POS 02 vs POS 10: Why Telehealth Claims Are Still Getting Rejected

Telehealth has come a long way from being a niche offering to becoming a core component of modern care delivery. During the COVID-19 pandemic, it was a lifeline, enabling providers to continue treating patients while minimizing exposure. 

But even as the pandemic subsided, telehealth didn’t fade. It evolved. In 2025, it’s not just a convenience — it’s a strategic necessity for practices looking to stay competitive, accessible, and efficient.

However, with significant expansion came great complexity.

One of the biggest ongoing headaches for providers and billing teams is telehealth claim denials due to incorrect Place of Service (POS) codes. Despite updated CMS guidance and payer-specific protocols, many practices are still seeing rejections tied to a straightforward issue: mixing up POS 02 and POS 10.

This blog dives into what these codes really mean, why they matter, and how to stop the cycle of denied telehealth claims.

Understanding POS 02 and POS 10

To bill telehealth correctly, you need to start with the basics, and nothing is more fundamental than using the proper Place of Service (POS) code. Introduced to help payers identify the context in which care was delivered, POS codes affect how much or whether you get reimbursed.

Let’s break down the difference:

POS 02: Telehealth Provided Other Than in Patient’s Home

This code is used when a telehealth service is provided to a patient who is not located in their home, such as when they’re at a hospital, nursing facility, or even a school. POS 02 tells the payer the service occurred via telecommunication, but in a professional or institutional setting.

Use POS 02 when:

• The patient is at a medical facility or any non-residential setting
  
• You’re delivering care virtually but not directly into the patient’s home.

📝 Reimbursement Note: In many cases, POS 02 is reimbursed at the facility rate, which can be significantly lower than the non-facility rate.

POS 10: Telehealth Provided in Patient’s Home

This code was introduced in 2022 by CMS to improve payment clarity post-pandemic. It applies when the patient is located at home during the telehealth service, whether it’s a video consult, behavioral health check-in, or remote management visit.

Use POS 10 when:

• The patient is physically at home, even if temporarily
  
• The service is performed via telecommunication technology.

📝 Reimbursement Note: POS 10 often qualifies for higher non-facility rates, which means you get paid more for the same service, just based on where the patient is.

Why is there still confusion while billing them? 

Despite clear definitions, many practices:

• Default to POS 02 out of habit
  
• Aren’t updating their EHR/PM systems correctly
  
• Misunderstand which code commercial or government payers require

And guess what? Payers are watching, and incorrect POS codes will be one of the top reasons for telehealth denials in 2024–2025.

💡 Pro Tip: Always double-check your patient’s location at the time of service and make sure your system is auto-populating the correct POS. Consider training the front desk or scheduling staff to verify this upfront.

Why Telehealth Claims Are Still Getting Rejected in 2025

Despite the widespread adoption of telehealth and updated CMS guidance, claim rejections are still frustratingly standard in 2025. Why? Many providers are overlooking the nuances in payer rules and billing protocols. Here are the most common reasons:

1. Mismatched POS and Modifier Combinations

Even if you’re using the correct Place of Service code (POS 10 for home-based telehealth, for example), some payers still require modifier 95 to indicate the visit was synchronous (real-time audio and video).

Know the required POS + modifier combos for each major payer. Some still need GT (especially Medicaid plans), while others are strictly 95-only.

2. Outdated Payer Policies

Not all payers are on the same page. While Medicare has updated its policies post-pandemic, many commercial payers and Medicaid plans vary by state. What’s reimbursable for one insurer might not be for another.

3. Improper Patient Location Documentation

It’s not enough to just use POS 10 — you need proof that the patient was actually at home. If audited, missing documentation can lead to recoupments. 

Add a pre-charting checkbox or auto-note in your EHR that captures patient location at the start of the visit.

4. Claim System Defaults Still Set to POS 02

Some billing or EHR systems haven’t updated their default settings, especially if you’ve been using POS 02 since 2020. This leads to incorrect coding even when staff enter the correct information.

Work with your RCM or tech vendor to ensure telehealth visit types are mapped correctly to POS 10 (or POS 02, when appropriate).

5. Missing Provider Type Eligibility

Not all provider types are eligible for telehealth reimbursement under all plans. For example, some Medicaid programs only reimburse MDs, DOs, and NPs, not PTs or LCSWs.

Review payer guidelines for eligible provider types before billing. Even better — integrate this logic into your scheduling workflow.

POS 02 vs. POS 10, What’s the difference? 

Understanding the difference between Place of Service (POS) 02 and POS 10 isn’t just a coding formality—it directly affects how much you get paid and whether your telehealth claim even gets processed.

What’s the Actual Difference?

• POS 02: Telehealth provided anywhere except the patient’s home. Commonly used for clinics, schools, or other facilities.
  
• POS 10: Telehealth services are provided while the patient is in their home. They were introduced in 2022 to reflect the explosion of home-based telehealth visits.

When to Use Which?

How to Fix Your Telehealth Billing Denials

Even the slightest mistake in your telehealth billing workflow can lead to denied claims or reduced reimbursements. But the good news? Most of them are easily fixable once you know what to look for.

Start with Your Coding Accuracy

• CPT Codes Must Match Telehealth Services
  Make sure you’re using telehealth-eligible CPT codes (e.g., 99201–99215 with appropriate documentation).
  
• Modifiers Matter More Than Ever
  • Modifier 95: For real-time synchronous telemedicine, often required for POS 10 or 02.
    
  • Modifier GT: Still used by some payers, especially in Medicaid plans.

Map Your Workflow: Front Desk to Submission

1. Patient Scheduling
   → Capture the location at the time of the visit (ask: “Will you be at home or another facility?”)
   
2. Provider Notes
   → Include location details and tech used (video/phone) in documentation.
   
3. Billing Entry
   → Apply correct POS + modifiers + CPT.
   
4. Claims Scrubbing
   → Use software rules or RCM QA to flag location/modifier mismatches before submission.

Common Issues That Cause Denials (and Quick Fixes)

Why Some Still Reject POS 10 Claims

Even when you do everything right—correct code, modifier, and place of service—some payers still reject POS 10 claims. Why? Because payer policies haven’t all caught up with CMS guidelines, or remain inconsistent across states.

CMS vs. Commercial Payers: A Policy Lag

• CMS (Medicare) officially recognizes POS 10 as of January 1, 2022.
  It indicates a patient received telehealth services in their home, ensuring lower facility reimbursements.
  
• But Commercial Payers?
  Some still process POS 02 as the default for all telehealth claims. Others haven’t updated their systems or portals to support POS 10, leading to claim rejections, edits, or delays.

A BCBS payer in one state may still treat POS 10 as invalid, while another accepts it—same provider, same claim, different result.

Key Reasons Payers Reject POS 10

The Future of Telehealth POS Codes: What to Expect in 2025?

The telehealth landscape isn’t done evolving—and neither are the billing rules around it. As virtual care becomes more integrated into standard practice, POS codes and payer policies will continue to shift. So what’s coming next?

CMS Is Watching and So Should You

CMS is constantly evaluating data around telehealth utilization, cost-effectiveness, and patient outcomes. In 2025, you can expect:

• Further clarity on POS 10 vs. 02
  CMS may publish updated guidance or remove ambiguities that still create confusion in the field.
  
• New modifiers or POS codes for hybrid models
  As care blends in-person with virtual, expect codes that distinguish between live video, phone-only, and asynchronous care.
  
• Permanent changes from temporary pandemic-era policies
  Many flexibilities were extended through 2024. Keep an eye out for which ones become permanent in 2025.

Commercial Payers Will (Eventually) Catch Up

Although they lag behind CMS, commercial payers are:

• Adjusting portals and EDI systems to recognize POS 10.
  
• Conducting internal audits on telehealth claim denials and appeals.
  
• Offering more direct guidance in provider manuals as complaints and appeals pile up.

Still, don’t expect instant change. Your best defense is to manage your billing based on current payer behaviors actively.

What You Should Be Doing Now

• Subscribe to CMS & MAC email updates to stay ahead of federal policy changes.
  
• Join payer webinars and forums—most host quarterly sessions with billing updates.
  
• Train staff quarterly on the latest POS + modifier changes per payer.

How to Fix Telehealth Claim Denials: A Checklist

Even when you’re doing everything almost right, minor missteps in telehealth billing can trigger costly denials. Here’s a battle-tested checklist to help you fix—or better yet, prevent—those frustrating rejections related to POS 02 and POS 10.

• 1. Verify the POS Code by Patient Location
• 2. Use the Correct Telehealth Modifiers
• 3. Match CPT Codes with Approved Telehealth Services
• 4. Clean Up Provider Credentialing for Virtual Care
• 5. Run a Telehealth Denial Audit Every 90 Days

Not sure where your denials are coming from? We offer a free Telehealth Billing Audit to help you:

• Spot coding errors
  
• Optimize POS usage
  
• Reduce denial rates
  
• Improve first-pass claim acceptance.