03/30/2018

POS 31 vs. POS 32

Please explain the difference between a Skilled Nursing Facility, (place of service code 31) and an Out Patient Nursing Facility, (place of service code32). Is there any overlap in services at these facilities which could make these codes synonomous? Is reimbursement different? Were these place of service changed or modified over the years

Use POS 31 when the patient is in a skilled nursing facility (SNF), which is a short-term care/rehabilitation facility. Use POS 32 when the patient is in a long-term nursing care facility.

Keep in mind that, one facility can provide BOTH types of care. To determine the correct POS for a particular patient, you must know how the nursing facility classifies that patient as SNF or long-term. 

Medicare created two different POS codes for nursing facility care for reimbursement reasons. Medicare Part A covers nursing facility costs for SNF patients (up to a maximum of 100 days). Medicare Part A does not cover nursing facility costs for long-term care patients. Medicare Part B will cover physician visits to both SNF and long-term patients, although more frequent visits are generally permitted to patients in a SNF

CMS has advised the proper places of services (POS) that are required for billing nursing facility (NF) services. This information can also be found in the CMS Internet-Only Manual (IOM), Publication 100-4, Chapter 12, Sections 30.6.13 and 14 http://www.cms.gov/Manuals/IOM/list.asp

The applicable codes and valid POS are as follows:

Current Procedural Terminology (CPT) Codes 99304 Through 99318

The CPT nursing facility service codes shall be used with POS 31 (skilled nursing facility or SNF) if the patient is in a part A SNF stay. They shall be used with POS 32 (nursing facility) if the patient does not have Part A SNF benefits or if the patient is in a NF or in a non-covered SNF stay (e.g., there was no preceding three-day hospital stay).