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Jurisdiction 11 Part B
I am leasing part of a community pool to provide aquatic therapy for my patients. What place of service should I submit for this service?

Answer:
Before submitting claims for this service, you must update your enrollment file to add the address of the community pool ('practice location'). When you submit this information on the CMS-855 form, include a copy of your lease indicating the part of the pool that is being used exclusively by your patients and the times to which that exclusive use applies. Submit claims with place of service 11 (office) and submit the address of the community pool as follows:
 
Electronic claims:
  • Address: Loop 2310D, N3, 01
  • City: Loop 2310D, N4, 01
  • State: Loop 2310D, N4, 02
  • ZIP code: Loop 2310D, N4, 03
Paper claims: Item 32
 
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last updated on 12/17/2013
ver 1.0.43