Recently several therapists in my NC networking groups told me their telehealth reimbursements dropped suddenly. A few months ago, similar reports came from Midwest states.

The likely culprit is Place of Service (POS) codes, the 2-digit codes on your claim CMS 1500 in Box 24 b that tell the payer where the session took place. For telehealth, there are two that matter:
POS 10: Telehealth provided in the patient’s home (which is a location other than a hospital or other facility where the patient receives care in a private residence)

POS 02: Telehealth provided other than in the patient's home.

CMS (Centers for Medicare and Medicaid Services) redefined these codes in 2022. In 2024, CMS began paying POS 02 at the lower facility rate while POS 10 pays at the higher non-facility rate. Commercial payers (such as BCBS in NC and a few midwest states) have slowly been making the same switch. Some solo and group private practice owners missed the updates on these changes… hence the panic in the networking groups. BCBS of NC announced in their email newsletter in August 2026, that effective 10/1/2026 they would start paying telehealth services with POS code 02 at the lower facility rate instead of the prior non-facility rate.

If you’ve been providing office based mental health services as LPC, LMHC, LMFT, LCSW, LP in a solo group or private practice setting, then it’s likely that you are not a facility (hospital or PHP). If you’ve been billing POS 02 for sessions when a client is at home… but they are also not in a facility… then you may now be paid less than you expect and you need to do some extra research on this!

Today, I want to talk about what "making sense out of making cents" actually looks like in your practice, and how I can help.

Early in my career, I often repeated a common therapist myth: "I didn't become a therapist for the money."

It is such a wonderful thing that so many people enter the mental health field because they truly want to help others and make an impact in the world around them.

But here's the thing — therapists still need money to survive and to do the work we're passionate about! Even if our goal isn't to become millionaires, therapists deserve a stable income and freedom from the stress of living paycheck to paycheck.

Our field seems to attract people who lead with a passion for helping others, and treat income as secondary. Unfortunately, there also seems to be a correlation with therapists being averse to math, numbers, and business concepts.

Not only are many of us uninterested in those areas, but we also get little to no training in accounting or business in graduate school.

Because cents don't always make sense: income, revenue, expenses, taxes — our eyes glaze over. We feel overwhelmed, so we shut down and say "I don't like math," "I can't run a business," "I'll just pay someone else to figure it out."

How I went from avoiding math to becoming a numbers nerd. My story about becoming a therapist and avoiding all the math classes possible during my academic career only to finally realize that I enjoy making sense of the business and financial side of running a private practice… which ironically means working with math and numbers! I share about my passion in helping other therapists who feel overwhelmed by the numbers and business side of therapy learn to Make Sense of Making Cents in their private practices.

I share some of the pros and cons of working as a therapist with the various tech companies that market heavily to therapists. They often offer flexibility, autonomy and enticing promises… but do they really deliver? And even if they do, is it worth it to work for them?