US · guidance
CMS Pub. 100-04, ch. 32, § 140.4.2.1
Correct Place of Service (POS) Code for PR Services on Professional Claims
Effective for claims with dates of service on and after January 1, 2010, place of service (POS) code 11
shall be used for pulmonary rehabilitation (PR) services provided in a physician’s office and POS 22 shall
be used for services provided in a hospital outpatient setting. All other POS codes shall be denied.
Medicare contractors shall adjust their prepayment procedure edits as appropriate.
The following messages shall be used when Medicare contractors deny PR claims for POS:
CARC 96: “Non-covered charge(s).”
RARC N428: “Service/procedure not covered when performed in this place of service.”
Medicare Summary Notice (MSN) 21.25: “This service was denied because Medicare only covers this
service in certain settings.”
Spanish Version: El servicio fue denegado porque Medicare solamente lo cubre en ciertas
situaciones."
NOTE: This is a new MSN message.
Contractors shall use Group Code PR (Patient `Responsibility) assigning financial liability to the beneficiary,
if a claim is received with a GA modifier indicating a signed ABN is on file.
Contractors shall use Group Code CO (Contractual Obligation) assigning financial liability to the provider, if
a claim is received with a GZ modifier indicating no signed ABN is on file.
History
(Rev. 11021; Issued: 10-01-21; Effective: 10-29-21; Implementation: 10-29-21)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
2ec1532453db3a616749d28a3f219be0ef537deab0b927960061584106521053
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