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SC Medicaid denying 99336 to POS 13

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Peter Davidyock

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420
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Coastal Coders
I have 2 physicians that care for the elderly in home settings. We are having a problem with South Carolina Medicaid. When Medicare is primary and we submit 99336 with POS 13 (Assisted Living Facility) they will pay according to thier rules. When the claim crosses to Medicaid (secondary) each and every one of them denies for invalid POS. Any thoughts? I was told that POS 13 was not payable by SC Medicaid but it's in thier manual as a payable POS. I am really stumped. Someone had mentioned Medicaid requires POS 33 but these are not group homes and to the best of my knowledge the physicians are visiting free standing residences and not having the patients brought to one room at the complex.
 
South Carolina Medicaid seriously sucks!!
We have to deal with them some because we are so close to the state line and I hate it when I see that a patient has it.
We have multiple patients with office visits from last year that still haven't been paid for various and sundry cockamamie reasons.
That being said I looked up POS 33 and it is Custodial Care Facility ( a facility that provides room, board, and other personal assistance services, generally on a long-term basis, and does not include a medical component). Could it be possible that POS 33 is a valid POS for your claims?
 
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