CurrentPriority HealthPolicy N/A

Durable Medical Equipment (DME) Place of Service (POS)

Defines required place-of-service coding, proof of delivery, and documentation requirements for DME claims submitted to Priority Health; applies to suppliers and providers billing DME for Priority Health members, with Medicare-specific notes.

Policy Summary

PayerPriority Health

PolicyDurable Medical Equipment (DME) Place of Service (POS)

Policy CodePolicy N/A

Change TypeAdded proof of delivery and administrative clarifications

Effective DateJan 1, 2025

Next Review DateN/A

Key ActionMaintain proof of delivery documentation (e.g., signed delivery slip with patient name, item details, date and signature) and retain records for 7 years.

SourceLink

POLICY UPDATE CHANGES

Added 'Disclaimer' section.

Added 'Proof of delivery' section.

No changes made on June 4, 2025.

7retention (years)

12 listedacceptable POS codes

3delivery methods

Jan 1, 2025effective

DME POS coverage and billing criteria

Coverage and billing requirements for DMEPOS items submitted to Priority Health:

DME claims should be coded with the POS where the member will primarily use the DME item; see our DME MAC for the list of appropriate DME POS codes.

ALL of the following

01 — Pharmacy
04 — Homeless Shelter
12 — Home
13 — Assisted Living Facility
14 — Group Home
16 — Temporary Lodging
27 — Outreach Site/Street
33 — Custodial Care Facility
54 — Intermediate Care Facility/Individuals with Intellectual Disabilities
55 — Residential Substance Abuse Treatment Facility
56 — Psychiatric Residential Treatment Center
65 — End Stage Renal Disease Treatment Facility

Proof of delivery is required to support payment; suppliers must maintain proof of delivery documentation for items provided to patients.

ALL of the following

Signed delivery slip with patient name and address, quantity delivered, detailed description of item, brand name, serial number, date delivered, and patient or designee signature (signature date must be the date item was received).
Delivery/shipping service tracking slip plus supplier shipping invoice; supplier records should include the delivery service package identification number and tracking details (each package, delivery address, package ID, and date delivered).
Return postage-paid delivery invoice from patient or designee that includes descriptive item information and required signature(s).
If delivered to a nursing facility on behalf of the patient: documentation demonstrating delivery to the facility by the supplier or delivery entity AND documentation from the nursing facility demonstrating receipt and/or beneficiary usage (quantities delivered and used must justify quantity billed).

Documentation retention: Proof of delivery documentation must be retained for 7 years from the date of service.

ALL of the following

A supplier may deliver a DMEPOS item to a patient in a hospital or nursing facility for fitting or training up to two days prior to the patient’s discharge to home.
The supplier should bill the date of service on the claim as the patient’s date of discharge and should report Place of Service 12 (Patient’s Home) when the item is for subsequent home use.
No billing may be made for the item on days when the patient was receiving training or fitting in the hospital or nursing facility.

Authorization and payment caveats: An authorization is not a guarantee of payment; proper billing, coding and documentation are required and failure to follow CMS/MDHHS guidance, policy or billing rules may result in denial, rejection, or recovery of payment.

Medicare PSOD: For Medicare, if indications do not meet an NCD, LCD or specific medical policy, a Pre‑Service Organization Determination (PSOD) is required.

Place of Service Codes and Billing Dates

Acceptable DME Place of Service (POS) codesmixed

01	Pharmacy
04	Homeless Shelter
12	Home
13	Assisted Living Facility
14	Group Home
16	Temporary Lodging
27	Outreach Site/Street
33	Custodial Care Facility
54	Intermediate Care Facility/Individuals with Intellectual Disabilities
55	Residential Substance Abuse Treatment Facility

1–10 of 12

1/2

Billing date for items delivered prior to discharge

Bill date of serviceSupplier should bill the date of service on the claim as the date of discharge

Place of Service for subsequent home useUse POS 12 (Patient's Home) when the item is for subsequent home use

Fitting/training daysDo not bill for days when the patient was receiving training or fitting in the hospital or nursing facility

Authorization and Provider Responsibilities

Prior Authorization

Pre-Service Organization Determination (PSOD) — Medicare

For Medicare members, when an indication does not meet the criteria of a National Coverage Determination (NCD), local Coverage Determination (LCD), or a specific Priority Health medical policy, providers must complete a Pre-Service Organization Determination (PSOD) prior to providing the service. See the Priority Health Provider Manual for full PSOD instructions and submission details. Note that an authorization or PSOD determination does not guarantee payment; claims must still meet coding, documentation, and billing requirements described in Priority Health billing policies and applicable CMS/MDHHS guidance.

Complete PSOD when NCD/LCD or Priority Health medical policy criteria are not met (Medicare only).
PSOD must be obtained prior to providing the service for Medicare members.
An authorization or PSOD does not guarantee payment — claims must meet CPT/HCPCS/revenue code, documentation, and billing requirements.
Reference Provider Manual for PSOD submission steps and required documentation.

Terms and Definitions

Place of Service (POS)

DefinitionPlace of service (POS) is a two-digit number used to report where a service was provided on a professional claim; list maintained by CMS

Use on professional claimsPOS is reported on professional claims to indicate where the service was provided

AuthorityPOS codes and list are maintained by the Centers for Medicare & Medicaid Services (CMS)

Designee

Designee definitionAny person who can sign and accept the delivery of durable medical equipment on behalf of the beneficiary

Role in deliveryMay receive and acknowledge DME delivery when beneficiary is unavailable or delegates acceptance

Documentation implicationSigned delivery by designee serves as proof of delivery for supplier records

OpenPayer

Durable Medical Equipment (DME) Place of Service (POS)

DME Place of Service Coverage & Billing Requirements

Place of Service Codes and Billing Dates

Authorization and Provider Responsibilities

Terms and Definitions