by Evan Gwilliam DC, MBA, BS, CPC, CCPC, CPC-I, QCC, MCS-P, CPMA, CMHP, AAPC Fellow
July 29th, 2019
I have a part time mobile clinic. I travel to treat patients at their homes. Are there special considerations when billing for these encounters?
On the CMS 1500 Claim Form, Item Number 24b, there is a space to designate where a service was rendered. Place of Service Codes are two-digit codes placed on health care professional claims to indicate the setting in which a service was provided. Most chiropractors use code 11 which designates that it was in an office setting. But here are a few others that you might consider:
04 Homeless Shelter A facility or location whose primary purpose is to provide temporary housing to homeless individuals (e.g., emergency shelters, individual or family shelters).
09 Prison/ Correctional Facility A prison, jail, reformatory, work farm, detention center, or any other similar facility maintained by either Federal, State or local authorities for the purpose of confinement or rehabilitation of adult or juvenile criminal offenders.
11 Office Location, other than a hospital, skilled nursing facility (SNF), military treatment facility, community health center, State or local public health clinic, or intermediate care facility (ICF), where the health professional routinely provides health examinations, diagnosis, and treatment of illness or injury on an ambulatory basis.
12 Home Location, other than a hospital or other facility, where the patient receives care in a private residence.
13 Assisted Living Facility Congregate residential facility with self-contained living units providing assessment of each resident's needs and on-site support 24 hours a day, 7 days a week, with the capacity to deliver or arrange for services including some health care and other services. (effective 10/1/03)
14 Group Home A residence, with shared living areas, where clients receive supervision and other services such as social and/or behavioral services, custodial service, and minimal services (e.g., medication administration).
15 Mobile Unit A facility/unit that moves from place-to-place equipped to provide preventive, screening, diagnostic, and/or treatment services.
16 Temporary Lodging A short term accommodation such as a hotel, camp ground, hostel, cruise ship or resort where the patient receives care, and which is not identified by any other POS code. (effective 4/1/08)
18 Place of Employment/Worksite A location, not described by any other POS code, owned or operated by a public or private entity where the patient is employed, and where a health professional provides on-going or episodic occupational medical, therapeutic or rehabilitative services to the individual.
Therefore, code 12 might be the next most commonly used after code 11. You might also consider code 15 for mobile unit, but note that special rules apply. Here is some guidance from CMS:
When services are furnished in a mobile unit, they are often provided to serve an entity for which another POS code exists. For example, a mobile unit may be sent to a physician's office or a skilled nursing facility. If the mobile unit is serving an entity for which another POS code already exists, providers should use the POS code for that entity. However, if the mobile unit is not serving an entity which could be described by an existing POS code, the providers are to use the Mobile Unit POS code 15. Apply the nonfacility rate to payments for services designated as being furnished in POS code 15; apply the appropriate facility or nonfacility rate for the POS code designated when a code other than the mobile unit code is indicated.