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Place of Service


Provider Administrative Policy

Section
Provider Information
Policy Date
November 2007
Status/Date
Revised/June 2012

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts.

Policy

Place of Service

 

Professional services in a clinic are billed as place of service 11 (office) even if the clinic is owned by a hospital.

Professional services performed in the outpatient department of a hospital are billed with place of service 22 (outpatient hospital) or 23 (emergency room), depending on where the service was rendered.

Professional services performed in an inpatient setting are billed as place of service 21 (inpatient hospital). 

Place of service is noted on the CMS1500 form in Box 24B.

A complete list of place of service codes can be found in the current year CPT® book or under the allowance calculation tool on bcidaho.com.

Our clinical editing software will deny claims with incorrect place of service codes if not appropriate with the CPT/HCPCS code being billed.

Below is an abbreviated list of place of service codes most commonly recognized by Blue Cross of Idaho.

PLACE OF SERVICE CODES

 

Place of Service Code

Place of Service Description

 

Place of Service Code

Place of Service Description

03

School

23

Emergency Room - Hospital

04

Homeless Shelter

24

Ambulatory Surgical Center

05

Indian Health Service
- Free-Standing Facility

25

Birthing Center

06

Indian Health Service
Provider-Based Facility

26

Military Treatment Facility

07

Tribal 638
Free-Standing Facility

31

Skilled Nursing Facility

08

Tribal 638
Provider-Based Facility

34

Hospice

11

Office

41

Ambulance - Land

12

Patient's Home

42

Ambulance - Air or Water

13

Assisted Living Facility

51

Inpatient Psychiatric Facility

14

Group Home

52

Psychiatric Facility Partial Hospitalization

15

Mobile Unit

53

Community Mental Health Center

20

Urgent Care Facility

61

Comprehensive Inpatient Rehabilitation Facility

21

Inpatient Hospital

81

Independent Laboratory

22

Outpatient Hospital

99

Other Unlisted Facility

 


Policy History

Date Action Reason
June 2012 Revised Language clarification
July 2009 Revised Removed last column from place of service codes

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