Place Of Service (POS) issue with Medicare and UHC

It turns out that UHC follows the same CMS policy which was recently posted on CMS Medicare-Learning-Network-MLN. "If the patient is seen in the OFFICE but resides in a Nursing Home as one example, CMS updated via the Medicare Learning Network resources to clarify how to use place of service codes 21, 31, and 32: Skilled Nursing Facility 3-Day Rule Billing fact sheet-2024-08-15-MLNC |

LINK: https://www.cms.gov/training-education/medicare-learning-network/newsletter/2024-08-15-mlnc#_Toc174600994 CMS Medicare Payment Systems: Skilled Nursing Facility Prospective Payment System educational tool Skilled Nursing Facility Billing Reference educational tool

Place of service (POS) codes identify where a patient gets a service. Enter the correct 2-digit code on Medicare claims to ensure proper payment for physician services provided to patients in inpatient facilities like SNFs and hospitals. POS codes frequently associated with SNF extended care services include:

• Inpatient hospital: 21

• SNF (with Part A coverage): 31

• Nursing facility (or SNF with no Part A coverage): 32

For example, if a patient is seen in a physician’s office but is also:

• An inpatient of a hospital, use POS code 21 for inpatient hospital

• A patient of a SNF (with Part A), use POS code 31 for SNF

• A patient of a nursing facility or SNF without Part A, use POS code 32 for nursing facility

The POS code reflects a different setting than the address and ZIP Code of the practice location.