Medical Billing Terms P: POS Codes (Place of Service) 02, 10, 11 and 12

POS codes (place of service codes) are two-digit codes that tell payers where a service was delivered. This page defines the place of service code and POS 02, 10, 11 and 12, plus terms from peer support to primary insurance, including PPO, PHQ-9 and pended claim. Each entry gives a plain definition, why it matters, an example, and an official source. MCM South Medical Billing Service, LLC works only in mental and behavioral health billing.

Last reviewed: October 10, 2026Sources linked at each term

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Billing Terms Glossary slide, Terms P: POS Codes - MCM South Medical Billing Service, LLC

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On this page (23 terms)

Peer Support Services
Peer-to-Peer Review
Pended Claim
Per Member Per Month (PMPM)
Personal Representative (HIPAA)
PHQ-9
Place of Service 02
Place of Service 10
Place of Service 11
Place of Service 12
Place of Service (POS)
Plan Year
POS Plan (Point-of-Service Plan)
Post-Payment Review
PPO (Preferred Provider Organization)
Practice Fusion
Practice Management System (PMS)
Prepaid Ambulatory Health Plan (PAHP)
Prepaid Inpatient Health Plan (PIHP)
Pre-Payment Review
Presumptive Eligibility
Primary Diagnosis
Primary Insurance

How to use these POS Codes definitions

Use this page as a quick reference for Place of Service Codes, from Peer Support Services to Primary Insurance. Each entry gives a plain definition, why it matters to a mental health practice, and an official source. When a rule changes by payer or state, the entry says so, so confirm Place of Service Codes details with the payer before you bill.

Checklist: put the pos codes definitions to work

Check the pos codes entries above before you send a claim that depends on them.
Share this pos codes page with front-desk and billing staff so everyone works from the same definitions.
When a payer letter mentions pos codes, find the matching entry and note the date you checked it.
Keep your pos codes notes next to your payer contracts, because a contract can define a term differently.
Ask the payer to confirm in writing how it applies pos codes before you change a workflow.
Train new staff on pos codes first, then move on to the rest of the glossary.
Log any pos codes question that comes up twice, then add the answer to your billing procedures.
Use the source links under the pos codes entries to confirm the current rule.
Print the pos codes entries you use most and keep them at the billing desk.
Review your pos codes notes each quarter, because payer and CMS rules change.
Mark where pos codes work differently for psychotherapists and for psychiatrists in your own procedures.
If a pos codes entry does not match what your payer tells you, follow the payer contract and ask for the answer in writing.
A common pos codes mistake is relying on an old payer bulletin, so check the date on every source.
Another pos codes mistake is copying a definition into a policy without citing the source.
Send questions about pos codes to one billing lead so the answer is shared once.
For pos codes that affect payment, record the claim number and the name of the payer representative.

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Peer Support Services

Medicaid (state-specific)

Also called peer support; certified peer specialist services; Medicaid peer support

Definition: Peer support services are support services delivered by people with lived experience of a mental health or substance use condition who are trained and often certified. Many state Medicaid programs cover them.
Why it matters: Coverage, provider certification, supervision, and codes vary by state. Check the state Medicaid manual.
Illustrative example: A clinic bills a state Medicaid program for peer support delivered by a certified peer specialist.

Reference sourceMedicaid.gov SAMHSAchecked 10/9/26

CategoriesBehavioral Health Specific Terms Medicare & Medicaid Terms

Peer-to-Peer Review

General (all payers)

Also called peer to peer; P2P

Definition: A conversation between the treating clinician and the payer's reviewer, used to discuss medical necessity of a denied or pending service.
Why it matters: Often the fastest way to reverse a medical necessity denial, but usually within a short window.
Illustrative example: A psychiatrist calls the payer's medical director to discuss a denial.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesDenials & Appeals Prior Authorization Terminology

Pended Claim

General (all payers)

Also called pending claim; claim in process; suspended claim

Definition: A claim the payer has received but not finalized, held for review, additional information, or a system reason.
Why it matters: Pended claims can hide problems and delay payment.
Illustrative example: A claim is pended for a COB questionnaire.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesClaims Processing

Per Member Per Month (PMPM)

General (all payers)

Also called PMPM; per-member-per-month payment

Definition: A fixed payment or metric expressed per enrolled member per month.
Why it matters: Used in capitation and care management payments.
Illustrative example: A payer pays a care management fee PMPM.

Related termsCapitation Value-Based Care

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesValue-Based Care Terminology Payment & Reimbursement

Personal Representative (HIPAA)

State law (varies by state)

Also called HIPAA personal representative; parent as personal representative; authorized representative

Definition: Under HIPAA, a personal representative is a person authorized under state or other applicable law to act for an individual in making health care decisions. HHS says a parent, guardian, or person acting in loco parentis is generally the personal representative of a minor child.
Why it matters: A parent is not treated as the personal representative in three situations HHS describes: when state or other law does not require a parent's consent for a service and the minor consents, when someone other than the parent is authorized by law to consent and does, and when a parent agrees to a confidential relationship between the minor and the provider. A provider may also decline to treat someone as a personal representative in abuse, neglect, or endangerment situations.
Illustrative example: A 15-year-old lawfully consents to outpatient therapy under state law, so the practice does not treat the parent as the personal representative for that care. It releases information to the parent only where HIPAA and state law allow.

Reference sourceHHS, Personal Representatives (HIPAA)HHS, HIPAA FAQ 516: disclosure to parents of a teenchecked 10/9/26

CategoriesAudits & Compliance Behavioral Health Specific Terms

PHQ-9

General (all payers)

Also called Patient Health Questionnaire-9; depression screening questionnaire

Definition: The PHQ-9 is a nine-item questionnaire used to screen for and monitor depression severity. It is commonly used with brief assessment billing.
Why it matters: Practices use it for measurement-based care and for billing CPT 96127 per instrument, where the payer allows it.
Illustrative example: A clinician gives the PHQ-9 at intake and bills 96127 with one unit.

Reference sourceAmerican Medical Association (AMA)checked 10/9/26

CategoriesBehavioral Health Specific Terms Quality & Risk Adjustment Terms

Place of Service 02

General (all payers)

Also called POS 02; telehealth other than home

Definition: The place of service code for telehealth provided other than in the patient's home.
Why it matters: Some payers require it when the patient is at a location other than home.
Illustrative example: A patient receives telehealth at a workplace and the claim uses POS 02.

Reference sourceCMS (Centers for Medicare & Medicaid Services)CMS Place of Service Code Setchecked 10/9/26

CategoriesTelehealth Terms Claims Processing

Place of Service 10

General (all payers)

Also called POS 10; telehealth in patient's home

Definition: The place of service code for telehealth provided in the patient's home.
Why it matters: Some payers require POS 10 for home-based telehealth and pay it differently from POS 02.
Illustrative example: A patient receives therapy at home and the claim uses POS 10.

Reference sourceCMS (Centers for Medicare & Medicaid Services)CMS Place of Service Code Setchecked 10/9/26

CategoriesTelehealth Terms Claims Processing

Place of Service 11

General (all payers)

Also called POS 11; office

Definition: The place of service code for services delivered in a physician's or practitioner's office.
Why it matters: In-person outpatient sessions commonly use POS 11.
Illustrative example: A therapist bills an in-person office session with POS 11.

Reference sourceCMS (Centers for Medicare & Medicaid Services)CMS Place of Service Code Setchecked 10/9/26

CategoriesClaims Processing

Place of Service 12

General (all payers)

Also called POS 12; home

Definition: The place of service code for services delivered in the patient's home in person.
Why it matters: In-home therapy uses POS 12, and Medicaid in-home programs may have their own rules.
Illustrative example: A clinician provides in-person therapy at a patient's home.

Reference sourceCMS (Centers for Medicare & Medicaid Services)CMS Place of Service Code Setchecked 10/9/26

CategoriesClaims Processing

Place of Service (POS)

General (all payers)

Also called POS code; place of service code

Definition: A two-digit code on the claim that shows where the service took place, such as office, home, or telehealth.
Why it matters: POS affects payment rate and telehealth rules.
Illustrative example: A claim lists POS 11 for an office visit.

Reference sourceCMS (Centers for Medicare & Medicaid Services)CMS Place of Service Code Setchecked 10/9/26

CategoriesClaims Processing Telehealth Terms

Plan Year

General (all payers)

Also called benefit year; contract year

Definition: The 12-month period over which a plan applies its deductible, out-of-pocket maximum, and visit limits. It may or may not follow the calendar year.
Why it matters: Deductibles and limits reset at the start of the plan year.
Illustrative example: A plan year starts July 1, so deductibles reset mid-year.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesEligibility & Benefits

POS Plan (Point-of-Service Plan)

General (all payers)

Also called point of service plan

Definition: A hybrid plan with HMO-like features that lets members go out of network at higher cost, often with a referral.
Why it matters: The referral and network rules can differ from a standard PPO.
Illustrative example: A POS plan requires a PCP referral for reduced OON coverage.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesEligibility & Benefits

Post-Payment Review

General (all payers)

Also called postpayment review; retrospective review

Definition: A review of paid claims after payment, which can lead to recoupment if errors are found.
Why it matters: Can reach back over a period set by law or contract.
Illustrative example: A payer requests records for claims paid in the last year.

Related termsPre-Payment Review Recoupment Audit

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesAudits & Compliance

PPO (Preferred Provider Organization)

General (all payers)

Also called PPO plan

Definition: A managed care plan that pays for both in-network and out-of-network care, generally with higher costs out of network.
Why it matters: Many OON therapy reimbursements come from PPO plans.
Illustrative example: A PPO member sees an OON therapist and receives partial reimbursement.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesEligibility & Benefits

Practice Fusion

General (all payers)

Also called Practice Fusion EHR

Definition: An EHR product associated with the Tebra family of software. Listed for reference; not an endorsement or partnership.
Why it matters: Older records may reference it.
Illustrative example: A practice migrated from Practice Fusion.

Related termsTebra Kareo

Reference sourceTebrachecked 10/9/26

CategoriesEHR & Healthcare Technology Terms

Practice Management System (PMS)

General (all payers)

Also called PMS; practice management software; billing software

Definition: Software that handles scheduling, patient registration, charge entry, claims, and payment posting.
Why it matters: Often paired with or built into the EHR.
Illustrative example: A practice submits claims from its practice management system.

Reference sourceMGMAchecked 10/9/26

CategoriesEHR & Healthcare Technology Terms Revenue Cycle Metrics

Prepaid Ambulatory Health Plan (PAHP)

Medicaid (state-specific)

Also called PAHP

Definition: A type of managed care entity that provides ambulatory services under a state contract on a prepaid basis.
Why it matters: Some states use PAHPs for behavioral health.
Illustrative example: A PAHP manages outpatient behavioral health for a state.

Reference sourceMedicaid.govchecked 10/9/26

CategoriesMedicare & Medicaid Terms Behavioral Health Specific Terms

Prepaid Inpatient Health Plan (PIHP)

Medicaid (state-specific)

Also called PIHP

Definition: A type of managed care entity that provides inpatient and often other behavioral health services under a state contract on a prepaid basis.
Why it matters: Some states use PIHPs to manage Medicaid behavioral health.
Illustrative example: A state contracts with a PIHP for mental health services.

Reference sourceMedicaid.govchecked 10/9/26

CategoriesMedicare & Medicaid Terms Behavioral Health Specific Terms

Pre-Payment Review

General (all payers)

Also called prepayment review; claim hold for review

Definition: A payer review of claims and records before payment is made, often triggered by patterns or risk.
Why it matters: Delays payment and requires quick response to record requests.
Illustrative example: A payer holds claims for a provider until records are submitted.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesAudits & Compliance

Presumptive Eligibility

Medicaid (state-specific)

Also called Medicaid presumptive eligibility; PE; temporary Medicaid coverage

Definition: Presumptive eligibility lets certain qualified entities temporarily enroll a person in Medicaid while a full application is reviewed.
Why it matters: Coverage can start before the full decision, so check the effective date and what services are covered. It may end if no application follows.
Illustrative example: A patient shows a presumptive eligibility letter, so the biller verifies the coverage dates before billing.

Reference sourceMedicaid.gov CMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesMedicare & Medicaid Terms Eligibility & Benefits

Primary Diagnosis

General (all payers)

Also called principal diagnosis; first-listed diagnosis

Definition: The main diagnosis that the service addresses, listed first on the claim.
Why it matters: Payers check that the diagnosis supports the service and any coverage rules.
Illustrative example: The first listed diagnosis is the condition treated in that session.

Related termsICD-10-CM Diagnosis Pointer

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesClaims Processing

Primary Insurance

General (all payers)

Also called primary payer; primary coverage

Definition: The plan responsible for paying first when a patient has more than one plan.
Why it matters: Billing the wrong payer first leads to denials and reprocessing.
Illustrative example: A patient's employer plan is primary and a spouse's plan is secondary.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesEligibility & Benefits Claims Processing

Quick answer: POS Codes

What is a place of service (POS) code?

Place of Service (POS) is a two-digit code on the claim that shows where the service took place, such as office, home, or telehealth. POS affects payment rate and telehealth rules.

Frequently asked questions: POS Codes

What is place of service 02?

Place of Service 02 is the place of service code for telehealth provided other than in the patient's home. Some payers require it when the patient is at a location other than home.

What is place of service 10?

Place of Service 10 is the place of service code for telehealth provided in the patient's home. Some payers require POS 10 for home-based telehealth and pay it differently from POS 02.

What is a PPO?

PPO (Preferred Provider Organization) is a managed care plan that pays for both in-network and out-of-network care, generally with higher costs out of network. Many OON therapy reimbursements come from PPO plans.

Related resources

Where MCM South works

MCM South serves psychotherapists and psychiatrists in ten states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois.

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