Place of service (POS) 21, 22 , 23 codes.

POS code and Description

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.


Reporting Guidelines


• 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.

Using of POS 23 with modifier 26

Modifier 26 is only appropriate in one of the following places of service:

* Hospital inpatient (place of service 21).
* Hospital outpatient (place of service 22).
* Emergency Room (place of service 23).
* Use of Modifier 26 is not appropriate in conjunction with any other place of service code.

The place of service indicated on the radiologist’s claim, in this case, reflects the location where the CT was performed, not the location where the radiologist actually reviewed the film. If the radiologist indicated a place of service of 11 (office), the service 70450 appended with modifier 26 would be denied for an ineligible place of service. Please note the above also applies to the technical component (TC). Only place of service 21, 22 & 23 are appropriate for TC and PC component. If services are rendered in a freestanding radiology/imaging center then the center would bill globally. In addition, if a specialty physician is over-reading or interpreting the procedure as a consultation in the office (POS 11) the service will not be reimbursed separately from the global component.


The radiologist will submit a claim for the reading and interpreting of the results (the professional component PC) of that diagnostic service with the following claim elements:

CPT Code 70450 Modifier 26

POS 23

The place of service indicated on the radiologist’s claim, in this case, reflects the location where the CT was performed, not the location where the radiologist actually reviewed the film. If the radiologist indicated a place of service of 11 (office), the service 70450 appended with modifier 26 would be denied for an ineligible place of service. Please note the above also applies to the technical component (TC). Only place of service 21, 22 & 23 are appropriate for TC and PC component. If services are rendered in a freestanding radiology/imaging center then the center would bill globally. In addition, if a specialty physician is over-reading or interpreting the procedure as a consultation in the office (POS 11) the service will not be reimbursed separately from the global component.



Will Oxford reimburse the same physician for both an injection (96372-96379) and an Evaluation and Management (E/M) service code on the same date of service if each is performed in a different place of service?

A: Yes, Oxford will separately reimburse the same physician for both an injection procedure and E/M service on the same date of service if each is performed in a different place of service (POS) and the injection was provided in a POS other than 19, 21, 22, 23, 24, 26, 51, 52, and 61. For example, if the patient only receives an injection at a physician’s office (POS 11) and later that day the patient is admitted to the hospital (POS 21), both services, the injection service performed at the physician’s office and the E/M performed later that day at the hospital, would be separately reimbursed because the injection service and E/M service were performed in different locations by the same physician on the same date of service. Injection services are not reimbursable when provided in POS 19, 21, 22, 23, 24, 26, 51, 52, and 61.

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.

POS 22 - Update on Campus outpatient hospital

This Change Request revises the description of Place of Service (POS) code 22 to On Campus-Outpatient Hospital, and creates a new POS code for Off Campus-Outpatient Hospital.

As an entity covered under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Medicare must comply with standards and their implementation guides adopted by regulation under this statute. The currently adopted professional implementation guide for the ASC X12N 837 standard requires that each electronic claim transaction include a Place of Service (POS) code from the POS code set maintained by the Centers for Medicare and Medicaid Services (CMS). As a payer, Medicare must be able to recognize as valid any valid code from the POS code set that appears on the HIPAA standard claim transaction.

The POS code set provides setting information necessary to appropriately pay Medicare and Medicaid claims. At times, Medicaid has had a greater need for specificity than has Medicare, and many of the new codes developed over the past few years have been to meet Medicaid’s needs. While Medicare does not always need this greater specificity in order to appropriately pay claims, it nevertheless adjudicates claims with the new codes to ease coordination of benefits and to give Medicaid and other payers the setting information they require.

This Change Request (CR) updates the current POS code set by adding new POS code 19 for “Off CampusOutpatient Hospital” and revising POS code 22 from “Outpatient Hospital” to “On Campus-Outpatient Hospital.” Also, this CR will implement the systems and local contractor level changes needed for Medicare to adjudicate claims with the new and revised codes. Local contractors shall develop policies as needed to adjudicate claims containing new POS code 19 and revised POS code 22 in accordance with Medicare national policy. Contractor editing shall treat POS 19 and POS 22 in the same way. See Title 42 CFR 413.65(a)(2) for a definition of "campus."

Payments for services provided to outpatients who are later admitted as inpatients within 3 days (or, in the case of non-IPPS hospitals, 1 day) are bundled when the patient is seen in a wholly owned or wholly operated physician practice. The 3-day payment window applies to diagnostic and nondiagnostic services that are clinically related to the reason for the patient’s inpatient admission regardless of whether the inpatient and outpatient diagnoses are the same. The 3-day payment rule will also apply to services billed with POS code 19.

As discussed in the CY 2015 Physician Fee Schedule (PFS) final rule with comment period published on November 13, 2014 (79 FR 67572), in order to differentiate between on-campus and offcampus provider-based hospital departments, CMS is creating a new POS code (POS 19) and revising the current POS code description for outpatient hospital (POS 22) as follows:

POS 19: Off Campus-Outpatient Hospital Descriptor: 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

Descriptor: 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.

Unless prohibited by national policy to the contrary, Medicare not only recognizes valid POS codes from the POS code set but also adjudicates claims having these codes. Although the Medicare program does not always have the same need for setting specificity as other payers, including Medicaid, adjudicating the claims eases the coordination of benefits for Medicaid and other payers who may need the specificity afforded by the entire POS code set.

Claims for covered services rendered in an Off Campus-Outpatient Hospital setting, or in an On CampusOutpatient Hospital setting, if payable by Medicare, shall be paid at the facility rate. The payment policies that currently apply to POS 22 will continue to apply and will now also apply to POS19 unless otherwise stated.

9231.2 Effective for claims processed on or after January 1, 2016, contractors shall recognize the revised description for place of service (POS) code 22 from “Outpatient Hospital” to “On Campus-Outpatient Hospital”

9231.8 Contractors shall educate physicians/practitioners and other suppliers to use, at a minimum, POS code 19 (Off Campus-Outpatient Hospital) or POS code 22 (On Campus-Outpatient Hospital) when they furnish services to an outpatient of a hospital, irrespective of where the face-to-face encounter occurs. (As discussed under “Special Considerations for Outpatient Hospital Departments”

9231.10 Until notified otherwise by CMS, for claims processed on or after January 1, 2016, contractors shall make any necessary systems changes to process procedure codes submitted with the revised POS code 22 and the new POS code 19 in the same way as they did for claims with 2015 dates of service submitted with POS 22.

Under the Medicare Physician Fee schedule (MPFS), some procedures have separate rates for physicians’ services when provided in facility and nonfacility settings. The CMS furnishes both rates in the MPFSDB update.

Modifier 26 usage POS 21, 22 , 23

Generally, Modifier 26 is appended to a procedure code to indicate that the service provided was the reading and interpreting of the results of a diagnostic and/or laboratory service.

To help ensure the accurate adjudication of claims, we ask that you adhere to the following Modifier 26 guidelines.

Modifier 26 is only appropriate in one of the following places of service (POS):

· Hospital inpatient (POS 21)

· Hospital outpatient (POS 22)

· Emergency Room (POS 23)

· Off Campus-Outpatient Hospital (POS 19)

Use of Modifier 26 is not appropriate in conjunction with any other place of service code.

Modifier 26 is not appropriate when:

· The same provider performs both the technical and professional components (unless the same provider reports both components and the technical portion is purchased).

· Reporting re-read results of an interpretation provided by another physician.

· Appended to claims that include:

* Technical-only procedure codes.

* Global-test only codes.

· Claims submitted with Modifier 26 that are billed in conjunction with the global component will not be reimbursed.

Example use of Modifier 26

A patient seeks treatment at the Emergency Room (ER) of a hospital for a head injury. The facility performs a CT of the head without contrast (CPT® Code 70450). The film is sent by courier to a noted local radiologist’s office for review. The radiologist reads/interprets the CT film and seeing no sign of injury or damage calls the hospital’s ER and advises them to release the patient.

The facility will submit a claim for providing the technical component of the service with the following claim elements:

CPT Code 70450

Modifier TC (to indicate the technical component)

POS 23

The radiologist will submit a claim for the reading and interpreting of the results (the professional component PC) of that diagnostic service with the following claim elements:

CPT Code 70450

Modifier 26

POS 23

The place of service indicated on the radiologist’s claim, in this case, reflects the location where the CT was performed, not the location where the radiologist actually reviewed the film. If the radiologist indicated a place of service of 11 (office), the service 70450 appended with Modifier 26 would be denied for an ineligible place of service.

Please note the above also applies to the technical component (TC). Only POS 21, 22 and 23 are appropriate for TC and PC component. If services are rendered in a freestanding radiology/imaging center then the center would bill globally.

In addition, if a specialty physician is over-reading or interpreting the procedure as a consultation in the office (POS 11) the service will not be reimbursed separately from the global component.

Special Considerations for Outpatient Hospital Departments

The place of service (POS) code for “Outpatient Hospital” has been expanded. The description of POS 22 has been revised from “Outpatient Hospital” to “On Campus-Outpatient Hospital” and POS 19 has been created for the “Off Campus-Outpatient Hospital” setting. Throughout this Internet Only Manual (IOM) you may find references to “Outpatient Hospital” that do not differentiate between the “On Campus” or “Off Campus” setting; however, any reference to POS 22 (formerly “Outpatient Hospital”) found anywhere within the IOM is now defined as “On CampusOutpatient Hospital.” In addition, POS 19 will also apply in the majority of situations describing an outpatient hospital setting.

When a physician/practitioner furnishes services to an outpatient of a hospital, payment is made under the PFS at the facility rate. Physicians/practitioners who furnish services to a hospital outpatient, including in a hospital outpatient department (including in a provider-based department of that hospital) or under arrangement to a hospital shall, at a minimum, report the off campusoutpatient hospital POS code 19 or on campus-outpatient hospital POS code 22 irrespective of the setting where the patient actually receives the face-to-face encounter. In other words, reporting the outpatient hospital POS code 19 or 22 is a minimum requirement for purposes of triggering the facility payment amount under the PFS when services are provided to a registered outpatient. If the physician/practitioner is aware of the exact setting where the beneficiary is a registered hospital outpatient, the appropriate outpatient facility POS code may be reported consistent with the code list annotated in this section (instead of POS 19 or 22). For example, physicians/practitioners may use POS code 23 for services furnished to a patient registered in the emergency room, POS 24 for patients registered in an ambulatory surgical center, and POS 56 for patients registered in a psychiatric residential treatment center.

NOTE: Physicians/practitioners who perform services in a hospital outpatient department shall use, at a minimum, POS code 19 (Off Campus-Outpatient Hospital) or POS code 22 (On Campus-Outpatient Hospital). Code 19 or 22 (or other appropriate outpatient department POS code as described above) shall be used unless the physician maintains separate office space in the hospital or on the hospital campus and that physician office space is not considered a provider-based department of the hospital as defined in 42. C.F.R. 413.65. Physicians shall use POS code 11 (office) when services are performed in a separately maintained physician office space in the hospital or on the hospital campus and that physician office space is not considered a provider-based department of the hospital. Use of POS code 11(office) in the hospital outpatient department or on hospital campus is subject to the physician self-referral provisions set forth in 42 C.F.R 411.353 through 411.357.

Place of service (POS) For telehealth services in a member’s home setting

Consistent with CMS and industry-standard POS reporting guidelines, Blue Cross allows the following POS codes to be submitted:

• POS 02 (telehealth) and POS 11 (office). Blue Cross will treat POS 02 and POS 11 the same to allow the provider to be reimbursed at the office rate.

• Use of other POS codes may be subject to a facility site of service reimbursement differential. 

For telehealth services in a non-home setting

Use the POS code that best describes where the member is located.

• POS 21 (inpatient hospital)

• POS 22/19 (on/off campus outpatient hospital)

• POS 23 (emergency room)

• POS 31 (skilled nursing facility)

• Do not bill the provider’s location as the place of service

Would payment vary based on the POS?

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)

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


Site of Service Payment Differential


Under the Medicare Physician Fee schedule (MPFS), some procedures have separate rates for physicians’ services when provided in facility and nonfacility settings. The CMS furnishes both rates in the MPFSDB update.

The rate, facility or nonfacility, that a physician service is paid under the MPFS is determined by the Place of service (POS) code that is used to identify the setting where the beneficiary received the face-to-face encounter with the physician, nonphysician practitioner (NPP) or other supplier. In general, the POS code reflects the actual place where the beneficiary receives the face-to-face service and determines whether the facility or nonfacility payment rate is paid. However, for a service rendered to a patient who is an inpatient of a hospital (POS code 21) or an outpatient of a hospital (POS code 22), the facility rate is paid, regardless of where the face-to-face encounter with the beneficiary occurred. For the professional component (PC) of diagnostic tests, the facility and nonfacility payment rates are the same – irrespective of the POS code on the claim. See chapter 13, section 150 of this manual for POS instructions for the PC and technical component of diagnostic tests.

The list of settings where a physician’s services are paid at the facility rate include:

*Inpatient Hospital (POS code 21);

*Outpatient Hospital (POS code 22);

*Emergency Room-Hospital (POS code 23);

*Medicare-participating ambulatory surgical center (ASC) for a HCPCS code included on the ASC approved list of procedures (POS code 24);

*Medicare-participating ASC for a procedure not on the ASC list of approved procedures with dates of service on or after January 1, 2008. (POS code 24);

*Skilled Nursing Facility (SNF) for a Part A resident (POS code 31);

*Hospice – for inpatient care (POS code 34);

*Ambulance – Land (POS code 41);

*Ambulance – Air or Water (POS code 42);


*Inpatient Psychiatric Facility (POS code 51);

*Psychiatric Facility -- Partial Hospitalization (POS code 52);

*Community Mental Health Center (POS code 53);

*Psychiatric Residential Treatment Center (POS code 56); and

*Comprehensive Inpatient Rehabilitation Facility (POS code 61).

Physicians’ services are paid at nonfacility rates for procedures furnished in the following settings:

*Pharmacy (POS code 01);

*School (POS code 03);

*Homeless Shelter (POS code 04);

*Prison/Correctional Facility (POS code 09);

*Office (POS code 11);

*Home or Private Residence of Patient (POS code 12);

*Assisted Living Facility (POS code 13);

*Group Home (POS code 14);

*Mobile Unit (POS code 15);

*Temporary Lodging (POS code 16);

*Walk-in Retail Health Clinic (POS code 17);

*Urgent Care Facility (POS code 20);

*Birthing Center (POS code 25);

*Nursing Facility and SNFs to Part B residents (POS code 32);

*Custodial Care Facility (POS code 33);

*Independent Clinic (POS code 49);


*Federally Qualified Health Center (POS code 50);

*Intermediate Health Care Facility/Mentally Retarded (POS code 54);

*Residential Substance Abuse Treatment Facility (POS code 55);

*Non-Residential Substance Abuse Treatment Facility (POS code 57);

*Mass Immunization Center (POS code 60);

*Comprehensive Outpatient Rehabilitation Facility (POS code 62);

*End-Stage Renal Disease Treatment Facility (POS code 65);

*State or Local Health Clinic (POS code 71);

*Rural Health Clinic (POS code 72);

*Independent Laboratory (POS code 81);and

*Other Place of Service (POS code 99).

Medicare rejection or Audit for incorrect POS

Common Working File (CWF) Informational Unsolicited Response (IUR) or Reject for Place of Service Billed by Physician Office and either Ambulatory Surgical Center or Inpatient Hospital 

The Medicare physician fee schedule includes two payment amounts depending on whether a service is performed in a facility setting, such as an outpatient hospital department or ambulatory surgical center, or in a non-facility setting, such as a physician’s office. The payments to physicians are higher when the services are performed in non-facility settings. The higher payments are designed to compensate physicians for the additional costs incurred to provide the service at an office location as opposed to a facility location.

The Office of Inspector General identified incorrect place of service billing by physicians as a payment error in an audit report (see A-01-11-00508).  This report stated, “Physicians are required to identify the place of service on the health insurance claim forms that they submit to Medicare contractors. The correct place-of-service code ensures that Medicare does not reimburse a physician incorrectly for the overhead portion of the payment if the service was performed in a facility setting.”  This report also states that several Medicare contractors overpaid physicians who did not correctly identify the place of service on their claims.

To ensure proper payment, CWF will create an IUR for all claims where the dates of service, the beneficiary information, and procedure, are all the same and billed with a physician place of service code 11 - office, and a facility code for inpatient hospital – 21, and ambulatory surgical center (ASC) – 24, that is posted due to an update from CMS.   An IUR is a message from CWF to a MAC, carrier or fiscal intermediary, as applicable, to review claims for accuracy.

The issue listed below has been identified by the recovery auditors as significant improper payments and requires the development of an edit to correct these improper payments.  The edit for this issue will include claims that have physician place of service code and either ambulatory surgical center (ASC) code or inpatient hospital code.  This edit will act as a tool to protect the Medicare Trust Fund by preventing improper billing practices.

Background:   

1)  An audit in October 2004 by the Office of the Inspector General (OIG) identified place of service billing by physicians as a payment error.  This report stated, “Medicare overpaid physicians due to incorrect place of service coding. Seventy-nine of 100 sampled physician services, selected from a population of services identified as having a high potential for error, were performed in a facility but were billed by the physicians using the “office” place of service code. As a result of the incorrect coding, Medicare paid the physicians a higher amount for these services.”  Because these claims cannot be denied prior to payment, CMS is implementing an IUR for all claim types to recover these payments.

CWF will create an Informational Unsolicited Response (IUR) for all claims where the dates of service, the beneficiary information, and procedure, are all the same and billed with a physician place of service code 11 - office, and a facility code for inpatient hospital – 21, and ambulatory surgical center (ASC) – 24, that is posted due to an update from CMS.

List of all place of service with description

Place of Service Codes (POS)

03 School

A school facility where a recipient receives a Medicaid service. This new place of service is effective with HIPAA implementation.

11 Office
Location, other than a hospital, skilled nursing facility (SNF), military treatment facility, community health center, state or local public health clinic, intermediate care facility (ICF), or mobile van where the health professional routinely provides health examination, diagnosis and treatment of illness or injury on an ambulatory basis.

12 Patient’s 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.

14 Group Home
Congregate residential foster care setting for children and adolescents in state custodythat provides some social, health care, and educational support services and that promotes rehabilitation and reintegration of residents into the community.

21 Inpatient Hospital
A facility, other than psychiatric, which primarily provides diagnostic, therapeutic (both surgical and non surgical) and rehabilitation services, by or under the supervision of physicians, to patients admitted for a variety of medical conditions.

22 Outpatient Hospital
A portion of a hospital that provides diagnostic, therapeutic (both surgical and non surgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization.

23 Emergency Room - Hospital
A portion of a hospital where emergency diagnosis and treatment of illness or injury is provided on a 24-hour basis.

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, that provides a setting for labor, delivery and immediate postpartum care as well as immediate care of newborn infants.

31 Skilled Nursing Facility
A facility that 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 that primarily provides residents with skilled nursing care and related services for rehabilitation of an injured, disabled, or sick person; or on a regular basis, healthrelated care services above the level of custodial care to other than mentally retarded individuals.

33 Custodial Care Facility
A facility that 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.

Note: This place of service can only be used when the actual service is performed in a hospice facility. If a hospice patient receives services in a setting other than a hospice facility, then the specific location for that service must be used.

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.

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. This place of service code is only used for Medicare crossover billing.

53 Community Mental Health Center
A facility that provides comprehensive mental health services on an ambulatory basis primarily to individuals residing or employed in a defined area.

54 Intermediate Care Facility for the Developmentally Disabled (IFC-DD)

A facility that primarily provides health-related care and services above the level of custodial care to developmentally disabled individuals, but does not provide the level of care or treatment available in a hospital or a skilled nursing facility.

55 Residential Substance Abuse Treatment Facility

A facility that 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.

57 Non-residential Substance Abuse Treatment Facility

A location that 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.

62 Comprehensive Outpatient Rehabilitation Facility

A facility that provides comprehensive rehabilitation services under the supervision of a physician to outpatients with physical disabilities.

65 End Stage Renal Disease Treatment Facility
A facility other than a hospital, which provides dialysis treatment, and maintenance or training to patients or caregivers.

71 State or Local Public Health Clinic
A facility maintained by either state or local health departments that provides ambulatory primary care under the general direction of a physician.

72 Rural Health Clinic or Federally Qualified Health Center

A certified facility located in a rural medically underserved area that provides ambulatory primary medical care under the general direction of a physician.

A certified facility located in a medically underserved area that provides ambulatory primary medical care under the general direction of a physician.

81 Independent Laboratory
A laboratory certified to perform diagnostic or clinical tests independent of an institution or a physician’s office.

99 Other Unlisted Facility
Other service facilities not identified above.

PLACE OF SERVICE CODES - Full list

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)

10  Unassigned  

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
01    PHARMACY
03    SCHOOL
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
11    OFFICE
12    HOME
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
34    HOSPICE
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?

Answer:
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.






Code Descriptor

 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?

Answer:

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

Home 12

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

Hospice 34

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. 

Place of service codes List

POS - Place Of Service

Place of Service denotes the place where the service was rendered within the facility. For e.g. the patient may be an inpatient or an outpatient or in an emergency room or in an ambulatory surgical center. Certain carriers adopt the Medicare coding for Place of service while certain others have their own coding systems. For e.g. Medicare adopts the following places of service: Inpatient 21, Outpatient 22, Office Visit 11, Emergency Room 23, Ambulatory Surgical Center 24 and so on.


Place of Service Code(s) - 01

Place of Service Name - Pharmacy**   

Place of Service Description - A facility or location where drugs and other medically related   items and services are sold, dispensed, or otherwise provided directly to patients.

02 - Unassigned - N/A

03 - School - A facility whose primary purpose is education.

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).

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.

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.

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.

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.

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.

10- Unassigned

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.

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).

15-Mobile Unit-A facility/unit that moves from place-to-place equipped to provide preventive, screening, diagnostic, and/or treatment services.

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.

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)

18-19 - Unassigned-N/A

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.

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 - Outpatient Hospital -A portion of a hospital which provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization.

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 mentally retarded individuals.

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 10/1/03)

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/Mentally Retarded - A facility which primarily provides health-related care and services above the level of custodial care to mentally retarded 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.

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.

List of place of service codes

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 10/1/03)

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/Mentally Retarded - A facility which primarily provides health-related care and services above the level of custodial care to mentally retarded 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.

Define 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.

22 - Outpatient Hospital -A portion of a hospital which provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization.

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 mentally retarded individuals.

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.

What is POS

POS - Place Of Service

Place of Service denotes the place where the service was rendered within the facility. For e.g. the patient may be an inpatient or an outpatient or in an emergency room or in an ambulatory surgical center. Certain carriers adopt the Medicare coding for Place of service while certain others have their own coding systems. For e.g. Medicare adopts the following places of service: Inpatient 21, Outpatient 22, Office Visit 11, Emergency Room 23, Ambulatory Surgical Center 24 and so on.



Place of Service Code(s) - 01
Place of Service Name - Pharmacy**    
Place of Service Description - A facility or location where drugs and other medically related   items and services are sold, dispensed, or otherwise provided directly to patients.

02 - Unassigned - N/A

03 - School - A facility whose primary purpose is education.

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).

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.

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.

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.

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.

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.

10- Unassigned

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.

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).

15-Mobile Unit-A facility/unit that moves from place-to-place equipped to provide preventive, screening, diagnostic, and/or treatment services.

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.

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)

18-19 - Unassigned-N/A

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.