BLUE REVIEW^SM

May 2024

Filing Claims for Applied Behavior Analysis Services – Use the Correct Place of Service Code

It’s important that you use the correct Place of Service code when filing professional claims for Applied Behavior Analysis and other services that may be eligible for delivery in multiple locations. POS codes designate where the patient was located when they received services from you.

Remember: If you use the wrong POS code your claim may be denied, or payment may be delayed.

Familiarize yourself with using POS codes with guidance from the Centers for Medicare & Medicaid Services.

When filing claims, follow these examples of POS code guidance from CMS:

• POS 3 is for use on claims for services provided in a school
• POS 11 is for use on claims for services provided in the office
• POS 12 is for use on claims for services provided in the patient’s home
• POS 49 is for use on claims for services provided in an independent clinic
• POS 53 is for use on claims for services provided in a community mental health center
• POS 99 is for use on claims for services provided in all other settings not listed above, including community and daycare locations

For More Information
Also refer to our Clinical Payment and Coding Policies page to review CPCP011 Applied Behavior Analysis and CPCP022 Telemedicine and Telehealth.

Note: Claims are subject to the terms of a member’s coverage and medical necessity review.

Any samples in this article are for illustrative and/or educational purposes only and should not be relied on in determining how a specific provider will be reimbursed. In the event of a conflict between the information in this article and your contract, your contract will control.