Due to different referral and authorization requirements based on where services are rendered, it is important that your claim is submitted with the correct Place of Service code. The Place of Service code also affects how your claim is routed and which authorization/referral is utilized.
Please verify whether the Member was in the Emergency Room, admitted on an inpatient basis, or if he or she received outpatient services and submit the claim with the corresponding Place of Service code. When the incorrect Place of Service code is submitted, your claim may be denied due to “no authorization.” For example, if a claim is incorrectly submitted with an inpatient Place of Service code, and the Member was in the Emergency Room, there would not be an inpatient authorization on file. Therefore, your claim would be denied due to “no authorization.”
Please utilize the correct Place of Service code from the list below:
Code Description
11 Office
12 Home
15 Mobile diagnostic unit
20 Urgent care facility
21 Inpatient hospital
22 Outpatient hospital
23 Emergency room hospital
24 Ambulatory surgical center
25 Birthing center
26 Military treatment facility
31 Skilled nursing facility
32 Nursing facility
33 Custodial care
34 Hospice
41 Ambulance – land
42 Ambulance – air or water
51 Inpatient psychiatric facility
52 Psychiatric facility partial hospitalization
53 Community mental health center
54 Intermediate care facility/mentally retarded
55 Residential substance abuse
56 Psychiatric residential treatment center
61 Comprehensive inpatient rehabilitation facility
62 Comprehensive outpatient rehabilitation facility
65 End-stage renal disease facility
71 State or local public health clinic
72 Rural health clinic
81 Independent lab
99 Other unlisted facility
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