CMS Pub. 100-04, ch. 26, § 10.7

Medicare Administrative Contractors (MACs) must assign the proper TOS using the

annual HCPCS update from the CMS mainframe. Changes to this list are issued annually

via a Recurring Update Notification. Some procedures may have more than one

applicable TOS. For claims received on or after April 3, 1995, CWF produced alerts on

codes with incorrect TOS designations. Effective July 3, 1995, CWF began rejecting

codes with incorrect TOS designations.

The only exceptions to this annual update are:

• Surgical services billed for dates of service through December 31, 2007,

containing the ASC facility service modifier SG must be reported as TOS F.

Effective for services on or after January 1, 2008, the SG modifier is no longer

applicable for Medicare services. ASC providers should discontinue applying the

SG modifier on ASC facility claims. The indicator ‘F’ does not appear in the

TOS table because its use depends upon claims submitted with POS 24 (ASC

Facility) from an ASC (specialty 49). This became effective for dates of service

January 1, 2008 and after.

• Surgical services billed with an assistant-at-surgery modifier (80-82, AS) must be

reported with TOS 8. The 8 indicator does not appear on the TOS table because

its use is dependent upon the use of the appropriate modifier. (See Pub. 100-04,

Medicare Claims Processing Manual, Chapter 12, "Physician/Nonphysician

Practitioner," for instructions on when assistant-at-surgery is allowable.)

• TOS H appears in the list of descriptors. However, it does not appear in the table.

In CWF, "H" is used only as an indicator for hospice. The contractor should not

submit TOS H to CWF at this time.

• For outpatient services, when a transfusion medicine code appears on a claim that

also contains a blood product, the service is paid under reasonable charge at 80%,

coinsurance and deductible apply. When transfusion medicine codes are paid

under the clinical laboratory fee schedule pay at 100%, coinsurance and

deductible do not apply.

NOTE: For injection codes with more than one possible TOS designation, use the

following guidelines when assigning the TOS:

When the choice is L or 1,

• Use TOS L when the drug is used related to ESRD; or

• Use TOS 1 when the drug is not related to ESRD and is administered in the

office.

When the choice is G or 1:

• Use TOS G when the drug is an immunosuppressive drug; or

• Use TOS 1 when the drug is used for other than immunosuppression.

When the choice is P or 1,

• Use TOS P if the drug is administered through durable medical equipment

(DME); or

• Use TOS 1 if the drug is administered in the office.

The place of service or diagnosis may be considered when determining the appropriate

TOS. The descriptors for each of the TOS codes listed in the annual HCPCS update are:

Type of Service Indicators

Code Description

0 Whole Blood

1 Medical Care

2 Surgery

3 Consultation

Code Description

4 Diagnostic Radiology

5 Diagnostic Laboratory

6 Therapeutic Radiology

7 Anesthesia

8 Assistant at Surgery

9 Other Medical Items or Services

A Used DME

B High Risk Screening Mammography

C Low Risk Screening Mammography

D Ambulance

E Enteral/Parenteral Nutrients/Supplies

F Ambulatory Surgical Center (Facility Usage for Surgical Services)

G Immunosuppressive Drugs

H Hospice

J Diabetic Shoes

K Hearing Items and Services

L ESRD Supplies

M Monthly Capitation Payment for Dialysis

N Kidney Donor

P Lump Sum Purchase of DME, Prosthetics, Orthotics

Q Vision Items or Services

R Rental of DME

S Surgical Dressings or Other Medical Supplies

T Outpatient Mental Health Treatment Limitation

U Occupational Therapy

V Pneumococcal/Flu Vaccine

W Physical Therapy