CLM05 composite and they affect payment, because the Medicare Physician Fee Schedule’s practice expense component differs between facility and non-facility settings.
CMS maintains the code set.1
For a dental group, POS matters mainly in crossover billing. An 837D carries a place-of-treatment indication, but the facility and non-facility payment mechanics on this page belong to medical fee schedules. They apply when billing a medical plan on an 837P for oral surgery, sleep appliances, trauma, or hospital-OR dentistry. Groups that do not bill medical plans generally need only a basic understanding. See Bill medical plans for dental work.
Why POS affects payment
The practice expense RVU differs by setting. When a service is delivered in a facility, where the facility bears the overhead and bills separately, the professional payment is lower. When it is delivered in a non-facility setting like your office, the professional payment includes the practice expense.
Using the wrong POS can cause either an underpayment or an overpayment. An overpayment may create a refund obligation.
Common crossover codes
★ = the ones a dental group’s crossover claims most often carry: the office (11), the hospital settings where OR dentistry and major oral surgery happen (19, 21, 22), the ambulatory surgical center (24), and telehealth (02, 10).
Facility/non-facility designations and their payment consequences can change. Verify current designations against the CMS POS code set and the current fee schedule rather than relying on a static table; telehealth designations in particular have shifted repeatedly.
Distinguishing telehealth POS 02 and 10
Confusing POS 02 and POS 10 is a common outpatient billing error and can affect payment.- POS 02, telehealth provided other than in the patient’s home
- POS 10, telehealth provided in the patient’s home
The full list
The complete POS code set is published and maintained by CMS. Beyond the codes above, it includes settings for pharmacies, schools, homeless shelters, prisons, military treatment facilities, tribal facilities, hospices, psychiatric facilities, substance abuse treatment facilities, mass immunization centers, birthing centers, and others. Consult the CMS list for anything not in the table above.Common failures
Sources
- CMS, Place of Service Code Set. Facility/non-facility designations affect payment under the Medicare Physician Fee Schedule; see CMS, Physician Fee Schedule.