Getting Paid Correctly for Medicare Telehealth: Understanding POS 10

There’s a version of underpayment that doesn’t show up as a problem.

Claims go out. Payments come in. Nothing gets denied.

And you’re still not getting paid correctly.

I recently worked with a behavioral health provider in Chicago who was billing Medicare for 90837 via telehealth.

Everything looked fine. No rejections. No obvious errors. Payments were landing consistently.

She was getting about $102 per visit.

Seemed low to me for a metro area like Chicago.

The issue wasn’t the code. It was the Place of Service.

Her claims were being billed with POS 02.

For a long time, that was standard for telehealth. Most systems still default to it, and many workflows haven’t been updated.

But Medicare created a newer distinction that actually impacts reimbursement.

• POS 02 = telehealth provided somewhere other than the patient’s home

• POS 10 = telehealth provided while the patient is at home

Her patients were at home during these sessions.

So while her claims weren’t “wrong,” they weren’t fully correct either.

What changed when we fixed it

We updated the Place of Service and resubmitted.

Her reimbursement increased to about $126.71 per visit.

Same CPT code (90837).Same documentation. Same exact service.

Just billed correctly.

That’s about a $23 difference per visit.

Why this is getting missed

POS 10 is still relatively new.

A lot of EHR systems default to POS 02. A lot of providers were never told to revisit it. And a lot of billing workflows were built before POS 10 was even introduced.

So what’s happening now is simple:

Providers are delivering telehealth to patients in their homes……but billing it like they’re not.

And Medicare is paying accordingly.

There’s no alert that tells you this. No denial that forces you to fix it.

Just a lower allowable.

This is how revenue leaks happen

Not from major issues.

From small details that go unchecked.

If you’re off by $20–$25 per visit, you won’t notice it in a single payment.

But over time, it adds up.

Even a modest Medicare caseload can mean thousands of dollars per year in missed reimbursement.

All for something that is easy to correct once you catch it.

A quick check worth doing

If you’re providing telehealth to Medicare patients, it’s worth asking:

Are your patients typically at home?

What Place of Service is actually being used on your claims?

Was that a deliberate setup, or just a system default?

Because if it’s a default, there’s a good chance it hasn’t been revisited.

This is what optimization actually looks like

Not more patients. Not longer hours.

Sometimes it’s just making sure you’re getting paid correctly for the work you’re already doing.

If something about your billing feels “fine but slightly off,” it’s usually worth a second look.

This is exactly the kind of thing I look for in audits, especially for therapy practices.

Because the goal isn’t just getting claims out.

It’s making sure you’re actually getting paid what you should be paid.

This is a small fix, but not an uncommon one.

If you want a second set of eyes on your billing setup, I offer targeted audits for therapy practices to identify gaps like this and correct them quickly.

You can book a free exploratory chat here: https://calendly.com/daniellewagar/exploratory-chat