Therefore, it is important to know the POS also plays a factor in the reimbursement. To account for the increased practice expense physicians incur by performing services in their offices, Medicare reimburses physicians a higher amount for services performed in their offices (POS code 11) than in an outpatient hospital (POS 22-23) or an ambulatory surgical center (ASC) (POS 24). Practice expense (reflects overhead costs involved in providing service(s)).This schedule is based on a payment system that includes three major categories, which drive the reimbursement for physician services: Physicians are paid for services according to the Medicare physician fee schedule (MPFS). The POS code is used to identify where the procedure is furnished. Physicians are required to report the place of service (POS) on all health insurance claims they submit to Medicare Part B contractors. Reporting place of service (POS) codes to Medicare Use of POS code 11 (office) in the hospital outpatient department or on hospital campus is subject to the physician self-referral provisions set forth in 42.C.F.R.411.353 through 411.357. Physicians will use POS code 11 (office) when services are performed in a separately maintained physician office space in the hospital or on hospital campus and that physician office space is not considered a provider-based department of the hospital as defined in 42.C.F.R.413.6. Outpatient Hospital: Physicians/practitioners who perform services in a hospital outpatient department will use POS code 22 (Outpatient Hospital) unless the physician maintains separate office space in the hospital or on hospital campus and that physician office space is not considered a provider-based department of the hospital as defined in 42.C.F.R.413.65. Outpatient hospital.If the patient treated in hospital less than 24 hours use this POS.Ī portion of a hospital’s main campus which providesĭiagnostic, therapeutic (both surgical and nonsurgical),Īnd rehabilitation services to sick or injured persons Place of Service 22 On Campus Outpatient Hospital Or under, the supervision of physicians to patientsĪdmitted for a variety of medical conditions. Provides diagnostic, therapeutic (both surgicalĪnd nonsurgical), and rehabilitation services by, If the patient treated in hospital more than 24 hours use this POS.Ī facility, other than psychiatric, which primarily Where the patient receives care in a private Location, other than a hospital or other facility, Place where the patient receives care in a private residence. O “Distinct entity” criteria defined in the ASC State Operations Manual O Physicians/practitioners are not to use POS code 11 (office) for ASC based services o Meets all other requirements for operating as a physician office at the same physical location as the ASC O When a physician/practitioner furnishes services to a patient in a Medicare-participating ASC, the POS code 24 shall be used O Physician office space is not considered a provider-based department of the hospital O Services are performed in a separately maintained physician office space in the hospital or on the hospital campus CMS-1500 place of service (POS) 11 or 81.It should be included when using the following forms: Health examinations, diagnosis, and treatment.Ī test identifier is an internal laboratory code used to more accurately identify a specific test performedīy a laboratory. Where the health professional routinely provides Health clinic, or intermediate care facility (ICF), Location, other than a hospital, skilled nursingįacility (SNF), military treatment facility,Ĭommunity health center, State or local public If service provided in the provider billing office then this is the correct POS. Medicare adopts the following places of service: Certain carriers adopt the Medicare coding for Place of service while certain others have their own coding systems. the patient may be an inpatient or an outpatient or in an emergency room or in an ambulatory surgical center. Place of Service denotes the place where the service was rendered within the facility.
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