03/07/2022

Billing for Patients Seen at an Adult Day Care

We see patients at an Adult Day Care Center. The patients come in the morning and leave in the evening. What is the Proper Place of Service code that should be used? Currently we are using "99" ( other unlisted facility) and billing an office CPT code.

When performing services in an adult day care center, the POS service code that can be used is 11. While this code is commonly used for office visits, the definition of the code is broad enough to designate any location that is not a medical facility or clinic, or a patient residence. When services are performed in this location, claims can be billed as if services were rendered in an office setting. The same E&M codes (99202-99215), along with many common procedures such as RFC, injections, etc. can be billed with no limitations. With this POS reported, there would be no reduction in payment as if services were performed in a facility POS, such as a hospital, nursing home, or assisted living facility.