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New and Revised Place of Service Codes (POS) for Outpatient hospital

The Centers for Medicare and Medicaid Services (CMS) is requiring the use of place of service (POS) code 19 Outpatient Hospital-Off campus to describe, “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 effective Jan. 1, 2016.”

The 2015 Outpatient Prospective Payment System Final Rule defines the hospital campus to include, “the physical area immediately adjacent to the provider’s main buildings, other areas and structures that are not strictly contiguous to the main buildings but are located within 250 yards of the main buildings, and any other areas determined on an individual case basis, by the CMS regional office…”

 

Additionally, POS code 22 On Campus-Outpatient Hospital has been revised, effective Jan. 1, 2016 to, “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.”

 

Both of these POS codes have to be reported by the providers in the outpatient department of a hospital. As per CMS, “Claims for covered services rendered in an Off Campus-Outpatient Hospital setting, or in an On Campus- Outpatient Hospital setting, if payable by Medicare, shall be paid at the facility rate. The payment policies that currently apply to POS 22 will continue to apply and will now also apply to POS 19, unless otherwise stated.

Medicare transmittal download pdf