New and Revised Place of Service Codes for Hospital Outpatient Services

December 14, 2015

Dear MSN Clients,

TOPIC: New and Revised Place of Service Codes for Hospital Outpatient Services

Background : CMS requires that each claim include a Place of Service (POS) code from the POS code set maintained by the agency. The primary reason is to allow Medicare claims to be paid appropriately and per the correct clinical care setting, i.e. inpatient, emergency room, outpatient, IDTF, etc. This is not new.

What is New ? The 2015 Medicare Physician Fee Schedule Final Rule established a new POS code (19) to differentiate between on-campus and off-campus hospital-based outpatient departments. For 2016, Medicare will pay POS 19 (Off-Campus Hospital Outpatient Department) and POS 22 (On-Campus Hospital Outpatient Department) the same because the POS codes are for informational purposes only until further notice.

CMS defines “Off-Campus” as more than 250 yards from the hospital’s main campus or a remote location. “On-Campus” is defined as less than 250 yards from the hospital’s main campus or a remote location. An example of a “remote” location would be an affiliated rural hospital that is not a hospital system’s main campus.

What we need to know : MSN has been billing all hospital-based outpatient services with POS 22, which is correct through January 3, 2016. Effective January 4, 2016, MSN will begin billing with the new POS 19 code where applicable. Therefore, we need to know if you provide any services for a hospital-based outpatient department that is more than 250 yards from the hospital’s main campus or remote location.

Please email this information by December 28th directly to:

Suzanne Taylor – VP Operations
staylor@msnllc.com

Should you have any questions please feel free to contact Barbara Rubel at brubel@msnllc.com or (904)657-2038.