Mutually exclusive places of service

Beginning with claims processing on or after September 1, 2024, HealthKeepers, Inc. will update their claims editing process for professional claims to support mutually exclusive places of service edits.

According to CMS policy, the place of service (POS) code used should indicate the setting in which the patient received a face-to-face encounter or where the technical component of a service was rendered in the case of an interpretation. However, when a patient is in a registered inpatient status, all services billed by all providers should reflect and acknowledge the patient's inpatient status. A physician/practitioner/supplier furnishing services to a patient who is a registered inpatient shall, at a minimum, report the inpatient hospital POS code 21 irrespective of the setting where the patient receives the face-to-face encounter.

For additional information, please visit CMS.gov:

• CMS Transmittal 2679; R2679CP | CMS.
• CMS Transmittal 1170; R1170OTN | CMS.

If you have any questions about this communication, contact Anthem HealthKeepers Plus Provider Services at 800-901-0020.