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POS 13: Assisted Living Facility

POS 13 is the CMS place of service code for Assisted Living Facility, defined as congregate residential facility with self-contained living units providing assessment of each resident's needs and on-site support 24 hours a day, 7 days a week, with the capacity to deliver or arrange for services including some health… On Medicare professional claims paid under the physician fee schedule, POS 13 takes the non-facility rate (Pub. 100-04, chapter 26). CMS added it effective October 1, 2003.

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: CMS Place of Service code set: CMS page last modified February 17, 2026; code table updated May 2, 2024 (effective August 1, 2024). Next CMS release: no fixed schedule (CMS posts new place of service codes on its code set page, usually months before Medicare's effective date).

Place of service code
13
Medicare fee schedule rate
Non-facility rate
Pub. 100-04, chapter 26, section 10.5
In effect since
October 1, 2003
Reported on
Professional claims
CMS-1500 item 24B or the 837P
Setting group
Home and residential care

CMS definition of POS 13

Congregate residential facility with self-contained living units providing assessment of each resident's needs and on-site support 24 hours a day, 7 days a week, with the capacity to deliver or arrange for services including some health care and other services.

(Effective October 1, 2003)

CMS Place of Service code set, Assisted Living Facility

POS 13 has been in the national code set since October 1, 2003.

Facility or non-facility rate for POS 13

Medicare pays a physician fee schedule service billed with this code at the non-facility rate. The non-facility rate carries the larger practice-expense component, because the practitioner bears the cost of the space, the clinical staff, the equipment and the supplies used for the service.

Chapter 12, section 20.4.2 of the Medicare Claims Processing Manual lists this setting as “Assisted Living Facility” on its non-facility list. The rule behind the list is that the code reflects where the beneficiary received the face-to-face service, except that services to a registered hospital inpatient or outpatient are paid at the facility rate wherever the encounter took place.

Assisted living is a residential setting paid at the non-facility rate. When a hospice patient lives in an assisted living facility and receives a home level of care there, practitioners report POS 13 rather than the hospice code 34 (chapter 26, section 10.5).

Not every service has two rates: when the facility and non-facility amounts are the same, as they are for the professional component of a diagnostic test, the place of service does not change the payment. Outpatient therapy and comprehensive outpatient rehabilitation facility services are always paid at the non-facility rate.

Denials when POS 13 does not fit the claim

A place of service that conflicts with the procedure, the patient's registration or the payer's policy comes back with one of three codes. Claim adjustment reason code 5 means the procedure code or bill type is inconsistent with the place of service; reason code 58 means the payer considers the setting inappropriate or invalid for the service; and remark code M77 marks a missing, incomplete, invalid or inappropriate place of service. Medicare returns a line whose POS is missing, unassigned or incompatible with a site-specific procedure as unprocessable with CARC 16 and M77, so the fix is a corrected claim rather than an appeal (Pub. 100-04, chapter 26, section 10.6).

Where QuickIntell fits with place of service

QuickRCM covers eligibility, claim readiness, denials, posting and A/R with configurable automation and human review, the stage where the place of service code is checked against the setting, the registration and the modifier before the claim goes out, and where CARC 5, CARC 58 and M77 denials are worked.

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Frequently asked questions

What is place of service code 13?

POS 13, Assisted Living Facility, is defined by CMS as follows: Congregate residential facility with self-contained living units providing assessment of each resident's needs and on-site support 24 hours a day, 7 days a week, with the capacity to deliver or arrange for services including some health care and other services. POS 13 has been in the national code set since October 1, 2003. It sits in the home and residential care group with POS 12, POS 14, POS 16, POS 33 and POS 54.

Does POS 13 pay the facility or the non-facility rate?

The non-facility rate. Medicare Claims Processing Manual, Pub. 100-04, chapter 26, section 10.5 designates POS 13 NF, so a physician fee schedule service billed with it is paid at the non-facility rate, the higher practice-expense amount paid when the practitioner carries the cost of the space, staff, equipment and supplies. Chapter 12, section 20.4.2 lists it as "Assisted Living Facility" on the non-facility list. Services whose two rates are equal, such as the professional component of a diagnostic test, pay the same either way (chapter 12, section 20.4.2).

When should a claim use POS 13?

Assisted living is a residential setting paid at the non-facility rate. When a hospice patient lives in an assisted living facility and receives a home level of care there, practitioners report POS 13 rather than the hospice code 34 (chapter 26, section 10.5).

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

The definition is reproduced from the CMS Place of Service code set; the Medicare rate and instructions are from Pub. 100-04, chapters 12 and 26. Medicaid and commercial plans publish their own place of service rules. Not legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.