Medicare and commercial payers drastically changed the rules for telehealth billing. The biggest point of confusion for billers today is when to use Place of Service (POS) 02 versus POS 10.
The Difference Between POS 02 and 10
The distinction is entirely based on where the patient is located at the exact moment of the telehealth visit.
- POS 10 (Telehealth Provided in Patient''s Home): Use this if the patient is sitting in their house, apartment, or a temporary lodging (like a hotel) during the call.
- POS 02 (Telehealth Provided Other than in Patient''s Home): Use this if the patient is at a hospital, skilled nursing facility, or another clinic/office during the call.
Reimbursement Impacts
For Medicare, using POS 10 generally pays at the non-facility (higher) rate, reflecting that the provider maintains their own clinic overhead. POS 02 pays at the facility (lower) rate, assuming the facility where the patient is located is also getting paid.
Modifier 95 and NCCI Edits
Depending on the specific payer, you may still need to append Modifier 95 (Synchronous Telemedicine) to the E/M code along with the POS. Always verify your specific MAC guidelines.