Code Submitted for Services Performed in a Group Home

In the United States, POS 14 is the code submitted for all services performed in a Group Home. Place of Service (POS) Codes are simply two-digit codes placed on healthcare professional claims to indicate the setting in which a service was provided.

The Centres for Medicare & Medicaid Services (CMS) maintain POS codes used throughout the healthcare industry. This code is used in the implementation guide adopted as the national standard for electronic transmission of professional healthcare claims under the provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

According to CMS, a group home is defined as a home or location where people live together in a group to receive care or supervision and other services such as social and/or behavioural services, custodial service and minimal services (example: Medication Administration).

In the United States, this standard transaction mandates all health plans and providers to use standard code sets to populate data elements in each transaction.

The Transaction and Code Set Rule adopted the ASC X12N-837 Health Care Claim: Professional, volumes 1 and 2, version 4010, as the standard for electronic submission of professional claims.

This standard names the POS code set currently maintained by CMS as the code set to be used for describing sites of service in such claims.

Note that if as a patient, your claims are being denied, it is imperative to first ensure the information on your claims is correct.

One of the billing issues identified by the government has to do with coding for the location where services have been provided. POS codes normally are assigned based on the setting in which the beneficiary receives the face-to-face service.

Since most services include a face-to-face component, this rule applies to the overwhelming majority of services. Where there is no face-to-face requirement, such as where an interpretation of a diagnostic test is performed remotely, you will have to use the POS code for the setting in which the beneficiary received the test (also referred to as the technical component (TC)) of the test.

For instance, this determination is made easily when distinguishing between a hospital and physician’s office. But note that it becomes much more complex when services are provided in the hospital because a determination will still have to be made as to whether the patient is being treated as an inpatient or outpatient.

When reporting POS, CMS mandates providers to pay more attention to the patient’s general inpatient or outpatient hospital status, rather than the precise inpatient or outpatient code.

Howbeit, if you know that a determination has been made regarding inpatient or outpatient status, that is what should be reported.

In times past, CMS had instructed practitioners to use the two-digit POS code that describes where they were physically located when rendering the service.

Place of Service Codes for Professional Claims in the United States

Below are place of service codes and descriptions used in the United States. These codes are only meant to be used on professional claims to specify the entity where service(s) were rendered.

1. POS 01 – Pharmacy: A facility or location where drugs and other medically related items and services are sold, dispensed, or otherwise provided directly to patients.
2. POS 02–Telehealth: The location where health services and health related services are provided or received, through a telecommunication system.
3. POS 03–School: A facility whose primary purpose is education.
4. POS 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).
5. POS 05 – Indian Health Service / Free – standing 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.
6. POS 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 non-surgical), and rehabilitation services rendered by, or under the supervision of, physicians to American Indians and Alaska Natives admitted as inpatients or outpatients.
7. POS 07 – Tribal 638/Free – standing 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 non-surgical), and rehabilitation services to tribal members who do not require hospitalization.
8. POS 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 non-surgical), and rehabilitation services to tribal members admitted as inpatients or outpatients.
9. POS 09- Prison/Correctional Facility: A prison, jail, reformatory, work farm, detention centre, 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. POS 10 – Unassigned
11. POS 11-Office: Location, other than a hospital, skilled nursing facility (SNF), military treatment facility, community health centre, 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.
12. POS 12 – Home: Location, other than a hospital or other facility, where the patient receives care in a private residence.
13. POS 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 for services including some healthcare and other services.
14. POS 14 – Group Home: A residence, with shared living areas, where clients receive supervision and other services such as social and/or behavioural services, custodial service, and minimal services (e.g., medication administration).
15. POS 15 – Mobile Unit: A facility/ unit that moves from place-to-place equipped to provide preventive, screening, diagnostic, and/ or treatment services.
16. POS 16 – Temporary Lodging: A short term accommodation such as a hotel, camp ground, hostel, cruise ship or resort where the patient receives care, and which is not identified by any other POS code.
17. POS 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, on an ambulatory basis, preventive and primary care services.
18. POS 18 – Place of Employment/ Worksite: A location, not described by any other POS code, owned or operated by a public or private entity where the patient is employed, and where a health professional provides on – going or episodic occupational medical, therapeutic or rehabilitative services to the individual.
19. POS 19 – Off Campus – Outpatient Hospital: A portion of an off-campus hospital provider based department which provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization.
20. POS 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!
21. POS 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 for a variety of medical conditions.
22. POS 22 – On Campus – Outpatient Hospital: A portion of a hospital’s main campus which provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization.
23. POS 23 – Emergency Room (Hospital): A portion of a hospital where emergency diagnosis and treatment of illness or injury is provided.
24. POS 24 – Ambulatory Surgical Centre: A freestanding facility, other than a physician’s office, where surgical and diagnostic services are provided on an ambulatory basis.
25. POS 25 – Birthing Centre: A facility, other than a hospital’s maternity facilities or a physician’s office, which provides a setting for labour, delivery, and immediate post-partum care as well as immediate care of new born infants.
26. POS 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. POS 27-30 – Unassigned
28. POS 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.
29. POS 32 – Nursing Facility: A facility which primarily provides to residents skilled nursing care and related services for the 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 individuals with intellectual disabilities.
30. POS 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.
31. POS 34 – Hospice: A facility, other than a patient’s home, in which palliative and supportive care for terminally ill patients and their families are provided.
32. POS35-40 – Unassigned
33. POS 41 – Ambulance – Land: A land vehicle specifically designed, equipped and staffed for lifesaving and transporting the sick or injured.
34. POS 42 – Ambulance – Air or Water: An air or water vehicle specifically designed, equipped and staffed for lifesaving and transporting the sick or injured.
35. POS 43-48 – Unassigned
36. POS 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.
37. POS 50 – Federally Qualified Health Centre: A facility located in a medically underserved area that provides Medicare beneficiaries preventive primary medical care under the general direction of a physician.
38. POS 51 – Inpatient Psychiatric Facility: A facility that provides inpatient psychiatric services for the diagnosis and treatment of mental illness on a 24 – hour basis, by or under the supervision of a physician.
39. POS 52 – Psychiatric Facility – Partial 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.
40. POS 53 – Community Mental Health Centre: 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.
41. POS 54 – Intermediate Care Facility/ Individuals with Intellectual Disabilities: A facility which primarily provides health – related care and services above the level of custodial care to individuals but does not provide the level of care or treatment available in a hospital or SNF.
42. POS 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 counselling, family counselling, laboratory tests, drugs and supplies, psychological testing, and room and board.
43. POS 56 – Psychiatric Residential Treatment Centre: 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.
44. POS 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 counselling, family counselling, laboratory tests, drugs and supplies, and psychological testing.
45. POS 58 – Non – residential Opioid Treatment Facility: A location that provides treatment for opioid use disorder on an ambulatory basis. Services include methadone and other forms of Medication Assisted Treatment (MAT).
46. POS 59 – Unassigned
47. POS 60 – Mass Immunization Centre: 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 centre, pharmacy, or mall but may include a physician office setting.
48. POS 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.
49. POS 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.
50. POS 63-64 – Unassigned
51. POS 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.
52. POS 66-70 – Unassigned
53. POS 71 – Public Health Clinic: A facility maintained by either State or local health departments that provide ambulatory primary medical care under the general direction of a physician.
54. POS 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.
55. POS 73-80 – Unassigned
56. POS 81 – Independent Laboratory: A laboratory certified to perform diagnostic and/ or clinical tests independent of an institution or a physician’s office.
57. POS 82-98 – Unassigned
58. POS 99 – Other Place of Service: Other place of service not identified above

Conclusion

Place of service codes play a very crucial role when submitting claims to insurance companies. To avoid the denials from insurance companies, make sure to submit the claims with the correct place of service codes while billing the claims to the insurance companies.