Place of Service (2017) - SNFCB

1 Questions ? Contact: CHOOSING THE CORRECT Place OF Service FOR THE CLAIMS ANALYSIS TOOL1500 Claim Form Place Of Service Code (Line ) 11 Physician Office 49 Independent Clinic 50 FQH Center 71/72 Public/Rural Clinic 22* Hospital Outpatient Facility UB-04 Claim Form Type Of Bill (Box #4) X = any number Correct Claim TypeTo Select On Claims Analysis Tool Physician Billing is not appropriate on UB-04 claim forms Hospital Outpatient Billing is not appropriate on 1500 claim forms 013x Hospital Outpatient 085x Critical Access Hospital ASC Billing is not appropriate on UB-04 claim forms 24 Ambulatory Surgery Center (ASC) Ambulance Billing is not appropriate on UB-04 Claim Forms 41 Ambulance (Land) 42 Ambulance (Air or Water)

2 Place of Service codes for professional claims (database updated 10/2019 by CMS) These codes should be used on professional claims to specify the entity where Service (s) were rendered. Correct hospital to SNF billing requires patient identifiers, Service date, revenue code, valid HCPCS, unit # and charge amount. 65 End Stage Renal Disease (ESRD) Treatment Facility Place Of Service Codes including but not limited to: 81 Independent Laboratory 31 Skilled Nursing facility Or non-claim invoices [such as for Durable Medical Equipment (DME)] Can be run under All Other If you receive a UB-04 claim form and are unsure of the site of Service , please contact for assistance *Professional services in Hospital Outpatient setting are not bundled to the SNF. The Hospital will bill separately for the facilities portion of the services .

3 2022 Consolidated Billing services , Inc. Dialysis Facility072x Hospital-Based Renal