Type of Service (TOS) Indicators
Medicare carriers must use the following table to assign the proper TOS. Some procedures may have more than one applicable TOS. For claims received on or after April 3, 1995, CWF will produce alerts on codes with incorrect TOS designations. Effective July 3, 1995, CWF is rejecting codes with incorrect TOS designations. All future updates will be submitted via a Recurring Update Notification.
- For outpatient services, when a transfusion medicine code appears on a claim that also contains a blood product, the service is paid under reasonable charge at 80%, coinsurance and deductible apply. When transfusion medicine codes are paid under the clinical laboratory fee schedule pay at 100%, coinsurance and deductible do not apply.
List of Type of Service Indicators(updated Sep 24, 2013)
|Indicator||Type of Service Name||Special Considerations/Exceptions|
|8||Assistant at Surgery||Surgical services billed with an assistant-at-surgery modifier (80-82, AS,) must be reported with TOS 8. The 8 indicator does not appear on the TOS table because its use is dependent upon the use of the appropriate modifier. (See Pub. 100-04, Medicare Claims Processing Manual, Chapter 12, "Physician/Nonphysician Practitioner," for instructions on when assistant-at-surgery is allowable.)|
|9||Other Medical Items or Services|
|B||High Risk Screening Mammography|
|C||Low Risk Screening Mammography|
|F||Ambulatory Surgical Center (Facility Usage for Surgical Services)||Surgical services billed for dates of service through December 31, 2007, containing the ASC facility service modifier SG must be reported as TOS F. Effective for services on or after January 1, 2008, the SG modifier is no longer applicable for Medicare services. ASC providers should discontinue applying the SG modifier on ASC facility claims. The indicator 'F' does not appear in the TOS table because its use depends upon claims submitted with POS 24 (ASC Facility) from an ASC (specialty 49). This became effective for dates of service January 1, 2008 and after.|
|G||Immunosuppressive Drugs||For injection codes with more than one possible TOS designation, use the following guidelines when assigning the TOS:
When the choice is G or 1:
|H||Hospice||TOS H appears in the list of descriptors. However, it does not appear in the table. In CWF, "H" is used only as an indicator for hospice. The carrier should not submit TOS H to CWF at this time.|
|K||Hearing Items and Services|
|L||ESRD Supplies||For injection codes with more than one possible TOS designation, use the following guidelines when assigning the TOS:
When the choice is L or 1,
|M||Monthly Capitation Payment for Dialysis|
|P||Lump Sum Purchase of DME, Prosthetics, Orthotics||For injection codes with more than one possible TOS designation, use the following guidelines when assigning the TOS:
When the choice is P or 1,
|Q||Vision Items or Services|
|R||Rental of DME|
|S||Surgical Dressings or Other Medical Supplies|
|T||Outpatient Mental Health Treatment Limitation||Psychiatric treatment services that are subject to the outpatient mental health treatment limitation should be reported with TOS T.|
Thank you for choosing Find-A-Code, please Sign In to remove ads.