September 1, 2022
Effective for claims processed on and after December 7, 2022, the new payment policy Place of Service (POS) Codes will be enforced during claims editing.
This new policy identifies the POS codes to be used on a professional claim form. These POS codes must match the CPT or HCPCS code(s) descriptions when applicable. POS codes are entered in block 23B on a CMS-1500 paper claim form or in loop 2300 CLM01-0 on an 837P electronic claim form.
These codes represent where a service was performed, received, or will be used. It is important to use the most accurate POS code as these codes are tied to several claim edits. When a CPT or HCPCS code description contains a reference to a specific place of service, a corresponding POS code must be used. If a corresponding POS code doesn’t match the CPT or HCPCS code description, the claim line may get denied reimbursement.
There are special coding considerations for registered inpatients, ambulatory surgery center, and diagnostic laboratory tests for which a correct corresponding POS code must be used.
Review the new payment policy to identify the full list of POS codes to be submitted on professional claim forms and when special coding should be considered.