Definition
Place of Service Code 11 is used on professional claims (CMS-1500 form) to indicate that the service was provided in a physician’s office, or a clinician-owned or leased space used to treat patients on an outpatient basis.
CMS definition: “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.”
Key Characteristics of POS 11
- Non-facility setting – The provider is responsible for overhead, such as rent, staff salaries, equipment, and supplies.
- Services are rendered on an outpatient basis (not admitted, no overnight stay).
- Used by solo practitioners, group practices, or specialty clinics.
- POS 11 affects the reimbursement rate. Payers use non-facility RVUs (Relative Value Units), which typically pay more than facility-based rates because of provider-incurred costs.
When to Use POS 11
You should use POS 11 when:
- The provider sees patients in their private medical office or clinic.
- It’s not part of a hospital or institutional setting.
- No hospital outpatient department resources are involved.
- No facility fees are being billed—this is strictly professional billing.
Examples
| Scenario | POS Code |
|---|---|
| Internal medicine doctor seeing a patient for hypertension follow-up in a private office | POS 11 |
| Dermatologist removing a mole in their outpatient clinic | POS 11 |
| Pediatrician performing a well-child exam in their own practice office | POS 11 |
Billing Implications
- Reimbursement Differences: Medicare and many commercial payers pay higher professional fees when the service is provided in an office (POS 11) than in a facility (e.g., POS 22).
- Bundling Risks: If POS is coded incorrectly, services may be bundled or denied, especially if the payer expected the service to occur in a hospital or facility.
Example:
- CPT Code: 99213 (Established patient office visit)
- POS 11: Paid using non-facility RVUs → Higher reimbursement.
- POS 22 (Hospital Outpatient): Paid using facility RVUs → Lower reimbursement.
Common Mistakes to Avoid
- Using POS 11 for services performed in a hospital outpatient department (should be POS 22).
- Mismatch between provider’s location in NPPES and the reported POS code.
- Submitting POS 11 for telehealth services (which should use POS 02 or 10, depending on where the patient is located).
Quick Tip:
If the practice owns the space and the provider is not using hospital resources, you’re most likely dealing with POS 11.