News & Information

The list of settings where a physician’s services are paid at the facility rate include:
  • Telehealth (POS 02);
  • Outpatient Hospital-Off campus (POS code 19);
  • Inpatient Hospital (POS code 21);
  • Outpatient Hospital-On campus (POS code 22);
  • Emergency Room-Hospital (POS code 23);
  • Medicare- participating ambulatory surgical center (ASC) for a HCPCS code included on the ASC approved list of procedures (POS code 24);
  • Medicare- participating ASC for a procedure not on the ASC list of approved procedures with dates of service on or after January 1, 2008. (POS code 24);
  • Military Treatment Facility (POS Code 26);
  • Skilled Nursing Facility (SNF) for a Part A resident (POS code 31);
  • Hospice – for inpatient care (POS code 34);
  • Ambulance – Land (POS code 41);
  • Ambulance – Air or Water (POS code 42);
  • Inpatient Psychiatric Facility (POS code 51);
  • Psychiatric Facility -- Partial Hospitalization (POS code 52);
  • Community Mental Health Center (POS code 53);
  • Psychiatric Residential Treatment Center (POS code 56); and
  • Comprehensive Inpatient Rehabilitation Facility (POS code 61).

For settings where physician's services are paid at Nonfacility Rates, Click Here.

References:

Medicare Claims Processing Manual Chapter 12 - (Rev. 4068, 05-31-18)

Author: 
Brittney