Where Is the Place of Service (POS) on a UB-04?

The UB-04 claim form is a standardized document used in healthcare to bill for institutional services. It is commonly utilized by hospitals, skilled nursing facilities, home health agencies, and hospices for submitting claims to Medicare, Medicaid, and private insurers. Accurate and complete information on this form is necessary for proper processing and timely reimbursement, as mistakes can lead to denials, payment delays, or audits.

Locating the Place of Service Field on the UB-04

Unlike the CMS-1500 form, which features a specific field (Box 24B) for the Place of Service (POS) code, the UB-04 form does not have a dedicated “POS” box. Instead, the place of service information on a UB-04 is derived implicitly from other details on the claim. This includes the “Type of Bill” (Form Locator 4), which indicates the type of facility and kind of bill, and the “Revenue Code” (Form Locator 42), which describes the specific service or accommodation provided within that facility.

The UB-04 primarily captures institutional services, where the location of service is generally understood to be the billing institution itself. For instance, a hospital bill (Type of Bill 11x or 13x) implies that services were rendered within the hospital setting. The revenue codes further specify the department or type of service, such as emergency room or operating room, providing additional context about the service location. While there isn’t a direct POS code entry, the combination of these fields informs payers about where the care was delivered.

Understanding Place of Service Codes

Place of Service (POS) codes are two-digit numerical identifiers used in healthcare billing to specify the setting where medical services were provided. These codes are maintained and standardized by the Centers for Medicare & Medicaid Services (CMS). Their main purpose is to inform insurance payers about the physical location of service delivery, which influences reimbursement rates and helps ensure compliance with billing guidelines.

The use of correct POS codes is necessary for avoiding claim denials and ensuring accurate payment. Common POS codes include 11 (office), 21 (inpatient hospital), and 22 (outpatient hospital). CMS periodically updates these codes, including those for telehealth services like 02 (telehealth provided other than in patient’s home) and 10 (telehealth provided in patient’s home).

Determining the Appropriate Place of Service Code

Selecting the correct Place of Service (POS) code requires careful consideration of the physical location where the medical service was rendered. The principle is to align the POS code with the setting where the patient received the face-to-face service. This ensures that the claim accurately reflects the circumstances of care delivery. For services like diagnostic test interpretations performed remotely, the POS code should reflect the location where the patient physically underwent the test.

Providers should consult the official list of POS codes available on the CMS website to ensure they are using the most current and appropriate codes. While many private insurers generally follow CMS guidelines, some may have specific requirements or policies. Incorrect POS code usage can lead to claim denials, payment delays, or audits. Therefore, providers should stay updated on guidelines and any changes. Regular training for billing teams and diligent double-checking of claim forms can help prevent POS coding errors.