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Tuesday Sep 01, 2015

Place of service codes for outpatient practices to change in 2016

Beginning Jan. 1, the Centers for Medicare & Medicaid Services (CMS) is changing how physicians affiliated with hospitals record where they provide health care services to patients.

To differentiate between provider-based hospital departments located either on or separate from the hospital’s main campus, CMS is creating a new place of service (POS) code. POS code 19 is for “Off Campus-Outpatient Hospital.” CMS describes this as “a portion of an off-campus hospital provider-based department (that) provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization.”

CMS is revising the current POS code 22 from “Outpatient Hospital” to “On Campus-Outpatient Hospital.” The description for this POS is “a portion of a hospital’s main campus (that) provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization.”

The payment policies that currently apply to POS 22 will continue to apply to both this POS and POS 19, unless CMS states otherwise. For instance, Medicare will pay for covered services at either POS at the facility rate under the Medicare physician fee schedule. Likewise, CMS will allow POS 19 to be billed for G0447 (Face-to-face behavioral counseling for obesity, 15 minutes) and G0473 (Face-to-face behavioral counseling for obesity, group (2-10), 30 minutes) in the same way as those services are billed with POS code 22.

CMS plans to use the coding change to better understand the trend of hospitals acquiring physician offices and treating those locations as off-campus provider-based outpatient departments. For more information, you can read a Medicare Learning Network Matters article(www.cms.gov) on the CMS web site.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

Posted at 11:11AM Sep 01, 2015 by David Twiddy

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