Place of Service Code
From SmartMedicalConsumer Wiki
Place of Service (POS) information describes the site of service. POS information is often needed by Medicare, Medicaid and private insurances, so that they can determinite the acceptability of charges by a provider for the services the provider rendered and the reimbursement amouts for these services.
Place of Service (POS) Codes are two-digit codes placed on claims submitted by the provider to payors (e.g., Medicare, private insurer). The Centers for Medicare & Medicaid Services (CMS) maintain POS codes used by health plans and providers.
This code set is required by the national standard for electronic transmission of professional health care claims under the provisions of the Health Insurance Portability and Accountability Act (HIPAA).
Athough the POS information is required in the claim and reimbursement transactions between the provider and Medicare (and private insurers), often times neither the invoices sent to the consumer by the provider, nor the explanation of benefits sent to the consumer by the insurer contain the Place of Service code.
Since the amounts reimbursed by the insurer and the correctness of charges by the provider may depend on the POS code, we are listing below some of the POS codes. For example, the determinitation of Facility Fees for Outpatient Services and the Physician Payment determined by the Medicare rely on POS code.
Place of Service Codes
The following are a subset of Place of Service (POS) codes. For the full list at Places of Service Codes, the Centers for Medicare & Medicaid Services (CMS).
- POS: 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.
- POS: 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.
- POS: 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.
- POS: 22, Outpatient Hospital: A portion of a hospital which provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization.
- POS: 23, Emergency Room or Hospital: A portion of a hospital where emergency diagnosis and treatment of illness or injury is provided.
- POS: 24, Ambulatory Surgical Center: A freestanding facility, other than a physician's office, where surgical and diagnostic services are provided on an ambulatory basis.
- POS: 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 10/1/03)
