We require all professional services performed in an office, whether the services were performed within the four walls of the hospital or at an off-campus hospital owned site, to be billed on a CMS 1500 claim form. When billing for these professional services on a CMS 1500, they should be billed with place of service (POS) 11, not POS 19 or 22. 


There are several reasons practices should use POS 11 when billing professional services on a CMS 1500:


  • Higher reimbursement - practices would receive a higher reimbursement for office level (POS 11) vs facility level (POS 19 or 22)
  • Lower member cost share to collect from the member – the cost share for the member would be a copay rather than a deductible/coinsurance
  • Less member abrasion and fewer calls to your customer or patient service center - members would no longer need to inquire why they are being charged a deductible and/or coinsurance, rather than a copay


Please see our policy, C-15004 - Place of Service and Evaluation and Management Policy, requesting that all professional services be billed on a CMS 1500 form.



Featured In:
November 2020 Anthem New Hampshire Provider News