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PAP224

Place of Service


Provider Administrative Policy

Section
Claims Submission
Policy Date
April 2007
Status/Date
Revised/June 2012
Provider Type(s)
All Providers  

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

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

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

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

Bill professional services performed in an inpatient setting as place of service 21 (inpatient hospital). 

Important Note: Place of service can determine benefits on some PPO contracts (99212 with place of service 22 would be applied to the patient`s deductible or be paid at a percentage, instead of applying a patient copayment amount).

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

Our clinical editing software denies claims with incorrect or invalid place of service codes.

The abbreviated list for places of service codes most commonly recognized by Blue Cross of Idaho is noted below.

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 Put POS codes in numerical order
July 2009 Revised Removed third column and put in numeric order
November 2008 Revised Language clarification

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