CurrentPremera BluecrossPolicy N/A

Place of Service (POS) Codes

Defines how Premera and affiliated plans require POS codes to be reported on professional claims (CMS-1500 / 837P), which codes correspond to service locations, and billing/reimbursement implications for providers submitting claims.

Policy Summary

PayerPremera Bluecross

PolicyPlace of Service (POS) Codes

Policy CodePolicy N/A

Change TypeRevisions and code additions (POS 27, POS 66POS 10 RVU change)

Effective DateSee individual changes (e.g., 10/01/2023, 01/01/2024, 08/01/2024)

Next Review Date

Key ActionEnsure correct POS code is submitted on CMS-1500 (block 24B) or 837P (loop 2300/CLM05-1) to avoid denials for POS conflicts.

SourceLink

POLICY UPDATE CHANGES

Added new Place of Service code 27 effective October 1, 2023.

Place of Service code 10 changed from facility (F) RVUs to non-facility (NF) RVUs effective January 1, 2024.

Added new Place of Service code 66 effective August 1, 2024.

Policy subsection on Place of Service Codes was revised and examples were added.

Removed prior exceptions related to POS 10 effective January 1, 2024.

~60Place of Service codes defined or referenced

POS 10Telehealth in patient's home now assigned NF RVUs

POS 27Outreach site/street POS code

Policy Summary

PayerPremera Bluecross

PolicyPlace of Service (POS) Codes

Policy CodePolicy N/A

Change TypeRevisions and code additions (POS 27, POS 66POS 10 RVU change)

Effective DateSee individual changes (e.g., 10/01/2023, 01/01/2024, 08/01/2024)

Next Review Date

Key ActionEnsure correct POS code is submitted on CMS-1500 (block 24B) or 837P (loop 2300/CLM05-1) to avoid denials for POS conflicts.

SourceLink

On This Page

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Billing & Place of Service Criteria

Billing & POS coding criteria

Billing and reimbursement criteria tied to Place of Service (POS) coding. Covered when ALL of the following are met:

POS must represent the physical location where the member is located or where the service/item is used.

Claims must include the required POS on professional claims (CMS-1500 block 24B) or electronic 837P (loop 2300/CLM05-1).

When a CPT or HCPCS description or coding guidance references a specific place of service, the corresponding POS must be billed to avoid denials for POS conflict.

Telehealth services: bill POS 10 when the member is located in their home; bill POS 02 when the member is physically located somewhere other than their home.

Durable medical equipment (DME): bill the POS that reflects where the member will use the equipment the majority of the time (example: home = POS 12).

ALL of the following

Examples
- If specimen originates in physician office and ONLY the pathologist performs the professional component: technical component is performed and billed by an entity other than the pathology provider; pathologist bills with POS 11 and modifier 26.
- If specimen originates in outpatient or inpatient hospital and professional component is performed by an outside pathologist: pathologist bills with POS 19, 21, or 22 with modifier 26; if hospital-owned lab performs technical component the hospital bills with modifier TC; if hospital performs both TC and PC (global) the hospital bills the global code with no modifiers and no separate professional billing is allowed.
- If specimen is obtained from a physician office or ambulatory surgical center (ASC) and BOTH TC and PC are performed by an outside lab: bill all tests with POS 81 (independent laboratory).

Claims edits may deny or adjust payment for POS conflicts; providers should ensure the POS submitted corresponds to coding guidance and CPT/HCPCS site restrictions.

Place of Service Codes and Coding Rules

POS codes referencedmixed

10	Telehealth Provided in Patient's Home; NF (non-facility) RVUs effective Jan 1, 2024
02	Telehealth Provided Other than in Patient's Home
11	Office
12	Home
19	Off-campus Outpatient Hospital
21	Inpatient Hospital
22	On Campus-Outpatient Hospital
24	Ambulatory Surgical Center
27	Outreach Site/Street (added Oct 1, 2023)
66	Programs of All-Inclusive Care for the Elderly (PACE) Center (added Aug 1, 2024)

1–10 of 12

1/2

Telehealth POS codesmixed

10	Telehealth Provided in Patient's Home; NF (non-facility) RVUs effective Jan 1, 2024
02	Telehealth Provided Other than in Patient's Home

Laboratory & facility POS codesmixed

24	Ambulatory Surgical Center
19	Off-campus Outpatient Hospital
21	Inpatient Hospital
22	On Campus-Outpatient Hospital
81	Independent Laboratory

Other referenced POS codesmixed

11	Office
12	Home
27	Outreach Site/Street (added Oct 1, 2023)
66	Programs of All-Inclusive Care for the Elderly (PACE) Center (added Aug 1, 2024)
99	Other Place of Service

Specimen origin billing rules (Diagnostic laboratory tests)

Determines billing componentPlace where procedure is performed and equipment ownership determine which entity bills technical (TC), professional (26/PC), or global components.

Specimen from physician office with pathologist only performing PROFESSIONAL componentTechnical component billed by entity other than pathology provider; pathologist bills with POS 11 and modifier 26 on the lab test(s).

Specimen from outpatient or inpatient hospitalIf outside pathologist performs professional component, pathologist bills with POS 19, 21, or 22 with modifier 26; hospital bills TC with modifier TC when hospital-owned lab performs technical component; if hospital performs global (both TC and PC) and pathologist is hospital employee, hospital bills global with no modifiers and no separate professional billing allowed.

Specimen from physician office or ASC performed entirely by outside labWhen both technical and professional components are performed by an outside lab for specimens obtained from a physician office or ASC, all tests are billed with POS 81 (Independent Laboratory).

Claims Submission Requirements and Provider Responsibilities

Billing Rule

Claims submission requirement — report correct POS on professional claims

Submit the correct two‑digit Place of Service (POS) code on professional claims: CMS‑1500 block 24B or 837P loop 2300/CLM05‑1. When a CPT/HCPCS description or coding guidance references a specific location, bill the corresponding POS to avoid claim denials or edits for POS conflicts.

POS is required on CMS‑1500 (block 24B) and on 837P (loop 2300/CLM05‑1).
If a CPT/HCPCS description specifies a site of service, code that POS to prevent denials during claims editing.

Key Definitions and Modifier Guidance

Place of Service (POS) codes — definitions and examples

DefinitionTwo-digit codes representing the physical location where a service/item is provided or used; required on professional claims (CMS-1500 block 24B or 837P loop 2300/CLM05-1).

POS 10Telehealth provided in patient’s home; effective Jan 1, 2024 assigned non-facility (NF) RVUs per policy changes.

POS 02Telehealth provided other than in patient’s home (telehealth location other than home).

POS 11 / 12 / 19 / 21 / 22 / 24 / 27 / 66 / 81 / 99Examples of POS codes referenced in policy: 11 Office; 12 Home; 19 Off-campus Outpatient Hospital Clinic; 21 Inpatient Hospital; 22 On-campus Outpatient Hospital; 24 Ambulatory Surgical Center; 27 Outreach Site/Street (added Oct 1, 2023); 66 PACE Center (added Aug 1, 2024); 81 Independent Laboratory; 99 Other Place of Service.

Technical (TC) and Professional (26/PC) components — modifiers and billing responsibility