Effective January 1, 2016, a new place of service (POS) code will go into effect for health care services provided in outpatient settings outside of the main hospital campus. As this new code is implemented, physicians will need to know whether their hospital location is considered “on” or “off campus” when submitting their professional claims to the Centers for Medicare & Medicaid Services (CMS).
On August 6, CMS created POS code 19, Off Campus-Outpatient Hospital, and revised the description of POS code 22 to On Campus-Outpatient Hospital (originally Outpatient Hospital), via a change request to the Medicare Claims Processing Manual. See Table 1 for a description of each code from the POS Codes for Professional Claims Database.*
Table 1. POS codes and descriptions
|POS Code||POS Name||POS Description|
|19||Off Campus-Outpatient Hospital||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. (Effective January 1, 2016.)|
|22||On Campus-Outpatient Hospital||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. (Description change effective January 1, 2016.)|
Source: Centers for Medicare & Medicaid Services
CMS defines “campus” as “the physical area immediately adjacent to the provider’s main building, other areas and structures that are not strictly contiguous to the main buildings but are located within 250 yards of the main buildings, and any other areas determined on an individual case basis by the CMS regional office to be part of the provider’s campus.”†
This change stems from CMS’ desire to better understand the growing trend toward hospital acquisitions of physician offices and the treatment of these offices as off-campus, provider-based hospital outpatient departments (HOPDs) from a practice expense payment perspective. In the 2015 Medicare physician fee schedule final rule, CMS stated its intention to create a new POS code for professional claims to collect better data on off-campus versus on-campus provider-based HOPDs. The addition of POS code 19 is primarily for data collection purposes and, for the time being, will follow the same payment policies as the current POS code 22.†
*Centers for Medicare & Medicaid Services. Place of service code set. Available at: www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set.html. Accessed September 16, 2015.
†Centers for Medicare & Medicaid Services. 42 CFR 413.65. Available at: www.gpo.gov/fdsys/pkg/CFR-2010-title42-vol2/pdf/CFR-2010-title42-vol2-sec413-65.pdf. Accessed September 16, 2015.