Place of Service Codes for Professional Claims

Place of Service Codes for Professional Claims

When you are a biller or a coder, one thing that you need to know first and foremost is where the service location was rendered. Your place of service can greatly affect how claims are processed and paid reimbursement. And you have to report the actual place of service where your physician had rendered his service.

Always make sure to check with your payers including all your commercial insurance payers’ policy guidelines based in these place of service codes for professional claims.

The following are the Place of Service Codes for Professional Claims that you can use when submitting claims.

01 Pharmacy A facility or location where drugs and other medically related items and services are sold,
dispensed, or otherwise provided directly to patients.

02 Unassigned N/A

03 School. A facility whose primary purpose is education.

04 Homeless shelter.  A facility or location whose primary purpose is to provide temporary housing to
homeless individuals (e.g., emergency shelters, individual or family shelters).

05 Indian Health Service freestanding facility. A facility or location, owned and operated by the Indian Health Service, which provides diagnostic, therapeutic (surgical and non-surgical), and rehabilitation services to American Indians and Alaska natives who do not require hospitalization.

Place of Service Codes for Professional Claims

06 (Indian Health Service Provider-based Facility) to 10

06 Indian Health Service provider-based facility. A facility or location, owned and operated by the Indian
Health Service, which provides diagnostic, therapeutic (surgical and nonsurgical), and rehabilitation
services rendered by, or under the supervision of, physicians to American Indians and Alaska natives
admitted as inpatients or outpatients.

07 Tribal 638 freestanding facility. A facility or location owned and operated by a federally recognized
American Indian or Alaska native tribe or tribal organization under a 638 agreement, which provides
diagnostic, therapeutic (surgical and nonsurgical), and rehabilitation services to tribal members who do not require hospitalization.

08 Tribal 638 Provider based Facility.  A facility or location owned and operated by a federally recognized
American Indian or Alaska native tribe or tribal organization under a 638 agreement, which provides
diagnostic, therapeutic (surgical and nonsurgical), and rehabilitation services to tribal members admitted as inpatients or outpatients.

09 Prison/correctional facility. A prison, jail, reformatory, work farm, detention center, or any other similar facility maintained by either federal, state or local authorities for the purpose of confinement or rehabilitation of adult or juvenile criminal offenders.

10 Unassigned N/A

Place of Service Codes for Professional Claims 11 (Office-based) to 15 (Mobile unit)

 11 Office Location

Other than a hospital, skilled nursing facility (SNF), military treatment facility, community health center, State or local public health clinic, or intermediate care facility (ICF), where the health professional routinely provides health examinations, diagnosis, and treatment of illness or injury on an ambulatory basis. This code is one of the Place of Service Codes for Professional Claims that is so commonly used.

12 Home Location

Other than a hospital or other facility, where the patient receives care in a private residence.

13 Assisted living facility. Congregate residential facility with self contained living units providing
assessment of each resident’s needs and on-site support 24 hours a day, 7 days a week, with the capacity to deliver or arrange services including some health care and other services.

14 Group home. A residence, with shared living areas, where clients receive supervision and other services such as social and/or behavioral services, custodial service, and minimal services (e.g., medication administration).

15 Mobile unit.  A facility/unit that moves from place-toplace equipped to provide preventive, screening,
diagnostic, and/or treatment services.

Place of Service Codes for Professional Claims 16 (Temporary Lodging) to 20 (Urgent Care Facility)

16 Temporary lodging. A short-term accommodation such as a hotel, campground, hostel, cruise ship or
resort where the patient receives care, and which is not identified by any other POS code.

17 Walk-in retail health clinic. A walk-in health clinic, other than an office, urgent care facility, pharmacy, or
independent clinic and not described by any other place of service code, that is located within a retail
operation and provides preventive and primary care services on an ambulatory basis.

18-19 Unassigned N/A

20 Urgent care facility. Location, distinct from a hospital emergency room, an office, or a clinic, whose
purpose is to diagnose and treat illness or injury for unscheduled, ambulatory patients seeking immediate medical attention. ** remember, this POS is distinct from the ER! Many get confused with this POS code 20.

Place of Service Codes for Professional Claims

Place of Service Codes for Professional Claims 21 (Inpatient Hospital) to 25 (Birthing Center)

21 Inpatient hospital

A facility, other than psychiatric, which primarily provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services by, or under, the supervision of physicians to patients admitted with variety of medical conditions.

22 Outpatient hospital

A portion of a hospital which provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization.

23 Emergency room— hospital.

A portion of a hospital where emergency diagnosis and treatment of
illness or injury is provided.

24 Ambulatory surgical center.

A freestanding facility, other than a physician’s office, where surgical and diagnostic services are provided on an ambulatory basis.

25 Birthing center A facility, other than a hospital’s maternity facilities or a physician’s office, which provides a setting on labor, delivery, and immediate post-partum care as well as immediate care of new born infants.

Place of Service Codes for Professional Claims 26 (Military Treatment Facility) to 30 (Unassigned)

26 Military treatment facility. A medical facility operated by one or more of the uniformed services. Military treatment facility (MTF) also refers to certain former U.S. Public Health Service USPHS) facilities now designated as uniformed service treatment facilities (USTF).

27-30 Unassigned N/A

Place of Service Codes for Professional Claims 31 (Skilled Nursing Facility) to 40 (Unassigned)

31 Skilled nursing facility.

A facility which primarily provides inpatient skilled nursing care and related
services to patients who require medical, nursing, or rehabilitative services but does not provide the level of care or treatment available in a hospital.

32 Nursing facility.

A facility which primarily provides to residents skilled nursing care and related services to rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care services above the level of custodial care to other than mentally retarded individuals.

** Place of service codes for Professional Claims –  31 and 32 is two different POS. Which POS are you? Understand the difference.

33 Custodial care facility. A facility which provides room, board, and other personal assistance services, generally on a long-term basis, and which does not include a medical component.

34 Hospice. A facility, other than a patient’s home, in which palliative and supportive care to terminally ill patients and their families are provided.

35-40 Unassigned N/A (unassigned place of service codes)

Place of Service Codes for Professional Claims 41 (Ambulance) to 50 (Federally Qualified Health Center)

41 Ambulance—land. A land vehicle specifically designed, equipped and staffed for lifesaving and
transporting the sick or injured.

42 Ambulance—air or water. An air or water vehicle specifically designed, equipped and staffed on
lifesaving and transporting the sick or injured.

43-48 Unassigned N/A (unassigned place of service codes)

49 Independent clinic A location, not part of a hospital and not described by any other place-of-service code, that is organized and operated to provide preventive, diagnostic, therapeutic, rehabilitative, or palliative services to outpatients only.

50 Federally qualified health center. A facility located in a medically underserved area that provides
Medicare beneficiaries preventive primary medical care under the general direction of a physician.

Place of Service Codes for Professional Claims 51 (Inpatient Psychiatric Facility) to 55 (Residential Substance Abuse Treatment Facility)

51 Inpatient psychiatric facility. A facility that provides inpatient psychiatric services with diagnosis and treatment of mental illness on a 24-hour basis, by or under the supervision of a physician.

52 Psychiatric facilitypartial hospitalization. A facility for the diagnosis and treatment of mental illness that provides a planned therapeutic program for patients who do not require full time hospitalization, but who need broader programs than are possible from outpatient visits to a hospital-based or hospital-affiliated facility.

53 Community mental health center. A facility that provides the following services: outpatient services,
including specialized outpatient services for children, the elderly, individuals who are chronically ill, and
residents of the CMHC’s mental health services area who have been discharged from inpatient treatment at a mental health facility; 24 hour a day emergency care services; day treatment, other partial hospitalization services, or psychosocial rehabilitation services; screening for patients being considered for admission to state mental health facilities to determine the appropriateness of such admission; and consultation and education services.

54 Intermediate care facility/mentally retarded. A facility which primarily provides healthrelated care and
services above the level of custodial care to mentally retarded individuals but does not provide the level of care or treatment available in a hospital or SNF.

55 Residential substance abuse treatment facility. A facility which provides treatment for substance (alcohol and drug) abuse to live-in residents who do not require acute medical care. Services include individual and group therapy and counseling, family counseling, laboratory tests, drugs and

55 Residential substance abuse treatment facilit. A facility which provides treatment for substance (alcohol and drug) abuse to live-in residents who do not require acute medical care. Services include individual and group therapy and counseling, family counseling, laboratory tests, drugs and supplies, psychological testing, and room and board.

Place of Service Codes for Professional Claims 56 (Psychiatric Residential Treatment Center to 60 (Mass Immunization Center)

56 Psychiatric residential treatment center. A facility or distinct part of a facility for psychiatric care which provides a total 24-hour therapeutically planned and professionally staffed group living and learning environment.

57 Non-residential substance abuse treatment facility. A location which provides treatment for substance
(alcohol and drug) abuse on an ambulatory basis. Services include individual and group therapy and
counseling, family counseling, laboratory tests, drugs and supplies, and psychological testing.

58-59 Unassigned N/A (unassigned place of service codes)

60 Mass immunization center. A location where providers administer pneumococcal pneumonia and
influenza virus vaccinations and submit these services as electronic media claims, paper claims, or using the roster billing method. This generally takes place in a mass immunization setting, such as, a public health center, pharmacy, or mall but may include a physician office setting.

Place of Service Codes for Professional Claims 61 (Comprehensive Inpatient Rehabilitation Facility) to 65 (ESRD Treatment Facility)

61 Comprehensive inpatient rehabilitation facility. A facility that provides comprehensive rehabilitation
services under the supervision of a physician to inpatients with physical disabilities. Services include
physical therapy, occupational therapy, speech pathology, social or psychological services, and orthotics and prosthetics services.

62 Comprehensive outpatient rehabilitation facility. A facility that provides comprehensive rehabilitation
services under the supervision of a physician to outpatients with physical disabilities. Services include
physical therapy, occupational therapy, and speech pathology services.

63-64 Unassigned N/A (unassigned place of service codes)

65 End-stage renal disease treatment facility. A facility other than a hospital, which provides dialysis
treatment, maintenance, and/or training to patients or caregivers on an ambulatory or home-care basis.

Place of Service Codes for Professional Claims 66 to 71

66-70 Unassigned N/A (unassigned place of service codes)

71 State or local public health clinic. A facility maintained by either state or local health departments that provides ambulatory primary medical care under the general direction of a physician.

72 Rural health clinic A certified facility which is located in a rural medically underserved area that provides ambulatory primary medical care under the general direction of a physician.

73-80 Unassigned N/A (unassigned place of service codes)

Place of Service Codes for Professional Claims 81 (Independent Laboratory) to 99 (Other Place of Service)

81 Independent laboratory A laboratory certified to perform diagnostic and/or clinical tests independent of an institution or a physician’s office.

82-98 Unassigned N/A (unassigned place of service codes)

99 Other place of service Other place of service not identified above.

Knowing your right place of service based on this list of place of service codes is important for your claims to be properly processed and reimbursed based on medical necessity.

Please read the most recent changes issued by Medicare’s new instructions on some Place of Service
Codes for Professional Claims. Read Here.

Searched Keyword: Place of Service Codes for Professional Claims

References: 2014 CPT Code Book, CMS Website http://www.cms.gov

Other useful references and policy guidelines when Place of Service Codes for Professional Claims are applicable.

Chapter 15 Medicare Benefit Policy Manual Covered Medical and Other Health Services Rev. 194 – 09-03-2014

Medicare CMS Processing Manuals 2014-2015

[wd_contact_form id=”2″]

Dig Deep, Dig Deeper, Still Deeper ... until you find what you are looking for.

Author: Pinky Maniri

Ms. Pinky, as she is fondly called - is a Reputable Professional Consultant and Expert in Practice Administration, Medical Billing, Coding, Health Information Technology, Insurance Credentialing and Compliance for Physician Offices. Well-educated with a Degree in Computer Systems Engineering and a background in Clinical Nursing and Small Business Management. Her professional mission is to make sure her clients/physicians maximize reimbursement while they remain compliant with the current rules, changes, guidelines and policies. Read More About Ms. Pinky here and See what Other's say about her Expertise Testimonials

Share This Post On