CMS Reminds Clinicians to Use Correct Place of Service Codes

The Centers for Medicare & Medicaid Services (CMS) has issued a reminder to clinicians about the importance of using the correct Place of Service (POS) codes on Medicare claims. These codes are crucial for ensuring proper payment for services provided to patients in various inpatient facilities, such as skilled nursing facilities (SNFs) and hospitals.

Understanding POS Codes

POS codes are two-digit codes that identify the location where a patient receives a service. Accurate entry of these codes on Medicare claims is essential for correct reimbursement. Some of the frequently used POS codes include:

• Inpatient hospital (21): For services provided to patients admitted to a hospital.
• SNF with Part A coverage (31): For services provided to patients in a SNF covered under Medicare Part A.
• Nursing facility or SNF without Part A coverage (32): For services provided to patients in a nursing facility or a SNF not covered under Medicare Part A.

Examples of Correct POS Code Usage

To illustrate the correct usage of POS codes, consider the following scenarios:

• If a patient is seen in a physician’s office but is also an inpatient of a hospital, the physician should use POS code 21 for inpatient hospital services.
• If the patient is a resident of a SNF with Part A coverage, POS code 31 should be used.
• For patients in a nursing facility or a SNF without Part A coverage, POS code 32 is appropriate.

It is important to note that the POS code should reflect the actual setting where the service is provided, which may differ from the address and ZIP Code of the practice location.

To assist clinicians in navigating the complexities of billing and coding, PALTmed's Guide to PALTC Coding, Reimbursement, and Documentation was developed as a comprehensive resource with information on coding, reimbursement, and documentation for services in PALTC settings. By following the guidelines outlined in this guide, physicians can ensure accurate billing practices and compliance with Medicare requirements.

Refer to the CMS website for more information on POS codes and billing guidelines.