Place of Service (POS) refers to a two-digit code used on medical claims to indicate where the healthcare service was provided. These codes are required by insurance companies (especially Medicare and Medicaid) and help determine the reimbursement amount for a claim.
Each POS code tells the payer:
- The physical location of where the patient received care.
- How the care was delivered (e.g., inpatient, outpatient, telehealth, home).
Why Is Place of Service Important?
- Affects Payment Rates: Reimbursement can differ depending on the place of service.
- Ensures Proper Billing: Incorrect POS codes may result in claim denials or underpayment.
- Helps in Compliance: It helps payers verify that the billed service aligns with location-specific rules.
Common POS Codes (with Explanation)
| POS Code | Description | Used When Services Are Provided… |
|---|---|---|
| 11 | Office | In a physician’s office or private clinic. |
| 20 | Urgent Care Facility | The patient walks into an urgent care center for non-emergency but immediate medical attention. |
| 21 | Inpatient Hospital | When the patient is formally admitted to the hospital. |
| 22 | Outpatient Hospital | For hospital-based outpatient services (e.g., same-day). |
| 23 | Emergency Room (Hospital) | In an ER setting at a hospital. |
| 24 | Ambulatory Surgical Center (ASC) | In a licensed surgery center outside of hospitals. |
| 31 | Skilled Nursing Facility | For post-hospital care with nursing or rehab support. |
| 32 | Nursing Facility | Long-term care services in a nursing home. |
| 12 | Home | Services provided at the patient’s residence. |
| 02 | Telehealth Provided Other than in Patient’s Home | Patient receives telehealth away from home (e.g., work). |
| 10 | Telehealth Provided in Patient’s Home | Telehealth done while the patient is at home. |
| 49 | Independent Clinic | Services in a standalone clinic, not part of a hospital. |
| 50 | Federally Qualified Health Center (FQHC) | In a federally funded health clinic for underserved areas. |