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Facility and Non-Facility Payment Assignments based on POS codes


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).

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