Decoding Place of Service Codes: The Essentials
Place of service codes are standardized HIPAA codes used on healthcare claims to indicate where the patient received the provided service. These two-digit codes are not arbitrary; they inform payers about the setting of care, which influences reimbursement rates and coverage rules. For instance, services provided in an inpatient hospital (POS code 21) are billed and reimbursed differently than those provided in a physician’s office (POS code 11) or a patient’s home (POS code 12).
Here’s a detailed breakdown of various Place of Service codes, relevant to different healthcare settings:
| 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. |
| 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. |
| 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 ServiceProvider-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 | 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. |
| 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. |
| 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. |
| 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. |
| 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 | 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. |
| 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 | Outreach Site/ Street | A non-permanent location on the street or found environment, not described by any other POS code, where health professionals provide preventive, screening, diagnostic, and/or treatment services to unsheltered homeless individuals. |
| 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. |
| 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. |
| 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. |
| 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. |
| 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) |
| 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. |
| 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 | Programs of All-Inclusive Care for the Elderly (PACE) Center* | A facility or location providing comprehensive medical and social services as part of the Programs of All-Inclusive Care for the Elderly (PACE). This includes, but is not limited to, primary care; social work services; restorative therapies, including physical and occupational therapy; personal care and supportive services; nutritional counseling; recreational therapy; and meals when the individual is enrolled in PACE. |
| 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. |
| 81 | Independent Laboratory | A laboratory certified to perform diagnostic and/or clinical tests independent of an institution or a physician’s office. |
| 99 | Other Place of Service | Other place of service not identified above. |
This table details a wide array of POS codes, from conventional settings like Offices (11) and Inpatient Hospitals (21) to more specific locations such as Homeless Shelters (04) and Mobile Units (15). Notably, within the context of palliative care, several POS codes become particularly relevant.
POS Codes and Palliative Care: Key Considerations
Palliative care focuses on improving the quality of life for patients and their families facing life-limiting illnesses. This care can be delivered in various settings, making POS codes critically important for accurate billing. Here are some key POS codes frequently used in palliative care:
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Home (12): A significant portion of palliative care is delivered in the patient’s home. This setting is designated by POS code 12. Home-based palliative care reflects a growing trend towards patient-centered care, allowing individuals to receive treatment in a comfortable and familiar environment.
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Hospice (34): Hospice care, a specialized type of palliative care for individuals with a terminal prognosis, often takes place in dedicated hospice facilities. POS code 34 is specifically for a Hospice facility, other than a patient’s home, providing palliative and supportive care for terminally ill patients and their families.
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Assisted Living Facility (13) & Nursing Facility (32): For patients residing in assisted living facilities or nursing facilities, POS codes 13 and 32 respectively are used. Palliative care teams often collaborate with these facilities to provide comprehensive care.
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Office (11) & Outpatient Hospital (22, 19): Palliative care consultations and follow-up visits can also occur in traditional office settings or outpatient hospital departments. Codes 11, 22, and 19 cover these scenarios, depending on whether the outpatient service is on or off the hospital campus.
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Telehealth Provided in Patient’s Home (10) & Telehealth Provided Other than in Patient’s Home (02): The rise of telehealth has expanded access to palliative care, particularly in rural or underserved areas. POS codes 10 and 02 are used for telehealth services, differentiating between services delivered when the patient is at home versus another location.
Navigating CMS Guidelines and Updates
While there isn’t a singular document titled “cms palliative care coding guidelines 2020,” CMS provides ongoing guidance on coding and billing practices that are relevant to palliative care. Staying updated with CMS guidelines is crucial. Key resources include:
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Medicare Learning Network (MLN): CMS’s MLN provides educational resources on various Medicare topics, including coding and billing. Regularly checking MLN for updates is advisable.
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CMS Website: The official CMS website (www.cms.gov) is the primary source for policy updates, regulations, and guidelines. Searching for “Place of Service codes” or “palliative care billing” on the CMS website can yield valuable information.
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Medicare Administrative Contractors (MACs): MACs are regional contractors that process Medicare claims. Each MAC provides specific guidance for providers in their jurisdiction. Contacting your local MAC is recommended for billing inquiries related to POS codes and palliative care.
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Coding and Billing Newsletters & Professional Organizations: Subscribing to industry newsletters and engaging with professional organizations focused on medical coding and palliative care can provide timely updates and insights into coding changes and best practices.
The Importance of Accurate POS Coding
Selecting the correct POS code is not merely a clerical task; it has significant implications for reimbursement and compliance. Incorrect POS coding can lead to claim denials, delays in payment, and even audits. For palliative care providers, who often operate across diverse settings, meticulous attention to POS coding is paramount for financial sustainability and adherence to payer regulations.
Furthermore, accurate POS data contributes to healthcare data analytics, helping to understand service utilization patterns in palliative care across different settings. This information can inform policy decisions and resource allocation to improve palliative care access and quality.
Conclusion: Mastering POS Codes for Palliative Care
Understanding Place of Service codes is a cornerstone of accurate and compliant billing for palliative care services. While specific “cms palliative care coding guidelines 2020” might not be the precise terminology, the broader framework of CMS coding guidelines, particularly concerning POS codes, is directly applicable to palliative care. By staying informed about POS codes, utilizing the correct codes for each service setting, and continuously monitoring CMS updates, palliative care providers can ensure accurate billing, optimize reimbursement, and focus on their primary mission: providing compassionate and comprehensive care to patients and families in need. Always consult with your Medicare Administrative Contractor (MAC) for the most up-to-date and specific guidance on billing place of service codes.
