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

Date Issued: 1/28/2016

Effective January 1, 2016, the Centers for Medicare and Medicaid (CMS) has assigned a new Place of Service (POS) code for Outpatient Hospital which will now be differentiated into two POS codes:

New: POS 19: Off Campus-Outpatient Hospital
Descriptor: 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. POS 19 is considered valid, regardless of the date of service, when it is processed on or after January 1, 2016.

POS 22: On Campus-Outpatient Hospital
Descriptor: 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.

EmblemHealth can accept POS 19 as a valid POS on electronic claim submissions.

The primary purpose of this mandate is to report/differentiate services rendered at on-campus and off-campus outpatient hospital settings. There are no reimbursement changes associated with this new POS code, and as per CMS, the payments for POS 22 and POS19 will be identical. In addition, use of POS 19 has no impact on our prior approval process. This change applies to all EmblemHealth lines of business.

Our vendor partners may now submit  278s for both  POS 22 and  POS 19.