Therapists lose money on telehealth when the claim carries the wrong place-of-service code or the wrong modifier. Two codes fix most of it. POS 10 tells the payer the client was at home, and modifier 95 confirms the session happened over live video. Get both right and the claim pays at the full rate.

Picture a therapist who runs a full week of video sessions and then watches the remittances come in short. Nothing looks wrong on the surface, so nobody questions it, and the shortfall quietly repeats every month across the whole caseload. The cause is almost always two small fields on the claim form. This article explains what they are, what they cost, and how to set them once so you never think about them again.

Telehealth changed one thing about therapy claims, not everything

The psychotherapy codes do not change when a session moves online. A 45-minute session is still 90834, a 60-minute session is still 90837, and an intake is still 90791. The American Medical Association confirms that telehealth uses the same CPT codes as in-person care.

What changes is the context. The payer needs to know where the client sat and how the session was delivered, and the claim form has exactly one field for each. The place-of-service code answers the first question, and the telehealth modifier answers the second.

Most telehealth billing problems come from treating those two fields as an afterthought. Consequently, the fix is not complicated. It is simply a matter of understanding what each field does and why the payer cares.

Place of Service 10 vs Place of Service 02: Where the client sat

POS 10 means telehealth provided in the client’s home. POS 02 means telehealth provided anywhere other than the home. That single distinction decides which fee schedule the payer applies, and it is the first place therapists lose money.

The CMS place-of-service code set added POS 10 in 2022 specifically so that home-based telehealth could pay at the non-facility rate. Before that, every telehealth claim used POS 02, and payers reimbursed it as if the client sat in a facility.

Many practices never updated their templates. As a result, they still bill POS 02 for clients sitting on their own sofas, and the payer pays the lower facility rate without ever flagging a problem. Therefore, the first fix is to use POS 10 in medical billing for every home session, which is nearly all of them.

Modifier 95 and Modifier 93: How the session was delivered

Modifier 95 means a synchronous audio and video session. Modifier 93 means a synchronous audio-only session. The place-of-service code tells the payer where the client was, and the modifier tells the payer how you reached them.

Here is the part that confuses many therapists. Modifier 95 does not reduce payment on its own. Its absence, or its misuse, is what causes the denial, because the payer sees a claim that contradicts itself.

The difference between modifier 93 and 95 matters more every year. Several payers reimburse audio-only sessions at a lower rate or limit them to specific codes, so billing a phone call as video can trigger an audit as well as a denial.

What the wrong codes cost across a caseload

None of this sounds expensive until you multiply it. Take one 60-minute session billed as 90837. Under the CMS Physician Fee Schedule, the non-facility rate that POS 10 unlocks runs roughly 10 to 15 percent higher than the facility rate that POS 02 pays, depending on the locality.

In practical terms, that gap works out to approximately $15–$20 dollars per session on Medicare rates, and commercial payers that follow the same structure show a similar spread. One session does not hurt. However, a therapist who sees 25 clients a week for 48 weeks bills 1,200 sessions a year.

At 15 to 20 dollars each, a wrong place-of-service code costs that therapist somewhere between 18,000 and 24,000 dollars a year. The money never shows up as a denial, so nobody goes looking for it.

The modifier error costs differently. A session billed at POS 10 with no modifier 95 denies outright, and each rework takes 20 to 30 minutes of admin time plus a delay of several weeks before the payment arrives. Across a caseload, that is days of unpaid work every quarter.

5 Telehealth denials therapists see most

These five errors account for the majority of telehealth claim problems in therapy practices. Each one has a simple fix.

1. POS 02 on a home session: This one underpays rather than denies, so it hides for months. Fix: default to POS 10 for every client who joins from home.
2. POS 10 with no modifier 95. The payer sees a telehealth location paired with an in-person service and rejects the contradiction. Fix: attach modifier 95 to every video session automatically.
3. Audio-only session billed with modifier 95: The note says phone, the claim says video, and the mismatch surfaces in an audit. Fix: use modifier 93 for any session without video.
4. The wrong legacy modifier: Some Medicaid plans still want GT, while most commercial plans have dropped it. Fix: keep a one-page list of which payers want which modifier.
5. Modifier present on the primary claim but missing on the secondary: The first payer pays, the second denies, and the balance sits in accounts receivable. Fix: check that modifiers carry over whenever a claim crosses to a secondary payer.

Notice that four of the five errors are template problems, not knowledge problems. Fix the template once and the denials stop.

Setting the 2 codes once so you never think about them again

The goal is to make the right codes the default rather than a decision. Start by building a telehealth template in your practice management system with POS 10 and modifier 95 already filled in, then add a second variant with modifier 93 for phone sessions.

Next, keep a one-page payer exception list. Note which plans still want GT, which ones insist on POS 11 with a modifier, and which ones pay audio-only sessions at a reduced rate. Review it twice a year, because these rules shift.

Finally, document the client’s location and consent in every telehealth note. A single line such as “client participated by video from home” supports POS 10 and modifier 95 if a payer ever asks. Group practices that would rather not maintain the exception list themselves often hand this work to specialised behavioral health billing services that track payer rules across every plan on their panel.

Takeaway

Therapists do not lose telehealth money to payers. They lose it to two fields on the claim form that nobody set up properly. POS 10 protects the rate, modifier 95 protects the claim, and once both sit in your default template, the quiet monthly shortfall stops. If you would like an outside check on how your telehealth claims are currently going out, a free billing audit from Right On Time Medical Billing will show you exactly where the money is going.

FAQs

• What is Modifier 95? Modifier 95 indicates a synchronous telehealth service delivered through real-time audio and video. Append it to the psychotherapy code for every live video session.
• What is Modifier 93? Modifier 93 indicates a synchronous telehealth service delivered by audio only. Use it for phone sessions or any session where video was not used.
• What is the difference between Modifier 93 and 95? Modifier 95 means video and audio together, while modifier 93 means audio alone. Payers often reimburse the two differently, so the modifier must match what actually happened in the session.
• What is Place of Service 10? Place of Service 10 means telehealth provided in the patient’s home. It pays at the non-facility rate, which is the same rate as an in-office visit.
• Does POS 10 need a modifier? Yes. POS 10 tells the payer where the client was, but the claim still needs modifier 95 or 93 to confirm the service was delivered by telehealth. Without it, most payers reject the claim as inconsistent.
• Is Modifier 95 required for telehealth? Most payers require it for video sessions, although a few still accept GT instead. Check each payer’s telehealth policy, and when in doubt, use 95.

Adam Mulligan, a psychology graduate from the University of Hertfordshire, has a keen interest in the fields of mental health, wellness, and lifestyle.