Corporate

March 12, 2013

Place of Service Codes and Face-to-Face Encounters

Effective for dates of service on or after April 1, 2013, the place of service (POS) reported on claims for all services that are payable under the Medicare Physician Fee Schedule (MPFS) must be the same setting as the face-to-face encounter for physicians and suppliers, with two exceptions:

  • When the patient is receiving care as a registered inpatient or outpatient of a hospital. Submit the POS of the setting in which the patient is receiving inpatient or outpatient care, regardless of where the service was performed.

Diagnostic Services

This is an important change for diagnostic services that have both a professional component (PC) and technical component (TC). In these cases, the POS is the setting in which the beneficiary received the technical component of the service.

For example: A beneficiary receives an MRI at an outpatient hospital near his/her home.

  • The hospital submits a claim that would correspond to the TC portion of the MRI.
  • The physician furnishes the PC portion of the beneficiary's MRI from his/her office location.
  • Submit POS code 22 on the physician's claim for the PC to indicate that the beneficiary received the face-to-face portion of the MRI (the TC) at an outpatient hospital.
Other Important Notes
Service is: Submit:
Furnished to a patient in a Medicare-participating Ambulatory Surgical Center (ASC) POS 24
Furnished to an inpatient of a hospice POS 34
A specimen drawn on a patient who is a registered inpatient or hospital outpatient POS for the setting in which the patient is receiving inpatient or outpatient care
Telehealth services, where the originating site is a physician's office (including a mobile physician's office) POS 11
Interpretation, provided under arrangements with a hospital, for a global service for which the test and interpretation are not separately billable (must be billed globally) No Part B claim (service is reimbursed through Part A)

Reference:


Two Vantage Way, Nashville, TN 37228 © CGS Administrators, LLC. All Rights Reserved