evekhm/cms_iom_500 huggingface dataset:
(Medicare Claims Processing Manual)
o Medicare must recognize and accept POS codes from the national POS code set in terms of HIPAA compliance. Note special considerations for Homeless Shelter (code 04), Indian Health Service (codes 05, 06), Tribal 638 (codes 07, 08), and 09 Prison/Correctional Facility settings,  describe below. Where there is no national policy for a given POS code, local contractors may work with their medical directors to develop local policy regarding the services payable in a given setting, and this could include creating a crosswalk to an exi sting setting if d esired. However, local contractors must pay for the services at either the facility or the nonfacility rate as designated below. In addition, local contractors, when developing policy, must ensure that they continue to pay appropriate rates for services rendered in the new setting; if they choose to create a crosswalk from one setting to another, they must crosswalk a facility rate des ignated code to another facility rate designated code, and a nonfacility rate designated code to another nonfacility rate de signated code. For previously issued POS codes for which a crosswalk was mandated, and for which no other national Medicare directive has been issued, local contractors may elect to continue to use the crosswalk or develop local policy regarding the servic es payable in the setting, including another crosswalk, if  appropriate. If a local contractor develops local policy for these settings, but later receives specific national instructions for these codes, the local contractors shall defer to and comply with the newer instructions. ( Note : While, effective January 1, 2003, codes 03 School, 04 Homeless Shelter, and 20 Urgent Care became part of the National POS code set and were to be crosswalked to 11 Office, this mandate to crosswalk has since been lifted, as indicated  above).  o National policy in the form of Special Considerations for Off Campus - Outpatient Hospital (POS 19), Inpatient Hospital (POS code 21), On Campus -Outpatient Hospital (POS code 22), Ambulatory Surgical  Center (POS code 24) and Hospice (POS code 34) are included  below.    The National POS Code Set and Instructions for Using It
(Medicare Claims Processing Manual)
 The National POS Code Set and Instructions for Using It  The following is the current national POS code set, with facility and nonfacility designations noted for Medicare payment for services on the Physician Fee Schedule. As a new POS code is established, the health care industry is permitted to use this code f rom the date that it is posted on the Medicare Place of Service Code Set Web page at http://www.cms.gov/Medicare/Coding/place -of-service - codes/Place_of_Service_Code_Set.html which is typically expected to be some months ahead of the final effective date for Medicare use.   The code set is annotated with the effective dates for this  and all other codes added on and after January 1, 2003. Codes without effective dates annotated are long -standing and in effect on and before January 1, 2003.   POS Code and Name (effective date)  Description  Payment Rate Facility=F Nonfacility=NF 01 Pharmacy (October 1, 2005)    A facility or location where drugs and other medically related items and services are sold, dispensed, or otherwise provided directly to patients. NF 02 Telehealth Provided Other than in Patients Home  (January 1, 2017)   The location where health services and health related services are provided or received, through telecommunication technology. Patient is not located in their home when receiving health services or health related services through telecommunication technology.   (See Special Considerations below.)  F POS Code and Name (effective date)  Description  Payment Rate Facility=F Nonfacility=NF 03 School (January 1, 2003)   A facility whose primary purpose is education. NF 04 Homeless Shelter (January 1, 2003)   A facility or location whose primary purpose is to provide temporary housing to homeless individuals (e.g., emergency shelters, individual or family shelters).   (See Special Considerations below.)  NF 05 Indian Health Service Free -standing Facility (January 1, 2003)   A facility or location, owned and operated by the Indian Health Service, which provides diagnostic, therapeutic (surgical and nonsurgical), and rehabilitation services to American Indians and Alaska Natives who do not require hospitalization.   (See Special Considerations below.)  Not applicable for adjudication of Medicare claims; systems must recognize for HIPAA  06 Indian Health Service Provider -based Facility (January 1, 2003)
(Medicare Claims Processing Manual)
(See Special Considerations below.)  Not applicable for adjudication of Medicare claims; systems must recognize for HIPAA  06 Indian Health Service Provider -based Facility (January 1, 2003)   A facility or location, owned and operated by the Indian Health Service, which provides diagnostic, therapeutic (surgical and nonsurgical), and rehabilitation services rendered by, or under the supervision of, physicians to American Indians and Alaska Natives admitted as inpatients or outpatients.  (See Special Considerations below.)  Not applicable for adjudication of Medicare claims; systems must recognize for HIPAA  07 Tribal 638 Free -Standing Facility (January 1, 2003)   A facility or location owned and operated by a federally recognized American Indian or Alaska Native tribe or tribal organization under a 638 agreement, which provides diagnostic, therapeutic (surgical and nonsurgical), and rehabilitation services to tribal members who do not require hospitalization.   (See Special Considerations below.)  Not applicable for adjudication of Medicare claims; systems must recognize for HIPAA  POS Code and Name (effective date)  Description  Payment Rate Facility=F Nonfacility=NF 08 Tribal 638 Provider -Based Facility (January 1, 2003)   A facility or location owned and operated by a federally recognized American Indian or Alaska Native tribe or tribal organization under a 638 agreement, which provides diagnostic, therapeutic (surgical and nonsurgical), and rehabilitation services to tribal members admitted as inpatients or outpatients.  (See Special Considerations below.)  Not applicable for adjudication of Medicare claims; systems must recognize for HIPAA  09 Prison/Correctional Facility (July 1, 2006)   A prison, jail, reformatory, work farm, detention center, or any other similar facility maintained by either Federal, State or local authorities for the purpose of confinement or rehabilitation of adult or juvenile criminal offenders.   (See Special Considerations below.)  NF 10 Telehealth Provided in Patients Home  (January 1, 2022)   The location where health services and health related services are provided or received, through telecommunication technology. Patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence)  when receiving health services or health related services through telecommunication technology.   (See Special Considerations below.)  Not applicable for adjudication of Medicare claims; systems must recognize for HIPAA  11 Office
(Medicare Claims Processing Manual)
(See Special Considerations below.)  Not applicable for adjudication of Medicare claims; systems must recognize for HIPAA  11 Office   Location, other than a hospital, skilled nursing facility (SNF), military treatment facility, community health center, State or local public health clinic, or intermediate care facility (ICF), where the health professional routinely provides health examina tions, diagnosis, and treatment of illness or injury on an ambulatory basis. NF 12 Home   Location, other than a hospital or other facility, where the patient receives care in a private residence.  NF POS Code and Name (effective date)  Description  Payment Rate Facility=F Nonfacility=NF 13 Assisted Living Facility (October 1, 2003)   Congregate residential facility with self -contained living units providing assessment of each residents needs and on -site support 24 hours a day, 7 days a week, with the capacity to deliver or arrange for services including some health care and other serv ices. NF 14 Group Home (Code effective, October 1, 2003; description revised, effective April 1, 2004)   A residence, with shared living areas, where clients receive supervision and other services such as social and/or behavioral services, custodial service, and minimal services (e.g., medication administration).  NF 15 Mobile Unit (January 1, 2003)   A facility/unit that moves from place -to-place equipped to provide preventive, screening, diagnostic, and/or treatment services.   (See Special Considerations below.)  NF 16 Temporary Lodging (April 1, 2008)   A short -term accommodation such as a hotel, camp ground, hostel, cruise ship or resort where the patient receives care, and which is not identified by any other POS code.      NF 17 Walk -in Retail Health Clinic (No later than May 1, 2010)   A walk -in health clinic, other than an office, urgent care facility, pharmacy or independent clinic and not described by any other Place of Service code, that is located within a retail operation and provides, on an ambulatory basis, preventive and primary care services.   (See Special Considerations below.)  NF 18 Place of Employment/Worksite (No later than May 1, 2013)
(Medicare Claims Processing Manual)
(See Special Considerations below.)  NF 18 Place of Employment/Worksite (No later than May 1, 2013)   A location, not described by any other POS code, owned or operated by a public or private entity where the patient is employed, and where a health professional provides on -going or episodic occupational medical, therapeutic or rehabilitative services to th e individual. Not applicable for adjudication of Medicare claims; systems must recognize for HIPAA  POS Code and Name (effective date)  Description  Payment Rate Facility=F Nonfacility=NF 19 Off Campus -Outpatient Hospital (January 1, 2016)   A portion of an off -campus hospital provider based department which provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization.   (See Special Considerations below.)  F 20 Urgent Care Facility (January 1, 2003)   Location, distinct from a hospital emergency room, an office, or a clinic, whose purpose is to diagnose and treat illness or injury for unscheduled, ambulatory patients seeking immediate medical attention.  NF 21 Inpatient Hospital   A facility, other than psychiatric, which primarily provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services by, or under, the supervision of physicians to patients admitted for a variety of medical conditions.  F 22 On Campus -Outpatient Hospital (description revised January 1, 2016)   A portion of a hospitals main campus which provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization.   (See Special Considerations below.)  F 23 Emergency Room -Hospital   A portion of a hospital where emergency diagnosis and treatment of illness or injury is provided. F 24 Ambulatory Surgical Center   A freestanding facility, other than a physician's office, where surgical and diagnostic services are provided on an ambulatory basis. F POS Code and Name (effective date)  Description  Payment Rate Facility=F Nonfacility=NF 25 Birthing Center
(Medicare Claims Processing Manual)
A facility, other than a hospital's maternity facilities or a physician's office, which provides a setting for labor, delivery, and immediate postpartum care as well as immediate care of newborn infants.  NF 26 Military Treatment Facility  A medical facility operated by one or more of the Uniformed Services. Military Treatment Facility (MTF) also refers to certain former U.S. Public Health Service (USPHS) facilities now designated as Uniformed Service Treatment Facilities (USTF).  F 27 Outreach Site/Street (October 1, 2023)   A non -permanent location on the street or found environment, not described by any other POS code, where health professionals provide preventive, screening, diagnostic, and/or treatment services to unsheltered homeless individuals.     NF 28-30 Unassigned  -- 31 Skilled Nursing Facility   A facility which primarily provides inpatient skilled nursing care and related services to patients who require medical, nursing, or rehabilitative services but does not provide the level of care or treatment available in a hospital.  F 32 Nursing Facility   A facility which primarily provides to residents skilled nursing care and related services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health- related care services above the level of custodial care to other than individuals with intellectual disabilities.   NF 33 Custodial Care Facility   A facility which provides room, board and other personal assistance services, generally on a long term basis, and which does not include a medical component.  NF POS Code and Name (effective date)  Description  Payment Rate Facility=F Nonfacility=NF 34 Hospice   A facility, other than a patient's home, in which palliative and supportive care for terminally ill patients and their families are provided.  F 35-40 Unassigned  -- 41 Ambulance Land   A land vehicle specifically designed, equipped and staffed for lifesaving and transporting the sick or injured.  F 42 Ambulance Air or Water   An air or water vehicle specifically designed, equipped  and staffed for lifesaving and transporting the sick or injured.  F 43-48 Unassigned  -- 49 Independent Clinic (October 1, 2003)   A location, not part of a hospital and not described by any other Place of Service code, that is organized and operated to provide preventive, diagnostic, therapeutic, rehabilitative, or palliative services to outpatients only. NF 50 Federally Qualified Health Center
(Medicare Claims Processing Manual)
A facility located in a medically underserved area that provides Medicare beneficiaries preventive primary medical care under the general direction of a physician.  NF 51 Inpatient Psychiatric Facility   A facility that provides inpatient psychiatric services for the diagnosis and treatment of mental illness on a 24 -hour basis, by or under the supervision of a physician.  F 52 Psychiatric Facility -Partial Hospitalization   A facility for the diagnosis and treatment of mental illness that provides a planned therapeutic program for patients who do not require full time hospitalization, but who need broader programs than are possible from outpatient visits to a hospital- based or hospital -affiliated facility.  F POS Code and Name (effective date)  Description  Payment Rate Facility=F Nonfacility=NF 53 Community Mental Health Center   A facility that provides the following services: outpatient services, including specialized outpatient services for children, the elderly, individuals who are chronically ill, and residents of the CMHCs mental health services area who have been discharged from inpatient treatment at a mental health facility; 24 ho ur a day emergency care services; day treatment, other partial hospitalization services, or psychosocial rehabilitation services; screening for patients being considered for admission to State mental health facilities to determine the appropriateness of such admission; and consultation and education services.  F 54 Intermediate Care Facility/Individuals with Intellectual Disabilities   A facility which primarily provides health -related care and services above the level of custodial care to individuals but does not provide the level of care or treatment available in a hospital or SNF.  NF 55 Residential Substance Abuse Treatment Facility   A facility which provides treatment for substance (alcohol and drug) abuse to live-in residents who do not require acute medical care. Services include individual and group therapy and counseling, family counseling, laboratory tests, drugs and supplies, psychological testing, and room and board.   NF 56 Psychiatric Residential Treatment Center   A facility or distinct part of a facility for psychiatric care which provides a total 24 -hour therapeutically planned and professionally staffed group living and learning environment.  F 57 Non -residential Substance Abuse Treatment Facility (October 1, 2003)
(Medicare Claims Processing Manual)
A facility or distinct part of a facility for psychiatric care which provides a total 24 -hour therapeutically planned and professionally staffed group living and learning environment.  F 57 Non -residential Substance Abuse Treatment Facility (October 1, 2003)   A location which provides treatment for substance (alcohol and drug) abuse on an ambulatory basis. Services include individual and group therapy and counseling, family counseling, laboratory tests, drugs and supplies, and psychological testing. NF POS Code and Name (effective date)  Description  Payment Rate Facility=F Nonfacility=NF 58 Non-residential Opioid Treatment Facility (January 1, 2020)   A location that provides treatment for opioid use disorder on an ambulatory basis.  Services include methadone and other forms of Medication Assisted Treatment (MAT).   (See Special Considerations below.)   NF 59 Unassigned  -- 60 Mass Immunization Center   A location where providers administer pneumococcal pneumonia and influenza virus vaccinations and submit these services as electronic media claims, paper claims, or using the roster billing method. This generally takes place in a mass immunization setting, such as, a public health center, pharmacy, or mall but may include a physician office setting.  NF 61 Comprehensive Inpatient Rehabilitation Facility   A facility that provides comprehensive rehabilitation services under the supervision of a physician to inpatients with physical disabilities. Services include physical therapy, occupational therapy, speech pathology, social or psychological services, and orthotics and prosthetics services.  F 62 Comprehensive Outpatient Rehabilitation Facility    A facility that provides comprehensive rehabilitation services under the supervision of a physician to outpatients with physical disabilities. Services include physical therapy, occupational therapy, and speech pathology services.  NF 63-64 Unassigned  -- 65 End -Stage Renal Disease Treatment Facility   A facility other than a hospital, which provides dialysis treatment, maintenance, and/or training to patients or caregivers on an ambulatory or home -care basis.  NF 66-70 Unassigned  -- POS Code and Name (effective date)  Description  Payment Rate Facility=F Nonfacility=NF 71 State or Local Public Health Clinic   A facility maintained by either State or local health departments that provides ambulatory primary medical care under the general direction of a physician. NF 72 Rural Health Clinic
(Medicare Claims Processing Manual)
A facility maintained by either State or local health departments that provides ambulatory primary medical care under the general direction of a physician. NF 72 Rural Health Clinic   A certified facility which is located in  a rural medically underserved area that provides ambulatory primary medical care under the general direction of a physician.  NF 73-80 Unassigned  -- 81 Independent Laboratory   A laboratory certified to perform diagnostic and/or clinical tests independent of an institution or a physician's office.  NF 82-98 Unassigned  -- 99 Other Place of Service   Other place of service not identified above.  NF  The Medicare contractor can provide guidance regarding which code applies in cases where the appropriate POS code may be unclear.    Special Considerations for Telehealth Claims (Codes 02, 10)   Note that while the modification of POS Code 02 and the creation of POS Code 10 are effective in the National POS code set effective January 1, 2022, Medicare contractors received instructions regarding how to process claims with these codes starting April  4, 2022, so that Medicare would align with existing Telehealth claims processing policy, as well as be considered HIPAA compliant.   Special Considerations for Homeless Shelter (Code 04)  Note that for the purposes of receiving durable medical equipment (DME), a homeless shelter is considered the beneficiarys home. Because DME is payable in the beneficiarys home, the crosswalk for Homeless Shelter (code 04) to Office (code 11) that was mandated effective January 1, 2003, may need to be adjusted or local policy developed so that HCPCS codes for DME are covered when other conditions are met and the beneficiary is in a homeless shelter. If desired, local contractors are permitted to work wi th their medical directors to determine a new crosswalk such as from Homeless Shelter (code 04) to Home (code 12) or Custodial Care Facility (code 33) for DME provided in a homeless shelter setting. If a local contractor is currently paying claims correctl y, however, it is not necessary to change the current crosswalk.    Special Considerations for Indian Health Service (Codes 05, 06) and Tribal 638 Settings (Codes 07, 08)
(Medicare Claims Processing Manual)
 Special Considerations for Indian Health Service (Codes 05, 06) and Tribal 638 Settings (Codes 07, 08)  Medicare does not currently use the POS codes designated for these settings. Follow the instructions you have received regarding how to process claims for services rendered in IHS and Tribal 638 settings. If you receive claims with these codes, you must initially accept them in terms of HIPAA compliance. However, follow your return as unprocessable procedures after this initial compliance check. Follow your return as unprocessable" procedures when you receive paper claims with these codes. (Note that whi le these codes became part of the National POS code set effective January 1, 2003, Medicare contractors received instructions regarding how to process claims with these codes effective October 1, 2003, so that Medicare could be HIPAA compliant by October 16, 2003).   Special Considerations for Mobile Unit Settings (Code  15)  When services are furnished in a mobile unit, they are often provided to serve an entity for which another POS code exists. For example, a mobile unit may be sent to a physicians office or a skilled nursing facility. If the mobile unit is serving an entit y for which another POS code already exists, providers should use the POS code for that entity. However, if the mobile unit is not serving an entity which could be described by an existing POS code, the providers are to use the Mobile Unit POS code 15. Apply the nonfacility rate to payments for services designated as being furnished in POS code 15; apply the appropriate facility or nonfacility rate for the POS code designated when a code other than the mobile unit code is indicated.