Place of Service for Distant Site

February 13th, 2012

It's not always easy to know where services to a patient are rendered where the physician component of a diagnostic procedure is done at a site distant from the technical component.

CMS has clarified how to treat these types of claims in MLN Matters Number:  MM7631.

The short answer is:  the place of service is where the patient received face-to-face service.

The example given in the Medlearn article is: 

A beneficiary receives an MRI at an outpatient hospital near his/her home. The hospital submits a claim that would correspond to the TC portion of the MRI. The physician furnishes the PC portion of the beneficiary’s MRI from his/her office location – POS code 22 will be used on the physician’s claim for the PC to indicate that the beneficiary received the face-to-face portion of the MRI, the TC, at the outpatient hospital.

There are just two exceptions to this rule that deal with a patients admission status in a hospital.  If the patient is classified as inpatient but goes to an outpatient part of the facility to receive a test, the place of service would remain inpatient.


Tags: Place of Service


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