CurrentPremera BluecrossPolicy N/A

Place of Service (POS) coding for professional claims

Defines how Premera Blue Cross and affiliated plans require Place of Service codes to be reported on professional claims, which POS values mean, and billing rules tied to location and components of services; applies to Premera Blue Cross, Premera BCBS of Alaska, LifeWise Health Plan of Washington, LifeWise Assurance, and Premera HMO lines of business and products.

Policy Summary

PayerPremera Bluecross

PolicyPlace of Service (POS) coding for professional claims

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateAug 18, 2022

Next Review DateN/A

Key ActionEnsure Place of Service codes submitted on professional claims accurately reflect the patient's physical location or service site because claims editing enforces correct POS and may deny conflicting submissions.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

~66POS entries described

5Payer lines applied

Telehealth ruleTelehealth location rule

Lab billingLab PC/TC billing guidance

EnforcedClaims editing enforcement

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Billing and Coverage Rules

POS billing and coverage criteria

Billing and coverage stance tied to Place of Service (POS) coding for specific service types and locations. Covered when the claim POS and modifiers reflect the member location, specimen origin, and site of service as described below.

ALL of the following

ONE OF
- If the member is physically in their home during the telehealth visit, bill POS 10.
- If the member is physically at a location other than their home during the telehealth visit, bill POS 02.

ALL of the following

If the patient specimen originates in the physician office setting and ONLY the pathologist performs the professional component: pathologist bills with POS 11 and modifier 26; the technical component is billed by the entity that performed it.
If the patient specimen originates in an outpatient or inpatient hospital facility and the technical component is performed by the hospital-owned lab: the hospital bills the technical component with modifier TC; if an outside pathologist performs the professional component the pathologist bills with POS 19, 21, or 22 and modifier 26; if the hospital performs both components in a hospital-owned lab and the pathologist is a hospital employee, the hospital bills the global code with no modifiers and no separate professional billing is allowed.
If the specimen is obtained from a Physician Office or Ambulatory Surgery Center (ASC) and BOTH the technical and professional components are performed by an outside lab: all tests are billed with POS 81 (Independent Lab).

Ambulatory Surgery Center (ASC) services must be billed with POS 24 when services are rendered in a certified ASC or the patient is registered in an ASC.

POS 24 indicates Ambulatory Surgical Center.

Durable medical equipment (DME) POS should reflect where the member will use the equipment for the majority of the time (for example, home use = POS 12).

Correct POS submissions are enforced during claims editing; POS conflicts with CPT/HCPCS descriptors or with site-of-service rules can lead to claim denials or edit-driven rejections.

Providers must ensure POS coding aligns with clinical documentation and place of service definitions to avoid editing denials.

Place of Service Codes and Billing Guidance

Representative POS codes and descriptionsmixed

01	Pharmacy - drugs and medically related items and services provided directly to patients (NF)
02	Telehealth Provided Other than in Patient's Home (F)
03	School (NF)

Telehealth and common site codesmixed

10	Telehealth Provided in Patient's Home (NF)
11	Office (NF)
12	Home (NF)

Facility POS codesmixed

21	Inpatient Hospital (F)
22	On Campus-Outpatient Hospital (F)
24	Ambulatory Surgical Center (F)

Lab specimen-origin billing rule (PC/TC guidance)

When specimen originates in physician officePathologist bills with POS 11 and modifier 26 when only the professional component is performed

Technical component billingTechnical component is performed and billed by an entity other than the pathology provider (billed separately)

Outpatient/Inpatient hospital specimen originIf hospital-owned lab performs TC, hospital bills with modifier TC; outside pathologist bills PC with POS 19, 21, or 22 and modifier 26

Hospital performs global lab serviceIf hospital performs both TC and PC in hospital-owned lab and pathologist is hospital employee, hospital bills global code with no modifiers and no separate professional billing allowed

Specimen from physician office or ASC sent to outside labWhen both TC and PC are performed by an outside lab, all tests are billed with POS 81 (Independent Lab)

Submission and Billing Actions Required

Denial Risk

Claims editing enforcement — submit correct POS

Correct Place of Service code submissions are enforced during claims editing; ensure the POS on professional claims accurately reflects where the service was performed to avoid automated claim edits or denials.

Verify POS aligns with service CPT/HCPCS and member location before submission.
Review claims edits triggered during adjudication and correct POS coding as needed.

Billing Rule

ASC services must be billed with POS 24

When services are rendered in a certified ambulatory surgery center or the patient is registered in an ambulatory surgery center, bill Place of Service 24 on the professional claim.

Key Definitions

Place of Service (POS) code — definition and requirements

DefinitionPlace of Service (POS) codes represent the location where a service was performed or received and are required on the CMS-1500 paper claim form in block 24B or on an 837P electronic claim in loop 2300/CLM05-1

Source guidancePolicy follows CMS Publication 100-04, Chapter 26, Section 10.5 POS codes and definitions for professional claims

POS must match CPT/HCPCS contextWhen a CPT or HCPCS code description references a specific place of service, a corresponding POS code must be billed to avoid denial due to POS conflict

PC/TC lab billing — modifier and POS instructions

Professional component (PC)When only the professional component is performed by a pathologist, bill with modifier 26 on the lab test(s) (pathologist bills POS according to specimen origin)

Technical component (TC)