a different telehealth modifier.
Verify provider eligibility if billing Medicare demonstration project services.
Record the payer representative’s name, reference number, and appeal instructions.

Interview Questions

Question 1

What does Modifier GQ represent?

Answer: Services furnished through an asynchronous (store-and-forward) telecommunications system.

Question 2

Does Medicare routinely reimburse Modifier GQ?

Answer: No. Medicare generally limits GQ to Federal telemedicine demonstration projects in Alaska and Hawaii.

Question 3

What is the difference between Modifier GQ and Modifier 95?

Answer: GQ is asynchronous (store-and-forward), while 95 is synchronous live audio-video telehealth.

Question 4

Can Modifier GQ be used for live video visits?

Answer: No. Live video encounters use synchronous telehealth billing rules, not Modifier GQ.

Practice Scenario

Scenario

A physician participating in a Federal telemedicine demonstration project in Alaska reviews wound images electronically submitted by a rural clinic. The review occurs several hours after the images are transmitted.

Question

Which modifier should be appended?

Answer

Report the appropriate CPT/HCPCS code with Modifier GQ, because the service was furnished using an asynchronous telecommunications system within an approved Medicare demonstration project.

Related Telehealth Modifiers

95 – Synchronous Telemedicine Service Rendered via Real-Time Interactive Audio and Video Telecommunications System
GT – Via Interactive Audio and Video Telecommunications System
93 – Synchronous Telemedicine Service Rendered via Audio-Only Telecommunications System
FQ – Audio-only Communication Technology
FR – Supervising Practitioner Present Through Real-Time Audio and Video Technology

Common Billing Mistakes

Using GQ for live video telehealth.
Reporting GQ on routine Medicare telehealth claims.
Confusing asynchronous with audio-only services.
Billing GQ when the payer does not recognize it.
Omitting documentation supporting store-and-forward technology.
Using the wrong Place of Service.

Key Takeaways

Modifier GQ identifies asynchronous (store-and-forward) telemedicine services.
It is fundamentally different from Modifiers 95 and GT, which identify live audio-video telehealth.
Medicare generally limits GQ to Federal telemedicine demonstration programs in Alaska and Hawaii.
Commercial payer policies vary and should always be verified before billing.
Proper documentation is essential to support asynchronous telemedicine services.

References

CMS Medicare Claims Processing Manual, Chapter 12 – Section 190.6.2 (Store-and-Forward Telehealth).
Noridian Medicare – Modifier GQ Guidance.
HCPCS Level II Code Book.
CPT® Professional Edition (American Medical Association).

Conclusion

Modifier GQ is a specialized telehealth modifier used to identify asynchronous (“store-and-forward”) telecommunications services. Unlike live telehealth modifiers, GQ applies only when clinical information is collected, transmitted, and reviewed at different times. Under Medicare, its use is generally restricted to Federal telemedicine demonstration programs in Alaska and Hawaii, while some commercial payers and Medicaid programs may have broader applications. Understanding the distinction between synchronous and asynchronous telemedicine is essential for accurate coding, compliant billing, and successful reimbursement.

Educational Disclaimer

This article was prepared with the assistance of artificial intelligence (AI) for educational and informational purposes. It is based on publicly available CMS guidance, Medicare telehealth policies, HCPCS Level II guidance, and general medical coding principles. It is not an official publication of CMS or the American Medical Association (AMA). Always consult the latest CMS Medicare Claims Processing Manual, Medicare Physician Fee Schedule, HCPCS Level II Code Book, CPT® Professional Edition, and payer-specific telehealth billing policies before coding, billing, or submitting claims.