Place of Service: A two-digit code used on health care professional claims to indicate the setting in which a service was provided.
Place of Service Codes are two-digit codes placed on health care professional claims to indicate the setting in which a service was provided. The Centers for Medicare & Medicaid Services (CMS) maintain POS codes used throughout the health care industry.
This code set is required for use in the implementation guide adopted as the national standard for electronic transmission of professional health care claims under the provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). HIPAA directed the Secretary of HHS to adopt national standards for electronic transactions. These standard transactions require all health plans and providers to use standard code sets to populate data elements in each transaction. The Transaction and Code Set Rule adopted the ASC X12N-837 Health Care Claim: Professional, volumes 1 and 2, version 4010, as the standard for electronic submission of professional claims. This standard names the POS code set currently maintained by CMS as the code set to be used for describing sites of service in such claims. POS information is often needed to determine the acceptability of direct billing of Medicare, Medicaid and private insurance services provided by a given provider.
Listed below are place of service codes and descriptions. These codes should be used to specify the entity where service(s) were rendered.
Place of Service Code(s) Place of Service Name Place of Service Description
01 Pharmacy ** A facility or location where drugs and other medically related items and services are sold, dispensed, or otherwise provided directly to patients. (Effective October 1, 2003)
02 Telehealth The location where health services and health related services are provided or received, through a telecommunication system. (Effective January 1, 2017)
03 School A facility whose primary purpose is education. (Effective January 1, 2003)
04 Homeless Shelter
A facility or location whose primary purpose is to provide temporary housing to homeless individuals (e.g., emergency shelters, individual or family shelters).
(Effective January 1, 2003)
05 Indian Health Service Free-standing Facility
A facility or location, owned and operated by the Indian Health Service, which provides diagnostic, therapeutic (surgical and non-surgical), and rehabilitation services to American Indians and Alaska Natives who do not require hospitalization. (Effective January 1, 2003)
06 Indian Health Service Provider-based Facility
A facility or location, owned and operated by the Indian Health Service, which provides diagnostic, therapeutic (surgical and non-surgical), and rehabilitation services rendered by, or under the supervision of, physicians to American Indians and Alaska Natives admitted as inpatients or outpatients.
(Effective January 1, 2003)
07 Tribal 638 Free-standing Facility
A facility or location owned and operated by a federally recognized American Indian or Alaska Native tribe or tribal organization under a 638 agreement, which provides diagnostic, therapeutic (surgical and non-surgical), and rehabilitation services to tribal members who do not require hospitalization. (Effective January 1, 2003)
08 Tribal 638 Provider-based Facility
A facility or location owned and operated by a federally recognized American Indian or Alaska Native tribe or tribal organization under a 638 agreement, which provides diagnostic, therapeutic (surgical and non-surgical), and rehabilitation services to tribal members admitted as inpatients or outpatients.
(Effective January 1, 2003)
09 Prison/ Correctional Facility
A prison, jail, reformatory, work farm, detention center, or any other similar facility maintained by either Federal, State or local authorities for the purpose of confinement or rehabilitation of adult or juvenile criminal offenders.
(Effective July 1, 2006)
11 Office Location, other than a hospital, skilled nursing facility (SNF), military treatment facility, community health center, State or local public health clinic, or intermediate care facility (ICF), where the health professional routinely provides health examinations, diagnosis, and treatment of illness or injury on an ambulatory basis.
12 Home Location, other than a hospital or other facility, where the patient receives care in a private residence.
13 Assisted Living Facility
Congregate residential facility with self-contained living units providing assessment of each resident’s needs and on-site support 24 hours a day, 7 days a week, with the capacity to deliver or arrange for services including some health care and other services.
(Effective October 1, 2003)
14 Group Home *
A residence, with shared living areas, where clients receive supervision and other services such as social and/or behavioral services, custodial service, and minimal services (e.g., medication administration).
(Effective October 1, 2003)
15 Mobile Unit
A facility/unit that moves from place-to-place equipped to provide preventive, screening, diagnostic, and/or treatment services.
(Effective January 1, 2003)
16 Temporary Lodging
A short term accommodation such as a hotel, camp ground, hostel, cruise ship or resort where the patient receives care, and which is not identified by any other POS code.
(Effective January 1, 2008)
17 Walk-in Retail Health Clinic A walk-in health clinic, other than an office, urgent care facility, pharmacy or independent clinic and not described by any other Place of Service code, that is located within a retail operation and provides, on an ambulatory basis, preventive and primary care services. (This code is available for use immediately with a final effective date of May 1, 2010)
18 Place of Employment- Worksite A location, not described by any other POS code, owned or operated by a public or private entity where the patient is employed, and where a health professional provides on-going or episodic occupational medical, therapeutic or rehabilitative services to the individual. (This code is available for use effective January 1, 2013 but no later than May 1, 2013)
19 Off Campus-Outpatient Hospital A portion of an off-campus hospital provider based department which provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization. (Effective January 1, 2016)
20 urgent Care Facility Location, distinct from a hospital emergency room, an office, or a clinic, whose purpose is to diagnose and treat illness or injury for unscheduled, ambulatory patients seeking immediate medical attention.
(Effective January 1, 2003)
21 Inpatient Hospital A facility, other than psychiatric, which primarily provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services by, or under, the supervision of physicians to patients admitted for a variety of medical conditions.
22 On Campus-Outpatient Hospital A portion of a hospital’s main campus which provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization. (Description change effective January 1, 2016)
23 Emergency Room – Hospital A portion of a hospital where emergency diagnosis and treatment of illness or injury is provided.
24 Ambulatory Surgical Center A freestanding facility, other than a physician’s office, where surgical and diagnostic services are provided on an ambulatory basis.
25 Birthing Center A facility, other than a hospital’s maternity facilities or a physician’s office, which provides a setting for labor, delivery, and immediate post-partum care as well as immediate care of new born infants.
26 Military Treatment Facility A medical facility operated by one or more of the Uniformed Services. Military Treatment Facility (MTF) also refers to certain former U.S. Public Health Service (USPHS) facilities now designated as Uniformed Service Treatment Facilities (USTF).
27-30 Unassigned N/A
31 Skilled Nursing Facility A facility which primarily provides inpatient skilled nursing care and related services to patients who require medical, nursing, or rehabilitative services but does not provide the level of care or treatment available in a hospital.
32 Nursing Facility
A facility which primarily provides to residents skilled nursing care and related services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care services above the level of custodial care to other than individuals with intellectual disabilities.
33 Custodial Care Facility A facility which provides room, board and other personal assistance services, generally on a long-term basis, and which does not include a medical component.
34 Hospice A facility, other than a patient’s home, in which palliative and supportive care for terminally ill patients and their families are provided.
35-40 Unassigned N/A
41 Ambulance – Land A land vehicle specifically designed, equipped and staffed for lifesaving and transporting the sick or injured.
42 Ambulance – Air or Water An air or water vehicle specifically designed, equipped and staffed for lifesaving and transporting the sick or injured.
43-48 Unassigned N/A
49 Independent Clinic
A location, not part of a hospital and not described by any other Place of Service code, that is organized and operated to provide preventive, diagnostic, therapeutic, rehabilitative, or palliative services to outpatients only.
(Effective October 1, 2003)
50 Federally Qualified Health Center A facility located in a medically underserved area that provides Medicare beneficiaries preventive primary medical care under the general direction of a physician.
51 Inpatient Psychiatric Facility A facility that provides inpatient psychiatric services for the diagnosis and treatment of mental illness on a 24-hour basis, by or under the supervision of a physician.
52 Psychiatric Facility-Partial Hospitalization A facility for the diagnosis and treatment of mental illness that provides a planned therapeutic program for patients who do not require full time hospitalization, but who need broader programs than are possible from outpatient visits to a hospital-based or hospital-affiliated facility.
53 Community Mental Health Center A facility that provides the following services: outpatient services, including specialized outpatient services for children, the elderly, individuals who are chronically ill, and residents of the CMHC’s mental health services area who have been discharged from inpatient treatment at a mental health facility; 24 hour a day emergency care services; day treatment, other partial hospitalization services, or psychosocial rehabilitation services; screening for patients being considered for admission to State mental health facilities to determine the appropriateness of such admission; and consultation and education services.
54 Intermediate Care Facility/ Individuals with Intellectual Disabilities A facility which primarily provides health-related care and services above the level of custodial care to individuals but does not provide the level of care or treatment available in a hospital or SNF.
55 Residential Substance Abuse Treatment Facility A facility which provides treatment for substance (alcohol and drug) abuse to live-in residents who do not require acute medical care. Services include individual and group therapy and counseling, family counseling, laboratory tests, drugs and supplies, psychological testing, and room and board.
56 Psychiatric Residential Treatment Center A facility or distinct part of a facility for psychiatric care which provides a total 24-hour therapeutically planned and professionally staffed group living and learning environment.
57 Non-residential Substance Abuse Treatment Facility
A location which provides treatment for substance (alcohol and drug) abuse on an ambulatory basis. Services include individual and group therapy and counseling, family counseling, laboratory tests, drugs and supplies, and psychological testing.
(Effective October 1, 2003)
58-59 Unassigned N/A
60 Mass Immunization Center A location where providers administer pneumococcal pneumonia and influenza virus vaccinations and submit these services as electronic media claims, paper claims, or using the roster billing method. This generally takes place in a mass immunization setting, such as, a public health center, pharmacy, or mall but may include a physician office setting.
61 Comprehensive Inpatient Rehabilitation Facility A facility that provides comprehensive rehabilitation services under the supervision of a physician to inpatients with physical disabilities. Services include physical therapy, occupational therapy, speech pathology, social or psychological services, and orthotics and prosthetics services.
62 Comprehensive Outpatient Rehabilitation Facility A facility that provides comprehensive rehabilitation services under the supervision of a physician to outpatients with physical disabilities. Services include physical therapy, occupational therapy, and speech pathology services.
63-64 Unassigned N/A
65 End-Stage Renal Disease Treatment Facility A facility other than a hospital, which provides dialysis treatment, maintenance, and/or training to patients or caregivers on an ambulatory or home-care basis.
66-70 Unassigned N/A
71 Public Health Clinic A facility maintained by either State or local health departments that provides ambulatory primary medical care under the general direction of a physician.
72 Rural Health Clinic A certified facility which is located in a rural medically underserved area that provides ambulatory primary medical care under the general direction of a physician.
73-80 Unassigned N/A
81 Independent Laboratory A laboratory certified to perform diagnostic and/or clinical tests independent of an institution or a physician’s office.
82-98 Unassigned N/A
99 Other Place of Service Other place of service not identified above.
PLACE OF SERVICE CODES
00 NOT SUPPLIED
04 HOMELESS SHELTER
05 INDIAN HEALTH SERVICE FREE-STANDING FACILITY
06 INDIAN HEALTH SERVICE PROVIDER-BASED FACILITY
07 TRIBAL 638 FREE-STANDING FACILITY
08 TRIBAL 638 PROVIDER-BASED FACILITY
13 ASSISTED LIVING FACILITY
14 GROUP HOME
15 MOBILE UNIT
20 URGENT CARE FACILITY
21 INPATIENT HOSPITAL
22 OUTPATIENT HOSPITAL
23 EMERGENCY ROOM – HOSPITAL
24 AMBULATORY SURGICAL CENTER
25 BIRTHING CENTER
26 MILITARY TREATMENT FACILITY
31 SKILLED NURSING FACILITY
32 NURSING FACILITY
33 CUSTODIAL CARE FACILITY
41 AMBULANCE (LAND)
42 AMBULANCE (AIR OR WATER)
49 INDEPENDENT CLINIC
50 FEDERALLY QUALIFIED HEALTH CENTER
51 INPATIENT PSYCHIATRIC FACILITY
52 PSYCHIATRIC FACILITY, PARTIAL HOSPITALIZATION
53 COMMUNITY MENTAL HEALTH CENTER
54 INTERMEDIATE CARE FACILITY/MENTALLY RETARDED
55 RESIDENTIAL SUBSTANCE ABUSE TREATMENT FACILITY
56 PSYCHIATRIC RESIDENTIAL TREATMENT CENTER
57 NON-RESIDENTIAL SUBSTANCE ABUSE TREATMENT FACILITY
60 MASS IMMUNIZATION CENTER
61 COMPREHENSIVE INPATIENT REHABILITATION FACILITY
62 COMPREHENSIVE OUTPATIENT REHABILITATION FACILITY
65 END STAGE RENAL DISEASE TREATMENT FACILITY
71 STATE OR LOCAL PUBLIC HEALTH CLINIC
72 RURAL HEALTH CLINIC
81 INDEPENDENT LABORATORY
99 OTHER UNLISTED FACILITY
Q: Where do the Place of Service codes come from?
A: The Place of Service codes can be found on the CMS website and contains two-digit codes placed on health care professional claims to indicate the setting in which a service was provided. The Centers for Medicare & Medicaid Services (CMS) maintains POS codes used throughout the health care industry.
Using correct POS FOR REIMBURSEMENT
Oxford will reimburse CPT and HCPCS codes when reported with an appropriate place of service (POS).
Many CPT and HCPCS codes include a place of service in their description or coding guidelines include the place(s) of service where the code may be performed. For example, CPT code 94002 (Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; hospital inpatient/observation, initial day) would not be appropriate for reporting in an office or home POS because its code description identifies hospital inpatient or observation.
The Centers for Medicare & Medicaid Services (CMS) maintain the Place of Service Code set, which are two-digit codes submitted on the CMS 1500 Health Insurance Claim Form or its electronic equivalent to indicate the setting in which a service was provided. The website containing the POS Code set can be accessed via this link: CMS Place of Service Code Set.
Reporting place of service (POS) codes
Physicians are required to report the place of service (POS) on all health insurance claims they submit to Medicare Part B contractors. The POS code is used to identify where the procedure is furnished. Physicians are paid for services according to the Medicare physician fee schedule (MPFS). This schedule is based on a payment system that includes three major categories, which drive the reimbursement for physician services:
• Practice expense (reflects overhead costs involved in providing service(s))
• Physician work
• Malpractice insurance
To account for the increased practice expense physicians incur by performing services in their offices, Medicare reimburses physicians a higher amount for services performed in their offices (POS code 11) than in an outpatient hospital (POS 22-23) or an ambulatory surgical center (ASC) (POS 24). Therefore, it is important to know the POS also plays a factor in the reimbursement.
Note: Check with individual payers (e.g., Medicare, Medicaid, other private insurance) for reimbursement policies regarding POS codes.
Important facts when filing a claim to Medicare
• The POS is a required field, entered in the 2400 Place of Service Code loop (segment SV105) of the 837P electronic claim or Item 24B on the CMS-1500 paper claim
• The name, address and ZIP code of where the service(s) were actually performed is required for all POS codes, and is entered in Item 32 on the CMS 1500 claim form or in the corresponding loop on its electronic equivalent
• Must specify the correct location where the service(s) is performed and billed on the claim, since both the POS and the locality address are components of the MPFS
• If the POS is missing, invalid or inconsistent with procedure code on claim form it will be returned as unprocessable (RUC)
• For example, POS 21 (inpatient hospital) is not compatible with procedure code 99211 (Establish patient office or other outpatient visit)
• If a provider specialty other than “69” (Clinical laboratory-billing independently) bills a claim with a POS 81 (Independent laboratory) it will be denied with a claim adjustment reason code (CARC) CO5, refer to Washington Publishing Company (WPC) website http://www.wpc-edi.com/reference/ external link.
Helpful hints for POS codes for professional claims
• Implement internal control systems to prevent incorrect billing of POS codes
• Keep informed on Medicare coverage and billing requirements
• For example, billing physician’s office (POS 11) for a minor surgical procedure that is actually performed in a hospital outpatient department (POS 22) and collecting a higher payment is inappropriate billing and may be viewed as program abuse
What place of service code (POS) should we bill for outpatient hospital?
Effective January 1, 2016, there will be two possible place of service codes to choose from for outpatient hospital settings: new place of service code 19 and revised place of service code 22.
POS 19 Off Campus-Outpatient Hospital
A portion of an off-campus hospital provider based department which provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization.
POS 22 On Campus-Outpatient Hospital
A portion of a hospital’s main campus which provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization.
Reporting outpatient hospital POS code 19 or 22 is a minimum requirement to trigger the facility payment amount under the Physician Fee Schedule (PFS) when services are provided to a registered outpatient. Therefore, you should use POS code 19 or POS code 22 when you furnish services to a hospital outpatient regardless of where the face-to-face encounter occurs.
The payment policies that currently apply to POS 22 will continue to apply to this POS, and will now also apply to POS 19 unless otherwise stated in Change Request (CR) 9231.
What place of service (POS) do I use when reading a test from a remote location?
Effective April 1, 2013, CR 7631 establishes that for all services – with two exceptions – paid under the MFPS, the POS code to be used by the physician and other supplier will be assigned as the same setting in which the beneficiary received the face-to-face service. Because a face-to-face encounter with a physician/practitioner is required for nearly all services paid under the MPFS and anesthesia services, this rule will apply to the overwhelming majority of MPFS services. In cases where the face-to-face requirement is obviated such as those when a physician/practitioner provides the PC/interpretation of a diagnostic test, from a distant site, the POS code assigned by the physician/practitioner will be the setting in which the beneficiary received the TC of the service.
There are two exceptions to this face-to-face provision/rule in which the physician always uses the POS code where the beneficiary is receiving care as a hospital inpatient or an outpatient of a hospital, regardless of where the beneficiary encounters the face-to-face service. The correct POS code assignment will be for that setting in which the beneficiary is receiving inpatient or outpatient care from a hospital, including the inpatient hospital (POS code 21) or the outpatient hospital (POS code 19 or 22). The Medicare Claims Processing Manual already requires this for physician services (and for certain independent laboratory services) provided to beneficiaries in an inpatient hospital and CR 7631 clarifies this exception and extends it to beneficiaries in an outpatient hospital.
Using the Correct Place of Service Code for Professional Component Claims Rendered in a Hospital Setting
Due to different referral and authorization requirements based on where services are rendered, it is important that your claim is submitted with the correct Place of Service code. The Place of Service code also affects how your claim is routed and which authorization/referral is utilized.
Please verify whether the Member was in the Emergency Room, admitted on an inpatient basis, or if he or she received outpatient services and submit the claim with the corresponding Place of Service code. When the incorrect Place of Service code is submitted, your claim may be denied due to “no authorization.” For example, if a claim is incorrectly submitted with an inpatient Place of Service code, and the Member was in the Emergency Room, there would not be an inpatient authorization on file. Therefore, your claim would be denied due to “no authorization.”
Please utilize the correct Place of Service code from the list below:
Description Code Office 11
Mobile diagnostic unit 15
Urgent care facility 20
Inpatient hospital 21
Outpatient hospital 22
Emergency room hospital 23
Ambulatory surgical center 24
Birthing center 25
Military treatment facility 26
Skilled nursing facility 31
Nursing facility 32
Custodial care 33
Ambulance – land 41
Ambulance – air or water 42
Inpatient psychiatric facility 51
Psychiatric facility partial hospitalization 52
Community mental health center 53
Intermediate care facility/mentally retarded 54
Residential substance abuse 55
Psychiatric residential treatment center 56
Comprehensive inpatient rehabilitation facility 61
Comprehensive outpatient rehabilitation facility 62
End-stage renal disease facility 65
State or local public health clinic 71
Rural health clinic 72
Independent lab 81
Other unlisted facility 99
PAYMENTS FOR INCORRECT PLACE-OF-SERVICE CODES
Physicians did not always correctly code nonfacility places of service on Part B physician claims submitted to, and paid by, Medicare contractors from January 2010 through September 2012. As a result, Medicare contractors potentially overpaid physicians approximately $33.4 million for physician services provided in facility locations.
Physician Services Performed in Ambulatory Surgical Centers Billed in Error From our computer match of nonfacility-coded physician services to ASC claims, we determined that Medicare contractors potentially overpaid physicians $7.3 million for billing more than 100,000 services using the incorrect place-of-service code.
CAUSES OF OVERPAYMENTS
Many physicians had not implemented internal controls to prevent billing with incorrect placeof-service codes. Physicians and their billing personnel or agents told us that they had coded the place of service incorrectly for one or more of the following reasons, which are consistent with alack of adequate controls:
* Billing personnel were confused about the precise definition of a “physician’s office” or other nonfacility location or were simply following established practices in applying the nonfacility codes.
* Some billing personnel were unaware that an incorrect place-of-service code could result in an increased Medicare payment.
* Billing personnel made isolated data entry errors.
* Undetected flaws in the design or implementation of some billing systems caused all claims to be submitted with a nonfacility location as the place of service. Insufficient Postpayment Reviews at Medicare Contractors
In our prior reviews, we recommended that CMS establish postpayment reviews through coordinated data matches of nonfacility-coded physician services and facility claims to identify and recover place-of-service overpayments. CMS concurred with this recommendation and stated that it would recover overpayments in a manner consistent with the agency’s policies and procedures. To address the recommendations from our 2011 nationwide report for 2009 dates of service, CMS commissioned in 2012 a place-of-service overpayment voluntary refund demonstration project, administered by one Medicare contractor. This limited scope project identified an expected overpayment recovery of $394,041 and demonstrated that additional projects of this type are needed to address a continual pattern of place-of-service coding errors that resulted in average overpayments of more than $10 million per year.