Place of service codes list in medical billing are playing an important role in every claim. The place where you get performed services is called the place of service (POS) like doctors’ office, hospital, emergency care, etc. In USA healthcare it is predefined that for every place where services performed denoted by some numbers and it is mandatory that before submitting any claim place of service should be correctly coded.
Some examples of place of service (POS) Codes:
- Doctors Office visit POS- 11
- Home visit POS- 12
- Inpatient Hospital POS- 21
- Emergency care POS- 23
Place of Service Codes List 2023
The following POS codes should be used in professional claims to specify that where service rendered.
| Place of Service Codes | POS Name | POS Description |
| POS 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 from 10-01-2003) |
| POS 02 | Telehealth Provided Other than in Patient’s Home | The location where health services and health related services are provided or received, through telecommunication technology. Patient is not located in their home when receiving health services or health related services through telecommunication technology. (Effective from 01-01-2017) (Description change effective from 01/01/2022, and applicable for Medicare 04/01/2022.) |
| POS 03 | School | A facility whose primary purpose is education. (Effective from 01/01/2003) |
| POS 04 | Homeless Shelter | A facility or location whose primary purpose is to provide temporary housing to homeless people (Ex., emergency shelters, individual or family shelters). (Effective from 01/01/2003) |
| POS 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 from 01/01/2003) |
| POS 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 from 01/01/2003) |
| POS 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 from 01/01/2003) |
| POS 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 from 01/01/2003) |
| POS 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 from 01/01/2003) |
| Place of Service Code(s) | Place of Service Name | Place of Service Description |
| POS 10 | Telehealth Provided in Patient’s Home | The location where health services and health related services are provided or received, through telecommunication technology. Patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health related services through telecommunication technology. (This code is effective 01-01-2022, and available to Medicare 04-01-2022.) |
| POS 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. |
| POS 12 | Home | Location, other than a hospital or other facility, where the patient receives care in a private residence. |
| POS 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 from 10-01-2003) |
| POS 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 from 10-01-2003) |
| POS 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) |
| Place of Service Code(s) | Place of Service Name | Place of Service Description |
| POS 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 from 01/01/2008) |
| POS 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 05/01/2010) |
| POS 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 01-01-2013 but no later than 05/01/2013) |
| 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. (Effective from 01/01/2016) |
| POS 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 from 01/01/2003) |
| Place of Service Code(s) | Place of Service Name | Place of Service Description |
| POS 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. |
| 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. (Description change effective January 1, 2016) |
| POS 23 | Emergency Room – Hospital | A portion of a hospital where emergency diagnosis and treatment of illness or injury is provided. |
| POS 24 | Ambulatory Surgical Center | A freestanding facility, other than a physician’s office, where surgical and diagnostic services are provided on an ambulatory basis. |
| POS 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. |
| POS 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). |
| POS 27-30 | N/A | Not Assigned Codes |
| POS 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. |
| Place of Service Code(s) | Place of Service Name | Place of Service Description |
| POS 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. |
| POS 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. |
| POS 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. |
| POS 35-40 | N/A | Not Assigned |
| POS 41 | Ambulance – Land | A land vehicle specifically designed, equipped and staffed for lifesaving and transporting the sick or injured. |
| POS 42 | Ambulance – Air or Water | An air or water vehicle specifically designed, equipped and staffed for lifesaving and transporting the sick or injured. |
| POS 43-48 | N/A | Not Assigned |
| POS 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 10/01/2003) |
| POS 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. |
| POS 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. |
| POS Codes | POS Name | POS Description |
| POS 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. |
| POS 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. |
| POS 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. |
| POS 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. |
| POS Codes | POS Name | POS Description |
| POS 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. |
| POS 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) |
| POS 58 | Non-residential Opioid Treatment Facility | A location that provides treatment for opioid use disorder on an ambulatory basis. Services include methadone and other forms of Medication Assisted Treatment (MAT). (Effective January 1, 2020) |
| POS 59 | N/A | Not Assigned |
| POS 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. |
| POS 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. |
| POS 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. |
| Place of Service Codes | POS Name | POS Description |
| POS 63-64 | N/A | Not Assigned |
| POS 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. |
| POS 66-70 | Unassigned | N/A |
| POS 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. |
| POS 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. |
| POS 73-80 | N/A | Not Assigned |
| POS 81 | Independent Laboratory | A laboratory certified to perform diagnostic and/or clinical tests independent of an institution or a physician’s office. |
| POS 82-98 | N/A | Not Assigned |
| POS 99 | Other Place of Service | Other place of service not identified above. |
Medical billing is a complex process that involves submitting and processing healthcare claims for reimbursement. To ensure accuracy and transparency in medical billing, various codes, and modifiers indicate the specific services provided and the location where they were rendered. One such code is the Place of Service (POS) code, which is crucial in medical billing. This article will delve into the intricacies of Place of Service codes and understand their significance in medical billing.
Importance of Place of Service Codes
Place of Service codes are essential in medical billing as they provide vital information about the type of facility or setting where a healthcare service occurs. These codes help payers, and insurance companies determine the appropriate reimbursement rates based on the resources and costs associated with different healthcare settings.
How is Place of Service Codes Used?
Place of Service codes is used in medical claims and billing processes to accurately reflect the location where a specific healthcare service was provided. These codes are typically included in the claim form submitted by healthcare providers to insurance companies or other payers. By having the appropriate Place of Service code, healthcare providers can ensure that the reimbursement process is smooth and accurate.
The Significance of Place of Service Codes in Medical Billing
Place of Service codes is significant in medical billing for several reasons. Let’s explore their significance in more detail:
1. Determining Reimbursement Rates
Insurance companies and payers determine reimbursement rates based on the setting in which healthcare services are delivered. Different healthcare settings have varying costs and resources associated with them. Place of Service codes helps in categorizing these settings, allowing payers to establish appropriate reimbursement rates for each specific code. This ensures that healthcare providers are reimbursed fairly for the services they render.
2. Coverage and Network Determination
The place of Service codes is crucial for determining the coverage and network applicability for specific medical services. Insurance plans often have different coverage policies based on the setting in which services are provided. For example, particular procedures may only be covered in a hospital, not an outpatient clinic. Place of Service codes assists in verifying the eligibility of services based on the coverage policies associated with each specific code.
3. Fraud and Abuse Prevention
One of the significant advantages of Place of Service codes is their ability to detect potential fraud and abuse in medical billing. By accurately identifying the service delivery location, these codes help ensure that services are billed appropriately and that healthcare providers accurately represent the setting to receive higher reimbursements.
What common Place of Service codes are used in medical billing?
A1: Some common Place of Service codes used in medical billing include:
- 11: Office
- 21: Inpatient Hospital
- 22: Outpatient Hospital
- 23: Emergency Room
- 24: Ambulatory Surgical Center
- 31: Skilled Nursing Facility
- 32: Nursing Facility
- 33: Custodial Care Facility
- 49: Independent Clinic
The Place of Service Code is a mandatory information that needs to be provided when submitting a claim. In electronic claims (837P), it should be entered in the 2400 Place of Service Code loop (segment SV105). For paper claims (CMS-1500), it should be entered in column 24B.
Additionally, it is necessary to include the actual location details where the service(s) were performed. This includes the name, address, and ZIP code. For CMS-1500 paper claims, this information should be entered in Item 32. In electronic claims, it should be entered in the corresponding loop of the electronic equivalent form.
Place of Service Codes for Professional Claims:
- Place of Service (POS) codes indicate where a service was performed for billing purposes.
- If the POS code on a claim is missing, invalid, or inconsistent with the procedure code, it may be returned as unprocessable.
- Using the incorrect POS code can result in claim denials or overpayments.
- Providers or Hospitals should implement internal control systems to prevent incorrect billing of POS codes.
- It is important to stay informed on Medicare coverage and billing requirements.
POS Codes for Outpatient Hospital:
- Effective January 1, 2016, there are two possible POS codes for outpatient hospital settings: POS 19 and POS 22.
- POS 19 (Off Campus-Outpatient Hospital) is for off-campus hospital provider-based departments that provide diagnostic, therapeutic, and rehabilitation services to patients who do not require hospitalization.
- POS 22 (On Campus-Outpatient Hospital) is for a portion of a hospital’s main campus that provides similar services to non-hospitalized patients.
- POS code 19 or 22 is required to trigger the facility payment amount under the Physician Fee Schedule (PFS) for outpatient services.
POS for Reading a Test from a Remote Location:
- In most cases, the POS code assigned should be the same setting in which the beneficiary received the face-to-face service.
- If a physician/practitioner provides the interpretation of a diagnostic test from a distant site, the assigned POS code should reflect the setting where the beneficiary received the technical component (TC) of the service.
- There are exceptions to this rule for inpatient and outpatient care from a hospital, where the POS code for the hospital setting should be used regardless of the face-to-face encounter location.
Consequences of Incorrect POS Codes:
- Submitting claims with incorrect POS codes can result in claim denials and potential overpayments.
- Physicians and billing personnel may make errors due to confusion, lack of awareness, data entry mistakes, or flawed billing systems.
- Medicare contractors have conducted postpayment reviews and recovery projects to identify and recover overpayments related to incorrect POS coding.
Frequently Asked Questions
Ans. The Place of Service codes can impact the reimbursement amount. Different settings have varying costs and resources, and reimbursement rates are determined based on these factors. Using the correct Place of Service code ensures that healthcare providers are reimbursed appropriately for the services provided.
Ans. Healthcare providers can refer to the CMS (Centers for Medicare and Medicaid Services) website or consult the official documentation and guidelines provided by insurance companies or payers to ensure they use the correct Place of Service codes. Staying up-to-date with the latest coding changes and seeking clarification from coding experts can also help ensure accuracy in coding and billing processes.
Ans. While many Places of Service codes are consistent across healthcare payers, there may be slight variations or specific requirements imposed by individual insurance companies or payers. Healthcare providers need to familiarize themselves with the coding guidelines and conditions of the particular payers they work with to ensure accurate billing.
Ans. Correctly Place of Service coding can lead to claim denials. Insurance companies and payers rely on accurate coding to process claims efficiently. Inaccurate or inappropriate coding, including incorrect Place of Service codes, can result in claim denials or delays in reimbursement. Healthcare providers must properly use Place of Service codes to avoid such issues.
Ans. Place of Service codes are periodically updated and revised to reflect changes in the healthcare landscape and evolving industry standards. To ensure accurate coding and billing practices, healthcare providers should stay informed about the latest updates and revisions.
Conclusion:
Place of Service codes plays a vital role in medical billing by accurately identifying the location where healthcare services are provided. These codes help determine reimbursement rates and coverage eligibility and prevent fraud and abuse in the billing process.
Codes for place of service (POS) in medical billing are in numeric forms always. If Place of service code is not updated correctly in a claim, get denials in a claim for the invalid place of service so need to update it correctly.
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