Place of service code changes for CPT codes

Effective June 1, 2024, and consistent with correct coding guidelines, Anthem will deny all medical professional claims billed with CPT® codes S9128, S9129, and S9131 when billed with a place of service (POS) code that is not a residence or home. When claims are billed with a place of service code other than 04, 10, 12, 13, 14, 16, 27, or 33, claims will deny with explanation code G56 for invalid place of service.

The place of service code sets are listed below:

• 04 — Homeless shelter
• 10 — Telehealth provided in patient’s home
• 12 — Home
• 13 — Assisted living facility
• 14 — Group home
• 16 — Temporary lodging
• 27 — Outreach site/street (for unsheltered, homeless individuals)
• 33 — Custodial care facility

Anthem reserves the right to apply correct coding guidelines on a post-payment basis prior to June 1, 2024.  If you have questions about this communication, please contact your provider relationship management representative or Provider Services at 855-661-2028.