Modifier FR is a HCPCS Level II telehealth modifier that identifies situations where the required supervising practitioner was present through real-time, two-way audio and video communication technology rather than being physically present.

CMS created Modifier FR effective January 1, 2022, as part of its telehealth updates. The modifier supports Medicare policies allowing virtual supervision for certain covered services when permitted by CMS regulations.

Modifier FR does not indicate that the patient received a telehealth visit. Instead, it identifies how the required supervision was provided.

Modifier

Modifier Name

Supervising Practitioner Present Through Real-Time Audio and Video Communication Technology

Plain English Explanation

Modifier FR tells the payer:

“The supervising physician or practitioner was not physically in the room but was immediately available through live, two-way audio and video communication technology.”

The patient may still receive services in a healthcare facility while supervision occurs virtually.

Purpose of Modifier FR

Modifier FR is used to:

Identify virtual supervision.
Document compliance with CMS supervision requirements.
Distinguish virtual supervision from physical presence.
Support Medicare payment when virtual supervision is permitted.
Identify services requiring supervisory presence through interactive technology.

Understanding Modifier FR

Modifier FR is not a telehealth visit modifier like Modifier 95.

Instead, it reports that:

A supervising physician was required.
The supervisor was immediately available.
The supervisor participated through real-time audio and video technology.

The practitioner furnishing the service and the supervising practitioner may be in different locations while remaining connected through secure interactive technology.

When to Use Modifier FR

Append Modifier FR when:

CMS or the payer permits virtual supervision.
The supervising practitioner is present through live two-way audio and video technology.
The service requires direct supervision.
Medicare specifically instructs reporting Modifier FR.

Examples include certain:

Mental health telehealth services.
Services requiring direct supervision when CMS allows virtual presence.
Other services specifically identified by Medicare or payer policy.

When NOT to Use Modifier FR

Do not use Modifier FR when:

The supervising practitioner is physically present.
No supervision requirement exists.
The encounter is a routine telehealth visit without virtual supervision.
Audio-only technology is used.
CMS or the payer does not permit virtual supervision for the service.

Medicare Rules

Under Medicare:

Modifier FR identifies that the supervising practitioner was present through real-time two-way audio and video communication technology.
It was introduced effective January 1, 2022.
It applies only when CMS requires or permits reporting of virtual supervision.
The supervising practitioner must be immediately available through interactive audio and video technology.
Modifier FR does not replace Modifier 95, FQ, GT, or POS codes because it reports supervision rather than the method of patient care delivery.

Commercial Insurance Rules

Commercial payer policies vary.

Some commercial insurers:

Recognize Modifier FR.
Follow Medicare supervision policies.
Do not require Modifier FR.
Use payer-specific supervision documentation requirements.

Always verify payer billing instructions before claim submission.

Documentation Requirements

Documentation should include:

Name of supervising practitioner.
Confirmation that supervision occurred through real-time audio and video technology.
Date and time of supervision.
Medical necessity.
Description of the supervised service.
Confirmation that the supervising practitioner was immediately available.
Provider signatures and credentials.

Real Billing Examples

Example 1 – Mental Health Service

A clinical staff member furnishes an eligible mental health service while the supervising psychiatrist is immediately available through secure audio-video technology.

Billing

Appropriate CPT/HCPCS code
Modifier FR (when required)

Example 2 – Virtual Direct Supervision

A physician supervises an eligible incident-to service remotely using a secure live audio-video connection under applicable CMS rules.

Billing

Appropriate CPT/HCPCS code
Modifier FR (if required by CMS or the payer)

Example 3 – Rural Clinic

A supervising physician participates through interactive audio-video communication while clinical staff perform the covered service.

Billing

Appropriate service code
Modifier FR

Example 4 – Behavioral Health

An eligible behavioral health service requires direct supervision. The supervising practitioner is virtually present through live audio-video technology.

Billing

Appropriate behavioral health code
Modifier FR

Example 5 – Incorrect Use

A supervising physician is physically present in the office.

Billing

Modifier FR

This is incorrect because Modifier FR is only used when supervision is provided through real-time audio-video technology rather than physical presence.

CMS-1500 Claim Example

Field	Example
CPT	99211 (example only when payer guidance requires FR)
Modifier	FR
POS	Appropriate POS
Diagnosis Pointer	F41.1 (Example)
Units	1

Common Denial Reasons

Modifier FR reported for services that do not allow virtual supervision.
Supervising practitioner not documented.
Audio-only technology used instead of audio-video.
Modifier reported unnecessarily.
Missing supervision documentation.
Incorrect modifier combination.
Payer does not recognize Modifier FR.

How to Correct the Denial

Verify payer policy regarding Modifier FR.
Confirm the supervising practitioner met CMS supervision requirements.
Review documentation supporting virtual supervision.
Remove Modifier FR if not applicable.
Submit a corrected claim.
Appeal with supporting documentation if appropriate.

Coding Tips

Modifier FR reports virtual supervision, not telehealth visits.
Use only when CMS or the payer specifically requires it.
Ensure supervision uses real-time audio and video, not audio-only.
Maintain detailed supervision documentation.
Verify annual Medicare supervision policy updates.

Modifier FR vs Modifier 95

Modifier	Description
FR	Virtual supervision by the supervising practitioner
95	Telehealth service furnished through live audio-video technology

Modifier FR vs Modifier FQ

Modifier	Description
FR	Virtual supervision
FQ	Audio-only telehealth service

Modifier FR vs Modifier GT

Modifier	Description
FR	Supervising practitioner present virtually
GT	Telehealth service performed through live audio-video technology

Modifier FR vs Modifier GQ

Modifier	Description
FR	Real-time virtual supervision
GQ	Asynchronous (store-and-forward) telemedicine

Frequently Asked Questions (FAQs)

Q1. What does Modifier FR mean?

Answer: It identifies that the required supervising practitioner was present through real-time two-way audio and video communication technology.

Q2. Is Modifier FR the same as Modifier 95?

Answer: No. Modifier 95 identifies a telehealth service, while Modifier FR identifies virtual supervision of a service.

Q3. Does Modifier FR mean the patient received telehealth?

Answer: No. The patient may receive services in person while the supervising practitioner participates virtually.

Q4. Can Modifier FR be used with audio-only supervision?

Answer: No. CMS requires real-time two-way audio and video communication technology for Modifier FR.

Q5. Does every payer recognize Modifier FR?

Answer: No. Recognition varies by payer. Always verify payer-specific billing requirements before submitting claims.

AR Caller Tips

When following up on claims billed with Modifier FR:

Verify that the payer accepts Modifier FR.
Confirm the service qualifies for virtual supervision.
Review documentation showing the supervising practitioner was immediately available.
Confirm audio-video technology—not audio-only—was used.
Record the payer representative’s name, reference number, and appeal instructions.

Interview Questions

Question 1

What does Modifier FR indicate?

Answer: The supervising practitioner was present through real-time two-way audio and video communication technology.

Question 2

Does Modifier FR indicate a telehealth visit?

Answer: No. It identifies virtual supervision, not the method by which the patient received care.

Question 3

Can Modifier FR be reported when the supervising physician is physically present?

Answer: No. It applies only when supervision occurs virtually through audio-video technology.

Question 4

Can Modifier FR be used with audio-only supervision?

Answer: No. CMS requires real-time audio and video communication.

Practice Scenario

Scenario

A nurse furnishes an eligible Medicare service requiring direct supervision. The supervising physician is immediately available through a secure two-way audio-video connection but is not physically in the clinic.

Question

Which modifier should be appended if CMS requires reporting?

Answer

Report the appropriate CPT/HCPCS code with Modifier FR, because the supervising practitioner was present virtually through real-time audio and video communication technology.

Related Telehealth Modifiers

95 – Synchronous Telemedicine Service Rendered via Real-Time Interactive Audio and Video Telecommunications System
93 – Synchronous Telemedicine Service Rendered via Audio-Only Telecommunications System
FQ – Service Furnished Using Audio-Only Communication Technology
GT – Via Interactive Audio and Video Telecommunications System
GQ – Via Asynchronous Telecommunications System

Common Billing Mistakes

Using FR for ordinary telehealth visits.
Reporting FR when the supervisor was physically present.
Using FR with audio-only supervision.
Omitting supervision documentation.
Applying FR when the service does not permit virtual supervision.
Assuming all payers recognize Modifier FR.

Key Takeaways

Modifier FR identifies that the supervising practitioner was present through real-time two-way audio and video communication technology.
It reports virtual supervision, not a telehealth encounter.
CMS introduced Modifier FR in 2022 for specific Medicare telehealth and supervision policies.
Audio-only communication does not qualify for Modifier FR.
Thorough documentation of virtual supervision is essential for compliant billing and successful reimbursement.

References

CMS Change Request 12549 – CY 2022 Telehealth Update Medicare Physician Fee Schedule.
Noridian Modifier FR Guidance
CMS Medicare Physician Fee Schedule Final Rule (Virtual Supervision Policies).
HCPCS Level II Code Book.
CPT® Professional Edition (American Medical Association).

Conclusion

Modifier FR is a specialized HCPCS Level II modifier that documents virtual supervision rather than telehealth care. It indicates that the supervising practitioner met Medicare’s supervision requirement by being immediately available through real-time, two-way audio and video communication technology. Correct use of Modifier FR requires careful attention to CMS guidance, payer-specific policies, and complete documentation demonstrating compliant virtual supervision.

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 Final Rule, HCPCS Level II Code Book, CPT® Professional Edition, applicable Local Coverage Determinations (LCDs), National Coverage Determinations (NCDs), and payer-specific telehealth billing policies before coding, billing, or submitting claims.