The list of settings where a physician’s services are paid at the facility rate include:
• Inpatient Hospital (POS code 21);
• Outpatient Hospital (POS code 22);
• Emergency Room-Hospital (POS code 23);
• Medicare-participating Ambulatory Surgical Center (ASC) for a Healthcare Common Procedure Coding System (HCPCS) code included on the ASC approved list of procedures (POS code 24);
• Medicare-participating ASC for a procedure not on the ASC list of approved procedures with dates of service on or after January 1, 2008. (POS code 24);
• Skilled Nursing Facility (SNF) for a Part A resident (POS code 31);
• Hospice – for inpatient care (POS code 34);
• Ambulance – Land (POS code 41);
• Ambulance – Air or Water (POS code 42);
• Inpatient Psychiatric Facility (POS code 51);
• Psychiatric Facility -- Partial Hospitalization (POS code 52);
• Community Mental Health Center (POS code 53);
• Psychiatric Residential Treatment Center (POS code 56); and
• Comprehensive Inpatient Rehabilitation Facility (POS code 61).
Physicians’ services are paid at non-facility rates for procedures furnished in the following settings:
• Pharmacy (POS code 01);
• School (POS code 03);
• Homeless Shelter (POS code 04);
• Prison/Correctional Facility (POS code 09);
• Office (POS code 11);
• Home or Private Residence of Patient (POS code 12);
• Assisted Living Facility (POS code 13);
• Group Home (POS code 14);
• Mobile Unit (POS code 15);
• Temporary Lodging (POS code 16);
• Walk-in Retail Health Clinic (POS code 17);
• Urgent Care Facility (POS code 20);
• Birthing Center (POS code 25);
• Nursing Facility and Skilled Nursing Facilities (SNFs) to Part B residents - (POS code 32);
• Custodial Care Facility (POS code 33);
• Independent Clinic (POS code 49);
• Federally Qualified Health Center (POS code 50);
• Intermediate Health Care Facility/Mentally Retarded (POS code 54);
• Residential Substance Abuse Treatment Facility (POS code 55);
• Non-Residential Substance Abuse Treatment Facility (POS code 57);
• Mass Immunization Center (POS code 60);
• Comprehensive Outpatient Rehabilitation Facility (POS code 62);
• End-Stage Renal Disease Treatment Facility (POS code 65);
• State or Local Health Clinic (POS code 71);
• Rural Health Clinic (POS code 72);
• Independent Laboratory (POS code 81); and
• Other Place of Service (POS code 99).
Refer http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM7631.pdf for Special guidelines for POS code Mobile Unit Settings (Code 15), Walk-In Retail Health Clinic (Code 17), Inpatient Hospital (Code 21), Outpatient Hospital (Code 22), Ambulatory Surgical Centers (Code 24), Hospice (Code 34).
• Inpatient Hospital (POS code 21);
• Outpatient Hospital (POS code 22);
• Emergency Room-Hospital (POS code 23);
• Medicare-participating Ambulatory Surgical Center (ASC) for a Healthcare Common Procedure Coding System (HCPCS) code included on the ASC approved list of procedures (POS code 24);
• Medicare-participating ASC for a procedure not on the ASC list of approved procedures with dates of service on or after January 1, 2008. (POS code 24);
• Skilled Nursing Facility (SNF) for a Part A resident (POS code 31);
• Hospice – for inpatient care (POS code 34);
• Ambulance – Land (POS code 41);
• Ambulance – Air or Water (POS code 42);
• Inpatient Psychiatric Facility (POS code 51);
• Psychiatric Facility -- Partial Hospitalization (POS code 52);
• Community Mental Health Center (POS code 53);
• Psychiatric Residential Treatment Center (POS code 56); and
• Comprehensive Inpatient Rehabilitation Facility (POS code 61).
Physicians’ services are paid at non-facility rates for procedures furnished in the following settings:
• Pharmacy (POS code 01);
• School (POS code 03);
• Homeless Shelter (POS code 04);
• Prison/Correctional Facility (POS code 09);
• Office (POS code 11);
• Home or Private Residence of Patient (POS code 12);
• Assisted Living Facility (POS code 13);
• Group Home (POS code 14);
• Mobile Unit (POS code 15);
• Temporary Lodging (POS code 16);
• Walk-in Retail Health Clinic (POS code 17);
• Urgent Care Facility (POS code 20);
• Birthing Center (POS code 25);
• Nursing Facility and Skilled Nursing Facilities (SNFs) to Part B residents - (POS code 32);
• Custodial Care Facility (POS code 33);
• Independent Clinic (POS code 49);
• Federally Qualified Health Center (POS code 50);
• Intermediate Health Care Facility/Mentally Retarded (POS code 54);
• Residential Substance Abuse Treatment Facility (POS code 55);
• Non-Residential Substance Abuse Treatment Facility (POS code 57);
• Mass Immunization Center (POS code 60);
• Comprehensive Outpatient Rehabilitation Facility (POS code 62);
• End-Stage Renal Disease Treatment Facility (POS code 65);
• State or Local Health Clinic (POS code 71);
• Rural Health Clinic (POS code 72);
• Independent Laboratory (POS code 81); and
• Other Place of Service (POS code 99).
Refer http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM7631.pdf for Special guidelines for POS code Mobile Unit Settings (Code 15), Walk-In Retail Health Clinic (Code 17), Inpatient Hospital (Code 21), Outpatient Hospital (Code 22), Ambulatory Surgical Centers (Code 24), Hospice (Code 34).