Medical billing is a complex process that involves numerous codes and regulations. One of the most critical elements of medical billing is the use of place of service codes. These codes are essential for determining where a medical service was provided, which is crucial for insurance claims and reimbursement.
This article will provide an in-depth overview of the place of service codes in medical billing. We will explain these codes, why they are important, and how they work. We will also address frequently asked questions and offer accurate and efficient medical billing tips.
Table of Contents
- What is the Place of Service Codes in Medical Billing?
- Why are Place of Service Codes Important?
- How Do Place of Service Codes Work?
- Place of Service Codes for Professional Claims (updated Sep-2021)
- `Understanding CMS Guidelines for Place of Service Codes
- What are CMS Guidelines for Place of Service Codes?
- AMA Guidelines for Place of Service Codes in Medical Billing
- Place of Service Codes for Telemedicine: Guidelines and Rules
- Guidelines and Rules for Using Place of Service Codes for Telemedicine
- Frequently Asked Questions:
- Conclusion :
- Related Articles:
What is the Place of Service Codes in Medical Billing?
The place of service code is a two-digit code indicating the location of the healthcare service. These codes classify where a medical service was rendered, essential for billing and reimbursement purposes. There are over 80 places of service codes that Medicare and other insurance providers recognize.
Some commonplace of service codes include:
- 11 – Office
- 22 – Outpatient Hospital
- 24 – Ambulatory Surgical Center
- 31 – Skilled Nursing Facility
- 52 – Clinic
- 71 – State or Local Public Health Clinic
- 81 – Independent Laboratory
- 99 – Other Place of Service
These codes provide critical information about where a medical service was provided, which can impact reimbursement rates and coverage. For example, an insurance company may only cover certain services when they are performed in specific locations. Additionally, the reimbursement rate for a particular service may vary depending on the place of service code used.
Why are Place of Service Codes Important?
Place of service codes are crucial for accurate medical billing and reimbursement. These codes help to ensure that insurance claims are processed correctly and that providers receive the appropriate payment for their services. With the place of service codes, it would be easier to determine where a medical service was provided, which could lead to accurate billing and denied claims.
Additionally, place of service codes can impact reimbursement rates and coverage. Insurance companies may have different reimbursement rates for the same service depending on the place of service code used. For example, a service performed in a hospital may have a higher reimbursement rate than the same service performed in an office.
How Do Place of Service Codes Work?
Place of service codes are typically included on medical claims forms, such as the CMS-1500 form. Providers must accurately report the place of service code for each medical service provided. Insurance companies use the code to determine the appropriate reimbursement rate and coverage.
Some important considerations when using the place of service codes include:
- Accuracy: It is essential to report the correct place of service code for each medical service provided. Using the wrong code can result in denied claims or incorrect reimbursement rates.
- Up-to-date codes: The place of service codes may change over time. Using the most current codes to ensure accurate billing and reimbursement is essential.
- Consistency: Using the same place of service code consistently for each medical service provided is crucial. Using different codes for the same service can result in denied claims or incorrect reimbursement rates.
Place of Service Codes for Professional Claims (updated Sep-2021)
These codes should be used on professional claims to specify the entity where service(s) were rendered. Check with individual payers (e.g., Medicare, Medicaid, other private insurance) for reimbursement policies regarding these codes.
NOTE: Please direct questions related to billing place of service codes to your Medicare Administrative Contractor (MAC) for assistance.
| 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 Oct 1, 2003) |
| 02 | Telehealth Provided Other than in Patient’s Home | The location where health services and health related services are provided or received, through telecommunication technology. Patient is not located in their home when receiving health services or health related services through telecommunication technology. (Effective Jan 1, 2017) (Description change effective Jan 1, 2022, and applicable for Medicare April 1, 2022.) |
| 03 | School | A facility whose primary purpose is education. (Effective Jan 1, 2003) |
| 04 | Homeless Shelter | A facility or location whose primary purpose is to provide temporary housing to homeless individuals (Ex. emergency shelters, individual or family shelters). (Effective Jan1, 2003) |
| Place of Service Code(s) | Place of Service Name | Place of Service Description |
| 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 Jan 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 Jan 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 Jan 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 Jan 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) |
| Place of Service Code(s) | Place of Service Name | Place of Service Description |
| 10 | Telehealth Provided in Patient’s Home | The location where health services and health related services are provided or received, through telecommunication technology. Patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health related services through telecommunication technology. (This code is effective January 1, 2022, and available to Medicare April 1, 2022.) |
| 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 Oct 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 Oct 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) |
| Place of Service Code(s) | Place of Service Name | Place of Service Description |
| 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 Jan 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 Jan 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 Jan 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 Jan 1, 2003) |
| Place of Service Code(s) | Place of Service Name | Place of Service 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 Jan 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- Not Assigned |
| 31 | Skilled Nursing Facility | A facility which primarily provides inpatient skilled nursing care and related services to patients who require medical, nursing, or rehabilitative services but does not provide the level of care or treatment available in a hospital. |
| Place of Service Code(s) | Place of Service Name | Place of Service Description |
| 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- Not Assigned |
| 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- Not Assigned |
| 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. |
| Place of Service Code(s) | Place of Service Name | Place of Service Description |
| 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. |
| Place of Service Code(s) | Place of Service Name | Place of Service Description |
| 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 | Non-residential Opioid Treatment Facility | A location that provides treatment for opioid use disorder on an ambulatory basis. Services include methadone and other forms of Medication Assisted Treatment (MAT). (Effective Jan 1, 2020) |
| 59 | Un-Assigned | N/A- Not Assigned |
| 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. |
| Place of Service Code(s) | Place of Service Name | Place of Service Description |
| 63-64 | Unassigned | N/A- Not Assigned |
| 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- Not Assigned |
| 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- Not Assigned |
| 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- Not Assigned |
| 99 | Other Place of Service | Other place of service not identified above. |
`Understanding CMS Guidelines for Place of Service Codes
As a healthcare provider, it is essential to understand the CMS guidelines for Place of Service (POS) codes. These codes indicate where a service was rendered and are necessary for claim processing and reimbursement. Incorrect POS codes can lead to denied claims, lost revenue, and legal consequences. This article aims to provide a clear understanding of CMS guidelines for Place of Service Codes, including what they are, their importance, and how to use them correctly.
What are CMS Guidelines for Place of Service Codes?
CMS guidelines for Place of Service Codes provide instructions on correctly using the codes. Place of Service Codes is a two-digit code that indicates where a healthcare service was provided. These codes are essential for claim processing and reimbursement purposes. Place of Service Codes helps to identify the place where a healthcare service was provided and are used to determine the correct fee schedule amount for reimbursement.
Why are CMS Guidelines for Place of Service Codes important?
CMS Guidelines for Place of Service Codes are essential for healthcare providers for the following reasons:
- Accurate reimbursement: Correctly identifying the Place of Service is essential to ensure proper reimbursement. Incorrect coding can lead to denied claims or underpayment.
- Compliance: Using the correct Place of Service Code is necessary for compliance with CMS regulations.
- Legal consequences: Incorrect coding can lead to legal consequences, including fines and penalties.
- Data collection: Place of Service Codes is used for data collection and analysis, essential for healthcare policy decisions and resource allocation.
How to Use CMS Guidelines for Place of Service Codes Correctly
To use CMS Guidelines for Place of Service Codes correctly, healthcare providers must follow the instructions provided in the CMS guidelines. Here are some key points to keep in mind:
- Code Selection: Select the code that accurately represents the Place of Service where the healthcare service was provided.
- Correct Coding: Ensure that the code is used correctly and matches the description provided in the CMS guidelines.
- Multiple Codes: If a healthcare service was provided in multiple places, use the appropriate code for each place.
- Updated Guidelines: Stay up-to-date with the latest CMS guidelines for Place of Service Codes to ensure accuracy and compliance.
AMA Guidelines for Place of Service Codes in Medical Billing
The AMA has classified place of service codes into two categories, which are as follows:
- Facility codes: Facility codes indicate the location where medical services are provided in a facility codes. These codes are essential for hospital-based services and outpatient services provided in a hospital or clinic.
- Non-facility codes: Non-facility codes indicate the location where medical services are provided in non-facility places such as the patient’s home, office, or other non-medical facilities.
Place of Service Codes for Telemedicine: Guidelines and Rules
The COVID-19 pandemic has led to a surge in the adoption of telemedicine. This remote healthcare service method has become popular because it allows patients to receive care from the comfort of their homes. However, with the rise of telemedicine, there have been questions about how to code and bill for these services.
The Centers for Medicare and Medicaid Services (CMS) has issued guidelines and rules for coding and billing for telemedicine services. These regulations and guidelines include Place of Service Codes for Telemedicine. In this article, we will explore what these codes are and how to use them correctly.
What are the Place of Service Codes for Telemedicine?
Place of Service Codes for Telemedicine are codes used to identify the location where a telemedicine service was provided. These codes are used to determine the reimbursement rate for telemedicine services. There are different Place of Service Codes for Telemedicine, depending on the type of telemedicine service provided.
Types of Place of Service Codes for Telemedicine
There are two types of Place of Service Codes for Telemedicine: synchronous and asynchronous.
Synchronous Place of Service Codes for Telemedicine
Synchronous Place of Service Codes for Telemedicine are used when a patient receives a real-time telemedicine service. These services are provided using interactive audio and video telecommunications systems. Synchronous services include:
- 02 – Telehealth
- 03 – School
- 04 – Home
- 05 – Indian Health Service (IHS) facility
- 06 – Federally Qualified Health Center (FQHC)
- 07 – Rural Health Clinic (RHC)
- 08 – Location other than a physician or other health care professional’s office
- 12 – Ambulatory Surgical Center (ASC)
- 22 – Outpatient Hospital
- 23 – Emergency Room – Hospital
- 24 – Ambulatory Surgical Center – Hospital
Asynchronous Place of Service Codes for Telemedicine
Asynchronous Place of Service Codes for Telemedicine are used when a patient receives a non-real-time telemedicine service. These services are provided using store-and-forward technology. Asynchronous services include:
- 01 – Pharmacy
- 09 – Prison/Correctional Facility
- 11 – Office
- 19 – Off-Campus-Outpatient Hospital
- 20 – Urgent Care Facility
- 21 – Inpatient Hospital
Guidelines and Rules for Using Place of Service Codes for Telemedicine
When using Place of Service Codes for Telemedicine, some guidelines and rules must be followed to ensure correct coding and billing.
Use the Correct Place of Service Code
The first rule is to use the correct Place of Service Code for the type of telemedicine service provided. Using the right code can result in correct reimbursement or denial of payment.
Follow State and Federal Regulations
The second rule is to follow state and federal regulations. Each state has its laws and regulations governing telemedicine services. It is important to be aware of these regulations and comply with them.
Document the Telemedicine Service
The third rule is to document the telemedicine service provided. This documentation should include the type of service provided, the service’s date and time, and the service’s duration. The documentation should also include the Place of Service Code used.
Verify Eligibility
The fourth rule is to verify eligibility for telemedicine services. Medicare and Medicaid have specific guidelines for telemedicine services. It is important to verify that the patient is eligible for the service and that the service meets the criteria for reimbursement.
Use Modifier Codes
The fifth rule is to use Modifier Codes when appropriate. Modifier Codes provide additional information about the service provided, such as whether it was a consultation or a follow-up visit.
Understand Reimbursement Rates
The sixth rule is to understand the reimbursement rates for telemedicine services. Reimbursement rates vary depending on the type of service provided, the Place of Service Code used, and the payer.
Frequently Asked Questions:
Q1. Can I use the same Place of Service Code for all telemedicine services?
Ans. You cannot use the same Place of Service Code for all telemedicine services. The Place of Service Code used depends on the type of service provided.
Q2. What happens if I use the wrong Place of Service Code?
Ans. Using the wrong Place of Service Code can result in incorrect reimbursement or denial of payment.
Q3. Can I bill for the originating and distant sites?
Ans. No, you cannot bill for both the originating and distant sites. Only one site can bill for the service provided.
Q4. How do I verify eligibility for telemedicine services?
Ans. You can verify eligibility for telemedicine services by checking with the patient’s insurance provider or Medicare/Medicaid.
Q5. What is the difference between the place of service codes and diagnosis codes?
Ans. Place of service codes indicates where a medical service was provided, while diagnosis codes indicate the reason for the service.
Q6. Who uses place of service codes?
Ans. Place of service codes are used by healthcare providers, insurance companies, and government agencies involved in medical billing.
Q7. What is the difference between Place of Service Codes and Revenue Codes?
Ans. Place of Service Codes indicates where a healthcare service was provided, while Revenue Codes indicate the type of service provided.
Q8. How do I know which Place of Service Code to use?
Ans. Select the code that accurately represents the Place of Service where the healthcare service was provided. CMS guidelines provide a list of codes and descriptions to help healthcare providers identify the correct code.
Conclusion :
Understanding CMS Guidelines for Place of Service Codes is essential for healthcare providers. These codes identify the place where a healthcare service was provided and are necessary for claim processing and reimbursement. More than incorrect coding can lead to denied claims, lost revenue, and legal consequences. To ensure accuracy and compliance, healthcare providers must stay current with the latest CMS guidelines for Place of Service Codes. Healthcare providers can ensure accurate reimbursement, compliance, and data collection by following the CMS guidelines.
Place of Service Codes for Telemedicine is an important part of coding and billing for telemedicine services. It is important to use the correct code for the type of service provided, follow state and federal regulations, document the service provided, verify eligibility, use Modifier Codes when appropriate, and understand the reimbursement rates for telemedicine services.
Reference – Place of Service Database CMS Pdf
Related Articles:
The Ultimate Guide to Medical Billing Jobs
CO 27 Denial Code-Expenses incurred After coverage Terminated