December 31, 2015

CMS Issues New and Revised POS Codes for OP Hospital

The Centers for Medicare and Medicaid Services (CMS), in order to provide a greater level of code specificity, have issued a number of new or revised Place of Service (POS) codes for implementation effective January 1, 2016. CMS has added POS Code 19 for “Off Campus Outpatient Hospital” and in turn will revise POS Code 22 from “Outpatient Hospital” to “On Campus-Outpatient Hospital”. Additionally, CMS has corrected the POS List to include the previously omitted POS codes 17 (Walk-in Retail Health Clinic) and 26 (Military Treatment Facility).

POS 19 will be accepted for any claims processed on or after January 1, 2016. That is, POS code 19 is valid for any claim, regardless of the date of service, when it is processed on or after January 1, 2016.

See MLN Matters article MM9231 for full descriptors of the new and revised POS codes and for further details.

Note: The rate, facility or nonfacility, that a physician service is paid under the MPFS is determined by the Place of service (POS) code that is used to identify the setting where the beneficiary received the face-to-face encounter with the physician, nonphysician practitioner (NPP) or other supplier. In general, the POS code reflects the actual place where the beneficiary receives the face-to-face service and determines whether the facility or nonfacility payment rate is paid. However, for a service rendered to a patient who is an inpatient of a hospital (POS code 21) or an outpatient of a hospital (POS codes 19 or 22), the facility rate is paid, regardless of where the face-to-face encounter with the beneficiary occurred. For the professional component (PC) of diagnostic tests, the facility and nonfacility payment rates are the same – irrespective of the POS code on the claim. See Transmittal 3315 New and Revised Place of Service Codes (POS) for Outpatient Hospital .

Please contact Dominick Parris in the Department of Economics and Health Policy with your questions at djparris@acr.org.