Introduction
When billing for services, selecting the correct Place of Service (POS) code is critical to ensure clean claims and proper reimbursement. One frequently used—but sometimes misunderstood—POS code is 20, which represents an Urgent Care Facility.
Let’s break down what POS 20 is, when it should be used, and how it affects billing and reimbursement.
What is POS 20?
Place of Service Code 20 indicates that services were provided in an urgent care facility, which is not part of a hospital and is primarily set up to treat patients who need immediate, non-emergency medical attention.
CMS Definition:
“A 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.”
What is an Urgent Care Facility?
An urgent care center is a walk-in clinic that treats conditions that require prompt attention but are not life-threatening. These centers bridge the gap between a primary care provider and an emergency room.
Common services at urgent care include:
- Minor fractures and sprains
- Respiratory infections
- Cuts requiring stitches
- Mild asthma attacks
- Fever, flu, and sore throat treatment
- Diagnostic services like X-rays or rapid lab tests
When to Use POS 20
You should report POS 20 when:
- Services are provided in an urgent care clinic specifically set up for walk-in, non-emergency, immediate care.
- The location operates independently from a hospital emergency department.
- The patient is not formally admitted and visits are unscheduled.
Example Scenarios
| Scenario | Correct POS |
|---|---|
| A patient walks into an independent urgent care center for a sprained ankle | POS 20 |
| A provider treats a flu patient at a retail urgent care facility | POS 20 |
| A clinic that offers evening hours for non-emergency walk-ins | POS 20 |
POS 20 vs. Other POS Codes
| POS Code | Description | Use When… |
|---|---|---|
| 11 | Office | Patient sees provider at a private practice |
| 20 | Urgent Care | Patient receives unscheduled care in a walk-in urgent care center |
| 22 | Hospital Outpatient | Services are provided in a hospital-based outpatient department |
| 23 | Emergency Room – Hospital | Patient is seen in a hospital ER for acute, potentially life-threatening issues |
Billing Considerations for POS 20
- Reimbursement Rate
- POS 20 is usually paid at the non-facility rate, similar to POS 11.
- However, reimbursement can vary based on payer contracts and urgent care designation.
- Documentation is Key
- Ensure clear notes that the patient was treated at an urgent care center, not in a primary care office or ER.
- Include unscheduled nature of the visit and reason for urgent attention.
- Payer Policies May Vary
- Some insurance companies require the facility to be registered as an urgent care center to bill POS 20.
- Others may require specific modifiers or taxonomy codes.
Common Mistakes with POS 20
- Using POS 11 (Office) for walk-in urgent visits – this could result in incorrect payment or denials.
- Reporting POS 20 for telehealth – this is inaccurate; use POS 02 or 10 instead.
- Mixing up POS 20 and POS 23 (ER) – POS 23 should only be used when services are performed in a hospital-based emergency department.
Sample CPT + POS 20 Billing
| CPT Code | Description | POS |
|---|---|---|
| 99203 | New patient office/outpatient visit (moderate complexity) | 20 |
| 87880 | Rapid strep test | 20 |
| 20610 | Joint injection | 20 |
Final Tips
- Always verify whether the urgent care facility is properly credentialed with payers.
- Ensure accurate documentation of symptom onset, urgency, and treatment provided.
- Double-check payer-specific rules on urgent care billing—especially Medicare Advantage and Medicaid plans.