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Update on POS Codes for Medicare – 4/27/22

27 Apr 2022 3:14 PM | CSWA Administrator (Administrator)


I have received a deluge of emails from you about the use of POS “10” for Medicare and other insurers.  This guidance that Medicare has provided about this policy is complicated.

The current guidance from CMS is that:

  • POS “11” should be used until the end of the Public Health Emergency, timing of which is currently unknown, even though this is not what the POS “11” is for. 
  • And, as of April 4, 2022, there is some variation according to Medicare Administrative Contractors (MACs) about whether or not to move to POS “10” as initially stated by CMS. 
  • Check with YOUR MAC to clarify  which POS code is being accepted currently if the patient is being seen through telemental health in their home; for example, technically, if a patient is in their car, the POS code should be “02”. 
  • You can find your MAC contact information at the CSWA website under “Clinical Practice”.
  • The Medicare Modifier for POS codes is still 95. This may seem counterintuitive as 95 is supposed to be for telemental health but it is the only combination that currently works.

Be sure to check with EACH private insurer for a patient to find out what combination of POS and Modifier are being requested so that claims will not be denied.

I hope this resolves the confusion about POS codes.  Let me know if there are any other questions.

POS Codes as of 4/1/22 – Medicare

There has been some confusion about what Point of Service (POS) Codes should be used for Medicare and other insurers as of April 1, 2022. 

As you know, there were changes to POS codes that were announced as of January 1, 2022 to be “available” for Medicare as of April 1, 2022.  POS “10”, a new POS code for telemental health services that are provided when the patient is in their home, and the LCSW is in their office or elsewhere.  Other POS Codes are “2” which is used when a patient is not in their own home and receiving telemental health services from an LCSW or “11” which is used when seeing a patient in the LCSW’s office.

The Medicare modifier is 95 for any of the above codes.

It appears that the POS 10 is now being used instead of POS 2 for Medicare for reimbursement.  All other insurers, public and private, should be contacted about the POS codes that are required for reimbursement of claims. The same goes for which modifier is being used – check with the individual insurer.

For more information, go to https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set  If you have other question, contact me at lwgroshong@clinicalsocialworkassociation.org.

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