Medicare Part B 101 Manual

Medicare Part B 101 Manual

Appendix 3: Place of Service Codes

Table of Contents

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Place of Service Codes

The following is the current national POS code set, with facility and nonfacility designations noted for Medicare payment for services on the physician fee schedule 4/1/2008. This code set has changed to include a new code, 16, for a temporary lodging setting, effective 4/1/2005.

Note: The addition of code 09 to the POS code set and Medicare claims processing reflects Medicare’s compliance with HIPAA laws and regulations carriers must continue to comply with CMS current policy that does not allow payment for Medicare services in a penal institution in most cases. The addition of a POS code for a prison/correctional facility setting does not supersede this policy.

When submitting claims to the Part B carrier, providers must report a two-digit POS code in Item 24B of the CMS-1500 claim form. (Refer to HIPAA and POS codes that require special considerations at the end of this section.)

Code Definition
01 Pharmacy—a facility or location where drugs and other medically related items and services are sold, dispensed or otherwise provided directly to patients (payment rate = nonfacility).
02 Telehealth provided other than in the patient’s home –Location where services are provided or received through telecommunication technology. (effective 1/1/2017) (description change effective 1/1/2022, and applicable for Medicare 4/1/2022).
03 School—a facility whose primary purpose is education (payment rate = nonfacility).
04 Homeless shelter—facility or location whose primary purpose is to provide temporary housing to homeless individuals (e.g., emergency shelters, individual or family shelters). (Payment rate = nonfacility)
05 Indian Health Service freestanding facility*—A facility or location, owned and operated by the Indian Health Service, which provides diagnostic, therapeutic (surgical and nonsurgical) and rehabilitation services to American Indians and Alaska natives who do not require hospitalization. (See instructions below)
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 nonsurgical) 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 nonsurgical) and rehabilitation services to tribal members who do not require hospitalization. (See instructions below)
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 nonsurgical) and rehabilitation services to tribal members admitted as inpatients or outpatients. (See instructions below)
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 (payment rate = nonfacility). (See instructions below)
10 Telehealth provided in patient’s home – Location where services are provided or received through telecommunication technology. (effective 1/1/2022, available for Medicare 4/1/2022). (payment rate = nonfacility)
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 (payment rate = nonfacility).
12 Home—A location (other than a hospital or other facility) where the patient receives care in a private residence (payment rate = nonfacility).
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, seven days a week, with the capacity to deliver or arrange for services—including some health care and other services (payment rate = nonfacility).
14 Group home—A residence with shared living areas, where clients receive supervision and other social and/or behavioral services, custodial services, and minimal services (e.g. medication administration) (payment rate = nonfacility).
15 Mobile unit—A facility/unit that moves from place-to-place equipped to provide preventive screening, diagnostic, and/or treatment services (payment rate = nonfacility).
16 Temporary lodging—A short-term accommodation such as a hotel, campground, hostel, cruise ship, or resort where the patient receives care, and which is not identified by another POS code (payment rate = nonfacility)
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, preventative and primary care services. (Payment rate = nonfacility)
18 Place of employment, worksite – Location, not described by any other POS code, owned or operated by public or private entity where patient is employed, and where health professional provides ongoing or episodic occupational medical, therapeutic, or rehabilitation services to the individual.
19 Off campus outpatient hospital – Portion of off campus hospital provider-based department which provides diagnostic, therapeutic, and rehabilitation services to patients who do not require hospitalization.
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 (payment rate = nonfacility).
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 (payment rate = facility)
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 (payment rate = facility).
23 Emergency room (hospital)—A portion of a hospital where emergency diagnosis and treatment of illness or injury is provided (payment rate = facility).
24 Ambulatory surgical center—A freestanding facility, other than a physician’s office, where surgical and diagnostic services are provided on an ambulatory basis (payment rate = nonfacility). (Note: Pay at the nonfacility rate for payable procedures not on the ASC list.)
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 newborn infants (payment rate = nonfacility).
26 Military treatment facility—A medical facility operated by one or more of the Uniformed Services. Military treatment facility also refers to certain former U.S. Public Health Service (USPHS) facilities now designated as Uniformed Service Treatment Facilities (USTF) (payment rate = facility).
27–30 Unassigned
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 (payment rate = facility).
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 (payment rate = nonfacility).
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 (payment rate = nonfacility).
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 (payment rate = facility).
35–40 Unassigned
41 Ambulance (land)—A land vehicle specifically designed, equipped and staffed for lifesaving and transporting the sick or injured (payment rate = facility).
42 Ambulance (air or water)—An air or water vehicle specifically designed, equipped and staffed for lifesaving and transporting the sick or injured (payment rate = facility).
43–48 Unassigned
  Independent clinic—A location, not part of a hospital and not described by any other POS code, that is organized and operated to provide preventive, diagnostic, therapeutic, rehabilitative, or palliative services to outpatients only (payment rate = nonfacility).
50 Federally qualified health center—A facility located in a medically under-served area that provides Medicare beneficiaries preventive primary medical care under the general direction of a physician (payment rate = nonfacility).
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 (payment rate = facility).
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 (payment rate = facility).
53 CMHC—A facility that provides the following services:
  • Outpatient services, including specialized outpatient services for children, 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
  • Consultative and education services (payment rate = facility)
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 with intellectual disabilities but does not provide the level of care or treatment available in a hospital or SNF (payment rate = nonfacility).
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 (payment rate = nonfacility).
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 (payment rate = facility).
57 Nonresidential 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 (payment rate = nonfacility).
58 Non-residential Opioid Treatment Facility – Location that provides treatment for opioid use disorder.
59 Unassigned
60 Mass immunization center—A location where providers administer pneumococcal pneumonia and influenza virus vaccinations and submit these services 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 (payment rate = nonfacility).
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 orthotic and prosthetic services. (Payment rate =facility)
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 (payment rate = nonfacility).
63–64 Unassigned
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 (payment rate = nonfacility).
66–70 Unassigned
71 State or local 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 (payment rate = nonfacility).
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 (payment rate = nonfacility).
73–80 Unassigned
81 Independent laboratory—A laboratory certified to perform diagnostic and/or clinical tests independent of an institution or a physician’s office (payment rate = nonfacility).
82–98 Unassigned
99 Other place of service—Other place of service not identified above (payment rate = nonfacility).

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Health Insurance Portability and Accountability Act

HIPAA of 1996 became effective 10/16/2003, for all covered entities. Medicare is a covered entity under HIPAA.

The Final Rule, “Health Insurance Reform: Standards for Electronic Transactions,” published in the Federal Register, 8/17/2000, adopts the standards to be used under HIPAA and names the implementation guides to be used for these standards. The ASC X12N 837 professional is the standard to be used for transmitting health care claims electronically, and its implementation guide requires the use of place of service (POS) codes from the national POS code set, currently maintained by CMS.

As a covered entity, Medicare must use the POS codes from the national POS code set for processing its electronically submitted claims. Medicare must also recognize as valid POS codes from the POS code set when these codes appear on such a claim.

Medicare must recognize and accept POS codes from the national POS code set in terms of HIPAA compliance.

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Special Considerations

Homeless Shelter (Code 04)

Note that for the purposes of receiving DME, a homeless shelter is considered the beneficiary’s home. Because DME is payable in the beneficiary’s home, the crosswalk for Homeless Shelter (code 04) to Office (code 11) that was mandated effective 1/1/2003, may need to be adjusted or local policy developed so that HCPCS codes for DME are covered when other conditions are met and the beneficiary is in a homeless shelter. If desired, local contractors are permitted to work with their medical directors to determine a new crosswalk such as from Homeless Shelter (code 04) to Home (code 12) or Custodial Care Facility (code 33) for DME provided in a homeless shelter setting. If a local contractor is currently paying claims correctly, however, it is not necessary to change the current crosswalk.

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Indian Health Service (Codes 05, 06) and Tribal 638 Settings (Codes 07, 08)

Medicare does not currently use the POS codes designated for these settings. Follow the instructions you have received regarding how to process claims for services rendered in IHS and Tribal 638 settings. If you receive claims with these codes, you must initially accept them in terms of HIPAA compliance. However, follow your “return as unprocessable” procedures after this initial compliance check. Follow your “return as unprocessable" procedures when you receive paper claims with these codes. (Note that while these codes became part of the National POS code set effective 1/1/2003, Medicare contractors received instructions regarding how to process claims with these codes effective October 1, 2003, so that Medicare could be HIPAA compliant by 10/16/2003).

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Mobile Unit Settings (Code 15)

When services are furnished in a mobile unit, they are often provided to serve an entity for which another POS code exists. For example, a mobile unit may be sent to a physician’s office or a SNF. If the mobile unit is serving an entity for which another POS code already exists, providers should use the POS code for that entity. However, if the mobile unit is not serving an entity which could be described by an existing POS code, the providers are to use the mobile unit POS code 15.

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Prison/Correctional Facility Settings (Code 09)

The addition of code 09 to the POS code set and Medicare claims processing reflects Medicare’s compliance with HIPAA laws and regulations. Local contractors must continue to comply with CMS current policy that does not allow payment for Medicare services in a penal institution in most cases. The addition of a POS code for a prison/correctional facility setting does not supersede this policy. (Refer to the CMS IOM Publication 100-04, Medicare Claims Processing Manual, Section 10.4, Chapter 1).

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