Can I Use POS 12 With Modifier 95 for a Telehealth Visit?

A nurse practitioner wrote in after watching the Office Ally videos. She had just taken her billing back in house after repeated mistakes by her biller, and she had one question.

What is the best code to use for a psych tele visit? Can I use POS 12 with modifier 95, or 10 with modifier 95, or 11 with modifier 95? I was told POS 12 with modifier 95 pays better than POS 02 with 95.

I want to answer the question. Then I want to look at the sentence underneath it, because that is the part that could cost her.

The short answer

None of those three combinations is correct. For a telehealth visit, the place of service is 10 or 02, and which one you use depends entirely on where your patient was sitting.

Here is the piece that matters more than the code itself. Place of service is not a payment lever. It is a factual statement about where your patient was physically located when you saw them. When a POS is selected because it pays more rather than because it is true, that stops being a coding error. It becomes a misrepresentation on the claim, and a repeating pattern of it is exactly what an auditor reads as intent.

What each code actually means

POS 10, Telehealth Provided in Patient's Home. Your patient was at home. This is the code most psych telehealth visits need.

POS 02, Telehealth Provided Other than in Patient's Home. Your patient was somewhere else. A clinic, a school, their workplace, a facility.

POS 12, Home. CMS defines this as a location, other than a hospital or other facility, where the patient receives care in a private residence. That is care you deliver in person, in their house. A home visit. It is not a telehealth code. Pairing it with modifier 95 builds a claim that contradicts itself, saying you were physically in the home and also that you were not.

POS 11, Office. Your patient was physically in your office. Billing 11 with modifier 95 was a temporary instruction during the public health emergency, roughly 2020 through 2023. CMS moved on. Some commercial plans and state Medicaid programs still ask for it, which is why the advice keeps circulating years after Medicare stopped wanting it.

Where the pays better advice came from

There is something real underneath that claim. It just got garbled in the retelling.

Since January 1, 2024, Medicare pays telehealth delivered to a patient in their home at the non facility rate. POS 02 pays the lower facility rate. So there is a genuine payment difference, and the home telehealth code genuinely does pay better than the other one.

The home telehealth code is 10. Somebody heard that the home one pays more, reached for 12 because 12 is the code labeled Home, and passed it down the line. One digit, an entirely different claim.

This is what most bad billing advice looks like up close. Not invented, just worn smooth by too many retellings.

Modifier 95 and modifier 93

Modifier 95 means synchronous, real time, two way audio and video. Modifier 93 means audio only.

For traditional Medicare, the place of service carries most of the message. For most commercial plans and state Medicaid programs, the modifier does, and their requirements do not match each other. Append what each payer's own published policy asks for rather than applying one habit across every claim you send.

If you bill psych or behavioral health

Two things work in your favor here, and they are easy to miss because most telehealth coverage news is written about everything else.

Behavioral and mental health telehealth delivered to a patient in their home is permanent under Medicare. No geographic restriction, and audio only is allowed. That permanence is unusual. Most of the other telehealth flexibilities are running on extensions through December 31, 2027.

The in person visit requirement, the one within six months of the first telehealth service and annually after that, is not in effect through December 31, 2027. Note the date rather than the rule. It has been extended more than once, and it will need checking again.

Your CPT code does not change

The original question asked for the best code for a psych tele visit, and that phrasing is worth untangling. A virtual visit does not get its own procedure code. You bill the same 90791, 90834, 90837, or your E/M level with 90833 for the psychotherapy add on, exactly as you would in the room.

Telehealth changes the place of service and the modifier. It does not change what you did.

If claims already went out as POS 12

Pull that list before you do anything else. You want to know the size of it, which payers received it, and how far back it goes. Corrected claims filed on your own initiative read very differently than the same claims found by somebody else two years later.

If the volume is large or it crosses multiple payers, that is a conversation for a compliance professional, not a decision to make alone on a Friday afternoon.

How to verify this for your own payers

You do not have to take my word for any of it, and you should not. Three steps.

Start at the source. The CMS Place of Service Code Set holds the official descriptor for every POS code. Read 02, 10, 11 and 12 side by side and the answer stops being a matter of opinion.

Check the current CMS telehealth guidance for what Medicare wants today, because the dates on these flexibilities keep moving.

Then check each payer individually. Your Medicare Administrative Contractor, your state Medicaid program, and every commercial contract you hold. They do not agree with each other, and the one that pays you the most is not automatically the one that is right.

Most billing problems leave clues. This one left a very specific clue, a single digit that turned a telehealth visit into a house call on paper.

Sources

CMS Place of Service Code Set: https://www.cms.gov/medicare/coding-billing/place-of-service-codes/code-sets

CMS Telehealth: https://www.cms.gov/medicare/coverage/telehealth

Billing and coding Medicare Fee for Service claims: https://telehealth.hhs.gov/providers/billing-and-reimbursement/billing-and-coding-medicare-fee-for-service-claims

Telehealth policy updates: https://telehealth.hhs.gov/providers/telehealth-policy/telehealth-policy-updates

Watch the walkthroughs

Tech Setup Tips for Telehealth, Zoom and Office Ally Workflow: https://youtu.be/YRTa4PRdNCc

More Office Ally training

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About the author

Marie Matteson, MS, is a healthcare consultant, educator, and Office Ally specialist with more than 30 years in healthcare, emergency medicine, and practice management. Helping you understand what's really going on.

Website: https://mariematteson.com/welcome

Contact: https://mariematteson.com/contact-us

This article is general billing education and is not legal, compliance, or coding advice for any specific claim. Coverage rules, place of service requirements, and telehealth flexibilities change, sometimes mid year. Verify current guidance against CMS, your Medicare Administrative Contractor, your state Medicaid program, and your own payer contracts before changing how you bill. Marie Matteson is not affiliated with, endorsed by, or sponsored by Office Ally. All patient information shown in related training materials is fictional and used for teaching purposes only.

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