POS 22: On Campus-Outpatient Hospital

CMS definition of POS 22

A portion of a hospital’s main campus which provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization.

(Description change effective January 1, 2016)

POS 22 is one of the long-standing codes that CMS lists without a date, meaning it was in effect on or before January 1, 2003 (Medicare Claims Processing Manual, Pub. 100-04, chapter 26, section 10.5), and its description was revised effective January 1, 2016.

Facility or non-facility rate for POS 22

Medicare pays a physician fee schedule service billed with this code at the facility rate. The facility rate carries a smaller practice-expense component than the non-facility rate, because in a facility setting the facility, not the practitioner, bears the cost of the room, the staff and most supplies; where the facility is a Medicare provider it is paid for those costs on its own claim.

Chapter 12, section 20.4.2 of the Medicare Claims Processing Manual lists this setting as “On Campus-Outpatient Hospital” on its 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.

POS 22 is a department on the hospital's main campus. Practitioners treating a registered outpatient report at least POS 19 or 22; one who keeps separately maintained office space on the campus that is not a provider-based department reports POS 11 for services there (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.

Medicare instructions for this setting

Chapter 26, section 10.5 gives special considerations for outpatient hospital departments that cover POS 19 and POS 22 together; the summary above restates the rule for POS 22, and the manual's full text is quoted on the place of service hub.

POS 19 vs POS 22: what changes

Both describe a hospital outpatient department and both pay the professional service at the facility rate; the split is location. POS 22 is a department on the hospital's main campus and POS 19 a provider-based department off the campus. CMS created POS 19 effective January 1, 2016 and renamed POS 22 from Outpatient Hospital to On Campus-Outpatient Hospital the same day. On the hospital's own outpatient claim, off-campus departments add HCPCS modifier PO or PN to their lines.

POS 11 vs POS 22: what changes

POS 11 is an office the practitioner maintains; POS 22 is the hospital's on-campus outpatient department. Medicare pays POS 11 at the non-facility rate and POS 22 at the facility rate, because in the hospital department the hospital carries the cost of the setting and bills its own facility claim. A practitioner's office space on a hospital campus qualifies for POS 11 only when it is separately maintained and is not a provider-based department (chapter 26, section 10.5).

POS 21 vs POS 22: what changes

Both are hospital codes paid at the facility rate; the patient's registration decides between them. POS 21 is for a registered inpatient and POS 22 for an outpatient of the main campus, including a patient in observation, which Medicare treats as an outpatient service. A practitioner reports at least POS 21 for a registered inpatient wherever the encounter took place (chapter 26, section 10.5).

Denials when POS 22 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).

Related place of service codes

Other codes in the hospital inpatient, outpatient and emergency department group, with the Medicare rate each one takes.

Frequently asked questions

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.

• CMS Place of Service Code Set (professional claims)
  Version CMS page last modified 2026-02-17; code table updated 2024-05-02 · effective 2024-08-01 · file code-sets.htmlSHA-256 d3a3caf2216784af…
• Medicare Claims Processing Manual, Pub. 100-04, chapter 26: Completing and Processing Form CMS-1500 Data Set
  Version Rev. 12779, issued 2024-08-09 · effective 2024-08-09 · file clm104c26.pdfSHA-256 4fae39895fea412a…
• Medicare Claims Processing Manual, Pub. 100-04, chapter 12: Physicians/Nonphysician Practitioners
  Version Rev. 13316, issued 2025-07-24 · effective 2025-07-24 · file clm104c12.pdfSHA-256 ca5ded3c8c676a23…
• CMS Place of Service Codes for Professional Claims (printable PDF)
  Version Place of Service Codes for Professional Claims, updated 2024-05-02 · effective 2024-05-02 · file website-pos-database.pdfSHA-256 cfe3ca7e3b130e5d…