Filing Claims for Behavioral Health Services – Use the Correct Place of Service Code

April 2024

Filing Claims for Behavioral Health Services – Use the Correct Place of Service Code

Remember to use the correct Place of Service code when filing professional claims for Applied Behavioral Analysis services. Place of Service codes designate where the patient is located when they received services from you.

Remember: If you use the wrong POS code your claim may be denied, or payment may be delayed.

Familiarize yourself with POS codes using guidance from the Centers for Medicare & Medicaid Services. Also, for more information review our Clinical Payment and Coding Policies on Applied Behavior Analysis CPCP011 and Telemedicine and Telehealth CPCP033.

When filing claims, follow these examples of POS code guidance from CMS:

POS 3 is for use on claims for services provided in a school
POS 11 is for use on claims for services provided in the office
POS 12 is for use on claims for services provided in the patient’s home
POS 49 is for use on claims for services provided in an independent clinic
POS 53 is for use on claims for services provided in a community mental health center
POS 99 is for use on claims for services provided in all other settings not listed above, including community and daycare locations.

Note: claims are subject to the terms of a member’s coverage and medical necessity review.

The material presented here is for informational/educational purposes only, is not intended to be medical advice or a definitive source for coding claims and is not a substitute for the independent medical judgment of a physician or other health care provider. Health care providers are encouraged to exercise their own independent medical judgment based upon their evaluation of their patients’ conditions and all available information, and to submit claims using the most appropriate code(s) based upon the medical record documentation, coding guidelines and reference materials. References to other third-party sources or organizations are not a representation, warranty or endorsement of such resources or organizations. The fact that a service or treatment is described in this material, is not a guarantee that the service or treatment is a covered benefit and members should refer to their member contract or member guide for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.

BLUE REVIEW^SM

for Providers