Place of Service Coding

Place of Service Coding

by John Verhovshek, MA, CPC
Place of Service Codes (POS) are two-digit codes reported on health care professional claims to indicate the setting in which a service was provided. Each billable line item should have a Place of Service Code listed to identify where the service was rendered. POS codes are listed in the front of the CPT® codebook, and are also available on the CMS website.
Improper application of POS codes can affect payments. As CMS Transmittal 2679 explains, “Under the Medicare Physician Fee schedule (MPFS), some procedures have separate rates for physicians’ services when provided in facility and nonfacility settings.” For this reason, POS errors have been a recurring area of interest in the Office of Inspector General’s (OIG’s) yearly Work Plans.
Per Transmittal 2679, the POS code generally “reflects the actual place where the beneficiary receives the face-to-face service and determines whether the facility or nonfacility payment rate is paid.” Sometimes, more information may need to be obtained by a facility before applying a POS Code for an encounter. For example, a coder initially may believe that a facility is a nursing home, when it actually may be categorized as a skilled nursing facility or an intermediate care facility.
Finally, note that he POS code assigned for the professional component of a diagnostic service must match the setting in which the beneficiary received the technical component of the service (even if, in actuality, the professional component was provided in a different setting).

Certified Inpatient Coder CIC

John Verhovshek
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About Has 573 Posts

John Verhovshek, MA, CPC, is a contributing editor at AAPC. He has been covering medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University.

No Responses to “Place of Service Coding”

  1. Janice Stead says:

    Hi John,
    I’m so glad I happened on this article, I’m confused about facility and nonfacility. An insurance co. wants money back because they say claim incorrectly paid at non-facility rate, this procedure was done in an out patient hospital facility, POS 22. Am I wrong in thinking they are incorrectly taking money back?
    Thank you,

  2. Gwen Price says:

    I have been researching to determine the POS code for some podiatry services a new provider is performing and am coming up empty. I contacted our local Medicare contractor and they were not much help.
    Here is the situation: Our provider goes to an ALF and sees some residents in the medical office there, these are clearly ALF as POS, however, this same facility as an independent living bldg., that these patients walk to the ALF and get the care there. These patients do not get any ALF services, they are truly independent living.
    Which POS would I chose? I certainly don’t want to do it wrong and also want to make sure the CPT codes match the POS. I would really appreciate if there is some resource out there to go to and try to learn more, in the meantime, I am not putting these claims in until I can find some sort of guidance on the subject.

  3. Michon Hemenway says:

    My question is – where can I find what POS is allowable for a specific code (mostly anesthesia codes)?

  4. Regina Wicker says:

    We are a ENT office and do sinus surgery in office and 61782 is allowed with those codes which are allowed as POS 11. So why is Medicare rejecting 61782 as POS 11 not allowed? Where can I find something that shows me the POS allowed on CPT codes. Medicare is no help in this department. This happened a couple of years ago with another CPT code but was fixed ,now that Palmetto has taken over it has started again. My doctors want to see where it shows me it is not allowed and Palmetto is not helping with that.

  5. Connie Sulzman says:

    I need help. I work in a behavioral health facility. This is by no means an inpatient facility, and I have no other professional coders to ask questions from. We bill by groups (3 per day) for residential substance abuse treatment. I want to know, can POS 11 be used on all claims? We have used POS 55 for SA claims and I have noticed several denials from insurance companies. From what I have been told, we have state funding that places us in an uncertain POS indicator. It seems to me that POS 55 needs 24 hour emergency staff. Thank you for any and all input.