POS 10 pays $31.73 more than POS 02 on a Medicare telehealth therapy hour

Medicare’s 2026 national rate for a 60-minute telehealth psychotherapy session is $167.00 if the claim carries POS 10 and $135.27 if it carries POS 02.10 cms.gov Same clinician, same session, same video call. $31.73 of difference, decided by one digit.

The digit is not a preference. POS 02 sits on the CMS list of settings paid at the facility rate; POS 10 sits on the list paid at the non-facility rate.2 cms.gov CMS made that explicit in Transmittal 12671, which told MACs that claims for covered telehealth using POS 10 “shall be paid at the Medicare Physician Fee Schedule non-facility rate,” effective for dates of service on or after 1 January 2024.1 cms.gov

What separates the two codes is where the patient is

POS 02 is “Telehealth Provided Other than in Patient’s Home.” POS 10 is “Telehealth Provided in Patient’s Home,” defined by CMS as a private residence other than a hospital or other facility. Both descriptors turn on the patient’s location. Neither says anything about where the clinician is sitting.3 cms.gov

That is the single most common error in this area. A therapist working from home who bills POS 02 because she is not in the office has just cut her own rate by roughly a quarter. CMS’s position on the distant-site practitioner is separate and unambiguous: a practitioner with a physical practice location who provides telehealth from home is not required to report the home address, and bills from the practice location as if the service had been furnished in person.4 cms.gov

The differential across the behavioral health codes

National unadjusted, standard conversion factor 33.4009. Source: CMS Physician Fee Schedule, 2026 Indicators.10 cms.gov 90849 was added to the Medicare Telehealth Services List for CY 2026.8 cms.gov

The E/M codes carry the widest spread — a psychiatrist billing 99214 loses $51.10 on a misplaced POS, a gap worth 60% of the facility rate itself. The individual and group psychotherapy codes cluster tighter, between 23% and 25%, because their practice expense is thinner to begin with.

A prescriber running four 99214 med-check telehealth visits a day, five days a week, is looking at roughly $53,000 a year riding on a two-character field.

Six modifiers, and what CMS actually instructs for each

Read CMS’s own professional-billing instructions and modifier 95 is conspicuously absent. The December 2025 MLN telehealth booklet tells professional billers to submit the CPT or HCPCS code, add GQ for asynchronous, and use GT for CAH Method II — and reserves 95 for institutional billing.8 cms.gov The Claims Processing Manual states flatly that Medicare telehealth services “are billed with POS 02 and 10.”2 cms.gov For a PFS professional claim, the POS is what CMS keys on.

None of that makes 95 safe to drop. MACs and commercial payers run their own edits, and plenty of them still reject a telehealth line without it. The point is narrower: appending 95 does not fix a wrong POS, and no modifier converts a facility rate into a non-facility one.

Audio-only is the case where a modifier is genuinely load-bearing. 42 CFR 410.78(a)(3) permits audio-only for any telehealth service to a patient in their home when the practitioner is capable of video and the patient is not capable of, or does not consent to, using it — and requires CPT modifier 93 on the claim to verify those conditions were met, plus modifier FQ for RHCs and FQHCs.6 ecfr.gov

Behavioral health is the carve-out, and it is the only one that is permanent

The Consolidated Appropriations Act, 2021 permanently removed geographic and site-of-service restrictions for behavioral health telehealth, including substance use disorder services. Urban and rural beneficiaries alike can receive it at home, and two-way audio-only technology is permitted.4 cms.gov

Everything else runs on a clock, and the clock has been reset repeatedly. The current reset came from the Consolidated Appropriations Act, 2026 (Pub. L. 119-75, 3 February 2026). Section 6209(a) and (b) pushed the general geographic, originating-site and eligible-practitioner flexibilities from 30 January 2026 to 31 December 2027. Section 6209(d) pushed the mental health in-person visit requirement to 1 January 2028. Section 6209(e) pushed the general audio-only allowance to the same date.5 federalregister.gov

From 1 January 2028, absent another extension, general telehealth reverts: the patient must generally be in a rural area and in a medical facility. Behavioral health does not revert.4 cms.gov

Two things about the in-person requirement are easy to get wrong. It is a 6-month look-back before the first mental health telehealth service in the home, then an in-person service every 12 months, with a documented-risk exception and the option for a same-specialty colleague in the same group to furnish it. And CMS has said patients who began receiving mental health telehealth on or before 31 December 2027 are treated as established — they face the 12-month rule, not the 6-month look-back.4 cms.gov

A caution for anyone reading the regulation instead of the statute: 42 CFR 410.78(b)(3)(xiv) still reads “ending on December 31, 2024,” because the extensions arrived as legislation and the regulatory text trails behind.6 ecfr.gov CMS said in the CY 2027 proposed rule that § 410.78 has been revised to align.5 federalregister.gov Treat the reg text as lagging, not as current law.

Two new modifiers arrive 1 January 2027

Section 6209(g) of the CAA, 2026 requires CMS to establish telehealth modifiers effective 1 January 2027 for two situations: services furnished through a virtual telehealth platform where the practitioner contracts with, or has a payment arrangement with, the entity that owns the platform; and services furnished incident to a physician’s or practitioner’s professional service. CMS said in the CY 2027 PFS proposed rule that it is creating modifiers BB and BC, that the modifiers do not affect payment, and that guidance on their use will follow on the CMS website.5 federalregister.gov

CMS has not yet published which descriptor attaches to which modifier. Anything you read that assigns them specifically is guessing. This one matters most to virtual-first behavioral health groups, which is to say a large share of the sector.

Before you change anything

Every figure above is national and unadjusted, and geographic practice cost indices move real rates in both directions. Run your own POS distribution first: pull twelve months of telehealth claims, split them 02 against 10, and check whether the split matches where your patients actually were. In most behavioral health practices it should be lopsided toward 10, and when it is not, the reason is usually a default in the EHR rather than a fact about the patient.