What POS code should I use for a telehealth visit?

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Use POS 10 if the patient is in their home during the telehealth visit, or POS 02 if the patient is at any other location (such as an office, clinic, or facility).

Choosing the Correct POS Code

  • POS 10 (Telehealth in Patient's Home): Use this code when the patient connects from their personal private residence. This usually triggers a non-facility payment rate.
  • POS 02 (Telehealth Other than Patient's Home): Use this code when the patient is located somewhere outside of a private home, such as a nursing facility, clinic, or outpatient department. This typically triggers a facility payment rate.
  • POS 11 (Office): Some commercial insurance plans prefer or require using the traditional office code if the provider is actively transmitting from their physical office, though you should verify specific payer rules.

Essential Billing Additions

  • Modifiers: Pair your POS code with Modifier 95 for live, real-time audio and video interactions. Use Modifier 93 for approved audio-only (telephone) phone consultations.
  • Payer Guidelines: Always check requirements with your specific Medicare Administrative Contractor (MAC) or commercial insurance provider, as exact rules and allowable codes vary by plan.

What POS should be used for telehealth?

For telehealth billing, you should use either POS 10 (Telehealth Provided in Patient's Home) or POS 02 (Telehealth Provided Other than in Patient's Home), depending on where the patient is physically located during the service.

Place of Service (POS) Codes

  • POS 10 (Home): Use this code when the patient is located in a private residence or at-home setting during the telehealth visit. This typically triggers the higher non-facility (in-office equivalent) payment rate.
  • POS 02 (Other than Home): Use this code when the patient is located in a setting other than their home, such as a hospital, clinic, or other healthcare facility. This typically triggers the lower facility payment rate.

Key Billing Requirements

  • Location Determination: The POS code must reflect the patient's location, not the provider's physical office.
  • Modifiers: Append appropriate modifiers like Modifier 95 for synchronous live audio-video communication or Modifier 93 for audio-only encounters, as required by your payer.
  • Official Guidelines: You can review further specifics via the CMS Telehealth FAQ Document.

Is POS 02 or 10 for telehealth?

Both POS 02 and POS 10 are valid Place of Service (POS) codes for telehealth, but you must choose the correct one based on where the patient is located during the visit.

  • POS 10 (Telehealth Provided in Patient's Home): Use this code when the patient is in their home (private residence or temporary lodging like a hotel) at the time of the virtual visit.
  • POS 02 (Telehealth Provided Other than in Patient's Home): Use this code when the patient is at a location other than their home, such as a clinic, office, skilled nursing facility, or hospital.

Key Payment Differences

  • POS 10 is generally paid at the non-facility rate (which is typically higher).
  • POS 02 is generally paid at the facility rate (which is typically lower).

What is the code for a telehealth visit?

For standard outpatient telehealth visits, you generally use regular office evaluation and management (E/M) codes—such as CPT 99202–99205 for new patients or CPT 99211–99215 for established patients—paired with a telehealth place of service (POS) and modifier.

Because coding rules depend heavily on whether you are billing Medicare or a commercial insurer, follow the specific guidelines for each payer type.

Medicare Fee-for-Service

Medicare does not use dedicated telehealth CPT codes for standard visits; instead, you report standard office codes with specific location and modifier indicators.

  • E/M Codes: Use standard office visit codes 99202–99205 (new) or 99211–99215 (established).
  • Place of Service (POS):
    • Use POS 10 if the patient is in their home.
    • Use POS 02 if the patient is at a location other than their home.
  • Modifiers:
    • Modifier 95 for synchronous audio-video services.
    • Modifier 93 for synchronous audio-only services.
  • Virtual Check-Ins: Medicare does accept dedicated code 98016 for brief 5-to-10-minute patient-initiated virtual check-ins.

Commercial Payers and Some State Medicaid

Many private insurance companies accept the dedicated AMA CPT telehealth code family, though policies still vary by contract:

  • Audio-Video E/M Codes: 98000–98007 (mirroring new and established office visit tiers).
  • Audio-Only E/M Codes: 98008–98015 (replacing older telephone codes like 99441–99443).
  • Brief Communication: 98016.
  • Note: Many commercial plans still prefer the traditional approach of billing standard office codes (99202–99215) with modifier 95, so always check individual payer contracts.

How to code telehealth visits in 2026?

Coding telehealth visits in 2026 requires knowing that Medicare and commercial payers use entirely different rules, as outlined by the Billing For Healthcare Guide.

Medicare Payer Rules

  • Standard E/M Codes: Medicare does not reimburse the dedicated CPT codes 98000 through 98015.
  • Required Coding: Use standard office visit codes (99202–99215) paired with the correct Place of Service (POS) code and modifiers.
  • Virtual Check-ins: Use CPT 98016 for brief 5-to-10 minute audio or video check-ins with established patients (replacing old code G2012).
  • Review additional billing breakdowns at the MedLife MBS Reference.

Commercial Payer Rules

  • Dedicated CPT Family: Many commercial plans accept the AMA-created telemedicine set (98000–98015) for synchronous audio-video and audio-only visits.
  • Alternative Requirements: Some commercial contracts still follow Medicare's style and require standard E/M codes with a telehealth modifier instead.
  • Check specific plan contracts using insights from the MedSole RCM Overview.

Place of Service (POS) Codes

  • POS 10: Patient is at home (pays at the higher non-facility rate).
  • POS 02: Patient is located somewhere other than home (facility rate).

Key Modifiers

  • Modifier 95: Real-time audio and video interactive communication.
  • Modifier 93: Synchronous audio-only communication.

Place of Service Codes for Telehealth

9 related questions found

What is appropriate for a telehealth visit?

Telehealth visits are appropriate for evaluating and treating non-emergency, common illnesses, minor injuries, and routine follow-ups where a physical examination is not strictly required.

Appropriate Conditions for Telehealth

  • Respiratory illnesses: Common cold, flu, cough, bronchitis, sinus infections, and sore throats.
  • Skin concerns: Mild and localized rashes, insect bites, eczema, or acne that are easy to photograph.
  • Common infections: Pink eye (conjunctivitis), uncomplicated urinary tract infections (UTIs), and vaginal yeast infections.
  • Chronic disease & medication management: Routine check-ins for stable conditions like high blood pressure or asthma, and simple prescription refills.
  • Mental health: Initial screenings and support for anxiety, stress, or mild depression.
  • Learn more about What should I know before my telehealth visit? from official patient resources.

When In-Person Care is Needed

  • Emergencies: Chest pain, severe shortness of breath, sudden weakness, or signs of a stroke or heart attack.
  • Severe symptoms: High fevers that do not respond to medication, sharp or worsening abdominal pain, and severe vomiting or diarrhea.
  • Complex exams: Conditions requiring physical touch, deep palpation, specialized tools (like a dermatoscope for new moles), or diagnostic testing like X-rays and blood cultures.

What are the CMS guidelines for telehealth billing in 2026?

CMS telehealth billing guidelines for 2026 extend key pandemic-era flexibilities through December 31, 2027, under the Consolidated Appropriations Act, 2026.

Place of Service (POS) and Coding

  • POS 10: Use for telehealth services provided while the patient is in their home; Medicare reimburses these at the higher non-facility rate.
  • POS 02: Use for telehealth services provided when the patient is not in the home (such as an office or clinic); reimbursed at the facility rate.
  • Medicare Code Divergence: Medicare denies the AMA’s dedicated telehealth E/M codes 98000–98015, except for brief virtual check-in code 98016. For standard Medicare telehealth visits, report regular in-person office codes (99202–99215) paired with the correct POS code.

Key Flexibilities and Rules

  • Geographic and Location Limits: Beneficiaries can receive telehealth from any location nationwide, including their homes, without rural/urban restrictions through 2027.
  • Audio-Only Care: Permitted for behavioral health and select services when video is unavailable or unconsented.
  • Supervision: Virtual direct supervision via real-time audio-video is permanently allowed for most services (excluding 010 and 090 global surgery periods).
  • Platform Compliance: Full enforcement requires HIPAA-compliant platforms; non-compliant consumer tools are no longer permitted under enforcement discretion.
  • Originating Site Fee: Facility-hosted originating sites may bill HCPCS code Q3014, set at a maximum standard of $31.85 for 2026.

Are telehealth visits billed differently?

Yes, telehealth visits use the same core procedure codes as in-person visits, but they are billed differently using specific place-of-service codes and modifiers.

Key Differences in Telehealth Billing

  • Procedure Codes (CPT): Providers generally use the same standard CPT codes (such as 99213 or 99214 for office visits, or specific therapy codes) for both virtual and face-to-face appointments.
  • Place of Service (POS) Codes: Claims must show where the patient and doctor were during the call.
    • POS 10: Used when the patient is located in their home.
    • POS 02: Used when the patient is at a location other than their home (like an office or secondary site).
  • Modifiers: Insurers often require specific add-on codes to indicate how the service was delivered.
    • Modifier 95: Used for live, real-time audio-video interactions.
    • Modifier 93: Used for interactive audio-only (phone call) visits.
  • Reimbursement Rates: Many states have "pay parity" laws requiring insurance companies to pay the same rate for telehealth as in-person visits, though rules vary widely by private commercial payer and specific state guidelines. You can review ongoing policy updates via the Centers for Medicare & Medicaid Services Telehealth FAQ.

What modifier do I use for telehealth visits?

Use Modifier 95 for live audio-video visits, and Modifier 93 for audio-only phone calls.

Common Telehealth Modifiers

  • Modifier 95: Live, real-time interactive audio and video communication (the standard video visit).
  • Modifier 93: Real-time audio-only communication (telephone calls), used when video is not available or the patient does not consent to video.
  • Modifier FQ: Audio-only communication used specifically by Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs).
  • Modifier GT: Interactive audio and video used exclusively on institutional claims billed by Critical Access Hospital (CAH) Method II providers.
  • Modifier GQ: Asynchronous "store-and-forward" telecommunications (limited to specific federal demonstration projects in Alaska and Hawaii).

Place of Service (POS) Codes Matter

Along with the modifier, you must report the correct Place of Service code to designate where the patient was during the encounter:

  • POS 10: Telehealth provided in the patient's home (reflects higher non-facility rates).
  • POS 02: Telehealth provided in a location other than the patient's home (facility setting).

Note: Payer rules vary. For instance, Medicare often identifies telehealth primarily via the Place of Service code rather than a modifier for standard video visits, while many commercial and private insurers still require Modifier 95. Always verify guidelines with your specific insurance carrier or CMS Telehealth Guidelines.

Can you bill a 99214 for a telehealth visit?

Yes, you can bill a 99214 for a synchronous audio-video telehealth visit for an established patient.

Requirements for Billing 99214 via Telehealth

  • Communication Type: Real-time, two-way audio-video interaction is required by most major payers.
  • Time or Decision Making: The visit must meet moderate-to-high complexity medical decision-making (MDM) or require 30 to 39 total minutes of clinician time on the date of service.
  • Place of Service (POS): Use POS 10 for patient home locations (non-facility rates) or POS 02 for other telehealth locations.
  • Modifiers: Attach Modifier 95 to indicate a synchronous telemedicine service, depending on specific payer instructions.