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.

Certified Inpatient Coder CIC

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).

John Verhovshek

John Verhovshek

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered 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, and a member of the Asheville-Hendersonville AAPC Local Chapter.
John Verhovshek

About Has 514 Posts

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered 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, and a member of the Asheville-Hendersonville AAPC Local Chapter.

3 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,
    Janice

  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)?

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