Nursing Facility Services

The Centers for Medicare & Medicaid Services (CMS) has advised the proper places of service (POS) that are required for billing nursing facility (NF) services. This information is contained in the CMS Internet-Only Manual (IOM), Publication 100-04, Chapter 12, Sections 30.6.13 and 14.

Claims submitted with an incorrect POS as identified in the IOM will be denied by Palmetto GBA with reason codes 5 (the procedure code/bill type is inconsistent with the POS) and M77 (missing/incomplete/invalid place of service). Please correct to the proper POS and resubmit.

As information, the applicable codes and valid POS are as follows: 

CPT Codes 99304 Through 99318 
The CPT nursing facility services codes shall be used with POS 31 (skilled nursing facility or SNF) if the patient is in a Part A SNF stay. They shall be used with POS 32 (nursing facility) if the patient does not have Part A SNF benefits or if the patient is in a NF or in a non-covered SNF stay (e.g., there was no preceding three-day hospital stay). The CPT NF code definition also includes POS 54 (intermediate care facility/individuals with intellectual disabilities) and POS 56 (psychiatric residential treatment center).

CPT Codes 99324 Through 99328 And 99334 Through 99337
Domiciliary, rest home (e.g., boarding home) or custodial care services are used to report Evaluation and Management (E/M) services to residents residing in a facility which provides room, board and other personal assistance services, generally on a long-term basis. These CPT codes are used to report E/M services in facilities assigned POS codes 13 (assisted living facility), 14 (group home), 33 (custodial care facility) and 55 (residential substance abuse facility). Assisted living facilities may also be known as adult living facilities.

CPT Codes 99341 Through 99350
Home services codes are used to report E/M services furnished to a patient residing in his or her own private residence (e.g., private home, apartment and townhome) and not residing in any type of congregate/shared facility living arrangement including assisted living facilities and group homes. The home services codes apply only to the specific two-digit POS 12 (home). Home services codes may not be used for billing E/M services provided in settings other than in the private residence of an individual.

Resource: CMS Internet-Only Manual (IOM), Publication 100-04, Chapter 12 (PDF, 1.1 MB), Sections 30.6.13 and 14