The Procedure and Place of Service policy addresses the reimbursement of Current Procedural Terminology (CPT®) and Healthcare Common Procedure Coding System (HCPCS) codes that are reported in a place of service (POS) considered inappropriate based on the code’s description or available coding guidelines when reported by a physician or other health care professional.
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Q: Why aren’t all CPT and HCPCS codes addressed in this policy?
A: This policy addresses CPT and HCPCS codes that include a place of service (POS) in their description or in their coding guidelines and CPT and HCPCS codes assigned the Non-Facility Indicator “NA”. Codes that do not fit these criteria, as well as mental health/substance abuse codes and codes addressed in other reimbursement policies, are out of scope for this reimbursement policy
Q: Where do the Place of Service codes come from?
A: The Place of Service codes can be found on the CMS website and contains two-digit codes placed on health care professional claims to indicate the setting in which a service was provided. The Centers for Medicare & Medicaid Services (CMS) maintains POS codes us ed throughout the health care industry.