Medicare and many other payers can’t determine how much to pay you for a claim unless you list a place of service (POS) code. Why? Because one factor that goes into calculating your payments involves determining where the service took place. When it comes to POS 22, confusion abounds. It’s not quite an inpatient location, but it’s not completely outpatient either.

Check out a quick primer so you can master the details of POS 22 and collect maximum pay every time.

Breaking Down the POS 22 Descriptor

The reason that so many people get confused about POS 22 is because its descriptor seems to contradict itself. It says, “On Campus-Outpatient Hospital.” Since most hospitals aren’t considered outpatient settings, it’s confusing to determine where this might apply. In addition, the “on campus” verbiage may be a head-scratcher if you’re not at a large hospital with a sprawling campus.

The descriptor used to say, “Outpatient hospital,” but CMS changed it a few years ago to include the verbiage about a campus.

What’s an Outpatient Hospital?

An outpatient hospital describes services the patient receives at a hospital but the patient hasn’t been admitted as an inpatient. Just as the emergency department is considered an outpatient section of the hospital, so are other areas as well.

For instance, an infusion clinic owned by the hospital could bill patients who come in simply for a one-hour infusion (without being admitted) as an outpatient, even though the hospital owns the clinic.

How Does It Differ From POS 19?

While the descriptors for POS 19 and 22 are quite similar, they’re assigned for very different purposes. POS 19 describes “Off Campus-Outpatient Hospital,” with the difference lying in whether the hospital is located off-campus or on-campus.

What that means: If the hospital department where the patient is receiving a service is located away from the hospital’s main campus, POS 19 applies. “A facility within 250 yards of the main buildings is generally considered to be on-campus,” says Medicare Administrative Contractor Palmetto GBA. “A facility outside of the 250 yard criteria but within 35 miles of the campus is generally considered to be off-campus.” Check with your payers to evaluate whether they have different rules for determining what constitutes an off-campus vs. on-campus location.

POS 22 vs. POS 11

In some cases, a physician may have an office near a hospital campus that’s owned by the doctor (not the hospital). If that’s the case, you’ll report POS 11 (Office) and not POS 22. The difference is that with POS 22, the clinic is owned by the hospital, and reimbursement will typically be lower than those claims billed with POS 11.