Commonly known for its abbreviation, POS, the Place of Service codes are essential in ensuring that the reimbursement on a center receives is the correct one. If not used properly along with the correct modifier, a rejected claim is eminent. You need to be especially aware of this when billing for a freestanding facility.

Let me review the three Place of Service codes most commonly used:

A. Office – POS "11"
B. Inpatient Hospital – POS "21"
C. Outpatient Hospital – POS "22"

The place of service box on the HCFA form is located on each line item in column "B".

As each charge is entered in the billing computer system it must have a POS entered in Column "B" of the HCFA form. You must have some knowledge understanding where Global, Professional (PC) and Technical (TC) components come into play. The POS and type of component fit hand in hand. Here are the explanations of the components for your understanding:

A. Professional (PC) Charge – a definition of coding that refers to the services rendered by the physician only! A –26 Modifier needs to be attached to the CPT code.
B. Technical (TC) Charge – a definition of coding that refers to services rendered by a facility or hospital. This reimbursement includes paying the staff, owning of the equipment and supplies, and space offered to supply the service. A TC modifier is added to the CPT code to refer to this.
C. Global Charge – the combination of the professional and technical component. This is mainly used in freestanding sites, or, hospital based departments where the physician is an employee of the hospital (i.e. VA Hospital) A Global charge has no modifier attachment.

Example of Medicare reimbursement using CPT code 77300, basic dosimetry calculation.

Professional – 36.92
Technical – 66.09
Global – 103.01

Now we are going to merge this information so that it all makes sense!

BILLING TIP

If a patient were treated in a freestanding facility as an outpatient, he would be billed globally, with a POS of "11", office. No modifier would be attached (except for CT Scan, 76370, which only has a technical reimbursement!). Why Globally? Because the doctor is billing for the professional component because he’s rendering the service & he owns the equipment, pays for supplies & pays employee salaries which is the technical. What do you get when you combine professional & technical components? You get a global component! (Don’t forget a global component has no modifier!)

If a patient is treated in a freestanding facility as an inpatient, the doctor can only receive the professional component. The hospital gets the technical component. The place of service for the freestanding billing would be "21". The –26 modifier would be attached to the CPT being billed (i.e. 77300-26).

It is important to remember that certain CPT codes are specifically designed for "TC" only or "PC" only.

Examples:

TC Only 77336 – weekly physics check 77370 – special physics consult All daily technical treatment codes 77402-77414

PC Only All consults & follow-up codes 77261-77263 – treatment planning 77427 – weekly treatment management

In these instances no modifiers are attached!

One last tip for your information:

According to Medicare Carrier’s Manual Section 150022, B1 & 2, if a patient is a hospital inpatient & is transported to a freestanding center for therapy, the Technical component of the services cannot be paid to the freestanding facility.

The freestanding facility can receive payments from the hospital only if there were prior arrangements with the hospital. In order for the freestanding to receive the global reimbursement, the patient would need to be discharged & readmitted for each service.

In hospital facilities, as long as the physician is not an employee, he would bill entirely professional only!