Modifier GQ
A complete practical guide to Modifier GQ for medical billers, coders, AR callers and healthcare Revenue Cycle Management teams.
Learn what GQ means, how asynchronous telehealth differs from interactive telehealth, the specific Medicare requirement, Alaska and Hawaii Federal telemedicine demonstrations, claim review, denial handling and common billing mistakes.
Modifier GQ at a Glance
The most important facts before reporting GQ.
Asynchronous
GQ identifies telehealth furnished via an asynchronous telecommunications system.
Store & Forward
Medical information is collected and transmitted for later review rather than requiring a live interaction.
Alaska
Medicare’s specific GQ exception applies to qualifying Federal telemedicine demonstration projects in Alaska.
Hawaii
The same specific Federal telemedicine demonstration exception applies in Hawaii.
What Is Modifier GQ?
Understand the modifier before using it on a claim.
Official Concept
Modifier GQ represents services provided through an asynchronous telecommunications system.
In practical terms, this is commonly described as store-and-forward telehealth.
Medical information is collected at one point, transmitted electronically, and reviewed by the distant practitioner without requiring a real-time interactive encounter.
GQ Has a Very Specific Medicare Application
CMS states that when Medicare telehealth is furnished through asynchronous technology, the GQ modifier is used when the service is part of a Federal telemedicine demonstration conducted in Alaska or Hawaii.
The distant-site physician or practitioner is certifying that the asynchronous medical file was collected and sent from the Federal telemedicine demonstration.
Therefore, GQ should not be treated as a general-purpose modifier for every modern portal message, uploaded image, e-consult or asynchronous communication.
Asynchronous vs Synchronous Telehealth
The communication method is the key difference.
Asynchronous
- Store-and-forward communication.
- Information can be collected before the practitioner reviews it.
- No requirement for a simultaneous live interaction.
- GQ is the Medicare modifier associated with the specific asynchronous demonstration exception.
- Current Medicare use is limited to the applicable Federal demonstration context.
Synchronous
- Real-time communication.
- Practitioner and patient interact during the encounter.
- Audio-video technology may be used.
- Medicare professional telehealth uses applicable CPT/HCPCS and POS reporting.
- Do not use GQ simply because a service is delivered remotely.
Important
Asynchronous does not automatically mean GQ. The specific payer and program requirements must be verified. For Medicare, CMS’s current guidance ties GQ to the qualifying Federal telemedicine demonstration projects in Alaska or Hawaii.
What Does “Store-and-Forward” Mean?
A simple workflow for understanding asynchronous telehealth.
Modifier GQ and Medicare in 2026
The current rule is narrower than many older billing articles suggest.
Asynchronous Service
The telehealth service must be furnished through an asynchronous telecommunications system.
Federal Demonstration
CMS specifies the GQ exception for a Federal telemedicine demonstration project.
Alaska or Hawaii
The qualifying Federal demonstration context is conducted in Alaska or Hawaii.
Distant Site
The distant-site practitioner certifies that the asynchronous medical file was collected and transmitted from the qualifying demonstration.
Documentation
The MAC may require documentation showing participation in the applicable Federal telemedicine demonstration.
Verify Before Billing
GQ should not be appended simply because a patient and practitioner communicated asynchronously.
Major Billing Warning
A modern patient portal message, email, image upload or asynchronous e-consult should not automatically be billed with GQ to Medicare. The CMS rule is tied to the specific Federal telemedicine demonstration exception.
Why Alaska and Hawaii?
The historical Medicare telehealth exception was designed around Federal telemedicine demonstration programs in these states.
Federal Telemedicine Demonstration
CMS recognizes asynchronous, store-and-forward telehealth under the Federal telemedicine demonstration framework conducted in Alaska.
The GQ modifier identifies the applicable asynchronous telecommunications circumstance.
Federal Telemedicine Demonstration
The same Medicare exception applies to qualifying Federal telemedicine demonstration activity conducted in Hawaii.
The geographic and program-specific requirement is important when determining whether GQ can be reported.
Modifier GQ vs Modifier GT
Two telehealth modifiers with very different current Medicare applications.
| Feature | Modifier GQ | Modifier GT |
|---|---|---|
| Basic Concept | Asynchronous telecommunications / store-and-forward | Interactive audio-video telehealth |
| Current Medicare Professional Use | Specific Federal demonstration exception | Not routinely required |
| Geographic Demonstration | Alaska or Hawaii | Not the same geographic requirement |
| CAH Method II | Not the CAH Method II modifier | GT applies to the specified institutional CAH Method II telehealth billing context |
| Communication | Store-and-forward | Interactive communication |
| Main Risk | Using GQ for ordinary asynchronous communications | Using GT automatically on routine Medicare professional telehealth claims |
Easy Memory Trick
GQ = asynchronous / store-and-forward.
GT = historical interactive telehealth; current Medicare
use is specific, including CAH Method II institutional
billing.
Modifier GQ vs Modifier 95
Do not confuse asynchronous communication with synchronous audio-video telemedicine.
GQ — Asynchronous
- Store-and-forward.
- No simultaneous interaction is required.
- Medicare’s specific use is tied to qualifying Federal demonstrations in Alaska or Hawaii.
- Practitioner certifies the applicable asynchronous file transmission.
95 — Synchronous Audio-Video
- Real-time interactive audio-video.
- Different from store-and-forward communication.
- Payer-specific reporting requirements must be verified.
- Do not substitute 95 for GQ without confirming the applicable policy.
What Modifier GQ Is NOT
Avoid these common assumptions.
Not Every Portal Message
A patient portal message does not automatically become a Medicare GQ telehealth service.
Not Every E-Consult
An asynchronous clinical communication does not automatically meet the Medicare GQ exception.
Not Every Image Upload
Uploading a photograph or document for later review does not automatically justify GQ.
Not a Coverage Modifier
GQ does not independently establish Medicare coverage.
Not a Substitute for Eligibility
Provider eligibility and service eligibility must still be satisfied.
Not Universal Across Payers
Medicaid, Medicare Advantage and commercial payer rules can differ.
Modifier GQ Claim Review Workflow
A practical workflow for billers and AR callers.
Should I Use Modifier GQ?
Use this decision process before claim submission.
Asynchronous?
Was the service delivered through store-and-forward technology?
Medicare?
Is Original Medicare the payer?
Demonstration?
Is there qualifying Federal telemedicine demonstration participation?
AK / HI?
Is the applicable demonstration conducted in Alaska or Hawaii?
GQ?
If all applicable requirements are met, verify GQ reporting.
If Any Required Condition Is Missing
Do not assume GQ is appropriate. Stop and verify the applicable payer policy or Medicare rule before submitting the claim.
Modifier GQ Practical Examples
Simplified examples for medical billing education.
A qualifying Federal telemedicine demonstration project in Alaska uses asynchronous technology to collect and transmit a patient’s medical information to a distant practitioner.
This is the type of Medicare asynchronous telehealth situation for which CMS identifies GQ.
A distant-site practitioner participates in the qualifying Federal telemedicine demonstration in Hawaii and receives an asynchronous medical file.
Verify all applicable CMS requirements and documentation before billing.
A Medicare patient sends a message through a standard patient portal and the physician reviews it later.
The existence of asynchronous communication alone does not establish eligibility for the GQ modifier.
A commercial payer allows asynchronous telehealth under its own telehealth policy.
Do not automatically apply Medicare’s GQ rule to a commercial payer.
The patient and physician interact live through two-way audio-video technology.
This is a synchronous encounter, not an asynchronous store-and-forward encounter.
A claim is submitted with GQ, but the provider cannot demonstrate participation in the applicable Federal telemedicine demonstration.
CMS/MAC may require documentation supporting the qualifying demonstration participation.
Common Modifier GQ Billing Mistakes
Errors that can create unnecessary denials and rework.
Treating GQ as Universal
Assuming every asynchronous telehealth service qualifies for GQ.
Ignoring Alaska/Hawaii Rule
Missing the specific Medicare Federal demonstration requirement.
Confusing GQ With GT
GT and GQ identify different telehealth circumstances.
Confusing GQ With 95
95 is associated with synchronous audio-video telemedicine, not the same asynchronous GQ concept.
No Demonstration Proof
Failing to maintain documentation supporting participation in the qualifying Federal program.
Copying Old Claims
Repeating a historical claim configuration without verifying the current rule.
Ignoring CPT/HCPCS
A modifier does not make an otherwise ineligible service payable.
Ignoring POS
Other telehealth claim requirements still need to be satisfied.
No Payer Verification
Medicaid and commercial payer requirements may differ from Medicare.
AR Caller Workflow for a GQ Denial
Investigate the root cause before rebilling.
Review ERA/EOB
Identify the exact denied claim line and reason.
Capture CARC/RARC
Document all adjustment and remark codes.
Confirm Claim Type
Determine whether the claim is professional or institutional.
Identify Communication Type
Confirm asynchronous versus synchronous delivery.
Verify GQ Requirement
Determine whether the claim meets the specific GQ conditions.
Check AK/HI Demonstration
For Medicare, verify the qualifying Federal demonstration participation.
Check CPT/HCPCS
Verify the service’s telehealth eligibility.
Contact MAC/Payer
Confirm the exact processing rule and obtain a call reference.
Correct or Appeal
Take the action supported by the verified root cause.
AR Call Script — Modifier GQ Denial
Practical questions for a payer or Medicare Administrative Contractor.
Common GQ Denial Root Causes
Identify the real problem before changing the claim.
GQ Not Applicable
The claim does not meet the specific Medicare GQ conditions.
No Demonstration Participation
The provider cannot establish participation in the applicable Federal telemedicine demonstration.
Wrong State/Program
The claim does not fall within the specified Alaska or Hawaii demonstration context.
Wrong Communication Type
The service was synchronous rather than asynchronous.
Non-Eligible Service
The underlying CPT/HCPCS service is not payable under the applicable telehealth rule.
Incorrect Modifier
Another telehealth reporting requirement applies to the claim.
Documentation Missing
The medical record or billing documentation does not support the claim circumstances.
Payer-Specific Rule
A non-Medicare payer applies a different asynchronous telehealth policy.
Outdated Workflow
The billing team relied on a historical telehealth rule without checking current guidance.
GQ Documentation Checklist
Maintain enough documentation to support the service and modifier decision.
Clinical Documentation
- Date of service.
- Patient identification.
- Practitioner identification.
- Reason for service.
- Clinical information reviewed.
- Assessment and plan.
- Medical necessity.
- Applicable follow-up.
GQ / Telehealth Documentation
- Asynchronous modality documented.
- Store-and-forward process documented when required.
- Originating location documented as required.
- Distant-site practitioner identified.
- Applicable Federal demonstration participation documented.
- Alaska/Hawaii demonstration eligibility verified.
- CPT/HCPCS code verified.
- Modifier GQ requirement verified.
Medicare GQ Claim Edits
CMS provides specific processing instructions for claims submitted with GQ.
Covered Service
The underlying service must qualify as a covered Medicare telehealth service under the applicable requirements.
Demonstration
GQ claims are payable only when the practitioner is affiliated with the applicable Federal telemedicine demonstration in Alaska or Hawaii.
Documentation
The MAC may require evidence of participation in the Federal telemedicine demonstration before payment.
Provider Eligibility
The practitioner must be eligible to furnish and bill for the applicable service.
State Licensure
Medicare contractors also apply applicable state licensure requirements.
Correct Modifier
If GQ is reported when the service is not eligible for asynchronous telehealth, the claim can be denied.
Modifier GQ Quick Cheat Sheet
Keep this reference available during claim review.
- GQ = asynchronous telecommunications system.
- Asynchronous telehealth is commonly called store-and-forward.
- GQ is not a universal modifier for every asynchronous medical communication.
- For Medicare, CMS specifically identifies GQ for qualifying Federal telemedicine demonstration projects in Alaska or Hawaii.
- The distant-site practitioner certifies that the asynchronous medical file was collected and transmitted from the applicable demonstration.
- A MAC may require documentation of demonstration participation.
- GQ is different from GT.
- GQ is different from Modifier 95.
- A live video visit is not an asynchronous GQ encounter.
- A standard portal message does not automatically justify GQ.
- Always verify CPT/HCPCS eligibility and other telehealth requirements.
- For non-Medicare payers, verify the payer-specific policy.
Modifier GQ Claim Audit Table
Use this before submitting or correcting a claim.
| Audit Item | Question | Verify | Risk |
|---|---|---|---|
| Payer | Who is paying the claim? | Medicare / MA / Medicaid / Commercial | High |
| Communication | Was it asynchronous? | Store-and-forward versus live interaction | High |
| Demonstration | Does Medicare’s specific exception apply? | Federal telemedicine demonstration | High |
| Location | Is the qualifying demonstration in AK/HI? | Applicable program documentation | High |
| CPT/HCPCS | Is the service payable? | Current CMS/payer telehealth policy | High |
| Modifier | Is GQ specifically required? | Current payer/program instructions | High |
| Documentation | Can the provider support the claim? | Clinical and demonstration records | High |
How to Prevent GQ Denials
Put modifier verification into the RCM workflow.
Front-End Prevention
- Identify the payer before claim creation.
- Identify synchronous versus asynchronous encounters.
- Maintain a current telehealth policy matrix.
- Flag Federal demonstration claims separately.
- Confirm Alaska/Hawaii eligibility where applicable.
- Verify CPT/HCPCS telehealth eligibility.
- Capture required telehealth documentation.
- Document the source supporting GQ use.
Back-End Prevention
- Trend GQ-related denials.
- Track CARC/RARC combinations.
- Review demonstration documentation.
- Audit GQ claims by state.
- Review recurring modifier errors.
- Separate GQ, GT and 95 denial trends.
- Update billing matrices after CMS policy changes.
- Educate staff on current Medicare telehealth rules.
Official CMS References
Use primary CMS sources when verifying Modifier GQ.
Educational Disclaimer
This page is for US medical billing, coding and Revenue Cycle Management education. Telehealth requirements can vary by payer, provider type, service, claim type and date of service. Always verify the current CMS, MAC, Medicaid, Medicare Advantage or commercial payer instructions before submitting or appealing a claim.
Modifier GQ FAQs
Common questions for medical billers, coders and AR callers.
What does Modifier GQ mean?
Modifier GQ identifies telehealth services furnished via an asynchronous telecommunications system, commonly described as store-and-forward telehealth.
What is asynchronous telehealth?
Asynchronous telehealth means medical information is collected and transmitted for later review rather than requiring the patient and practitioner to communicate simultaneously.
Does Medicare still use Modifier GQ?
Yes, but its Medicare application is specific. CMS currently identifies GQ for asynchronous telehealth services provided as part of a Federal telemedicine demonstration project conducted in Alaska or Hawaii.
Is GQ required for every asynchronous Medicare service?
No. The GQ modifier should not be treated as a universal modifier for every asynchronous communication. The specific Medicare demonstration requirement must be met.
What is store-and-forward telehealth?
Store-and-forward telehealth involves collecting clinical information and transmitting it electronically to a distant practitioner for review at another time.
Why are Alaska and Hawaii important for Modifier GQ?
CMS’s Medicare claims-processing rules identify the asynchronous GQ exception in connection with Federal telemedicine demonstration programs conducted in Alaska and Hawaii.
Is GQ the same as GT?
No. GQ represents asynchronous telecommunications, while GT has been associated with interactive telehealth and currently has a specific Medicare application, including CAH optional Method II institutional billing.
Is GQ the same as Modifier 95?
No. GQ is associated with asynchronous telecommunications. Modifier 95 is associated with synchronous telemedicine using real-time interactive audio-video.
Can I use GQ for a patient portal message?
Not automatically. A portal message does not by itself satisfy the specific Medicare GQ requirements.
Can I use GQ for an e-consult?
Do not assume so. Verify the payer’s current policy and, for Medicare, determine whether the service qualifies under the specific GQ demonstration exception.
What documentation can Medicare request for GQ?
CMS states that the MAC may require the distant-site practitioner to document participation in the Federal telemedicine demonstration program before paying for asynchronous GQ services.
Does GQ guarantee payment?
No. The underlying service, provider eligibility, telehealth requirements, documentation and all other Medicare payment requirements must be satisfied.
Can Medicaid require GQ?
Medicaid programs and Medicaid managed care organizations may establish their own telehealth billing rules. Verify the applicable state Medicaid or MCO policy.
Can commercial insurance require GQ?
A commercial payer can establish its own telehealth reporting requirements. Do not automatically apply the Medicare GQ rule to commercial claims.
What should an AR caller check for a GQ denial?
Review the ERA/EOB, CARC/RARC, payer, claim type, asynchronous versus synchronous modality, CPT/HCPCS, GQ requirement, demonstration participation, documentation and effective date.
Can an old paid claim prove GQ is required today?
No. Historical claim processing does not establish the current billing rule. Verify the current rule applicable to the date of service.
Is GQ still relevant in 2026?
Yes. CMS’s current 2026 educational material continues to identify GQ for asynchronous telehealth in the qualifying Federal telemedicine demonstration context in Alaska or Hawaii.
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