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Mark your calendars!  A new place of service code goes into effect May 1, 2010. Billers and managers for these types of clinics should check with their practice management software companies and clearinghouses to be certain that the new code will be added before the effective date.  They will also want to notify their billing staff of this change.

May 1, 2010
May 1, 2010

The trend of walk-in retail clinics is on the rise. As a result, the new POS code 17 was established because industry entities other than Medicare identified a need to track the suppliers and settings of immunizations in greater detail than afforded through the current POS code set; these entities specifically wished to capture the walk-in retail health clinic, which they believe will be a common setting for immunizations.

The current place of service (POS) code set has been updated to add a new code of 17 (Walk-in Retail Health Clinic). The code’s description is as follows: “a walk-in health clinic, other than an office, urgent care facility, pharmacy or independent clinic and not described by any other Place of Service code, that is located within a retail operation and provides, on an ambulatory basis, preventive and primary care services.”

The HIPAA effective date of the new POS code for walk-in retail health clinics is no later than May 1, 2010.  While Medicare has not identified a need for this added POS code, as a payer, Medicare must be able to recognize as valid any valid code from the POS code set that appears on the HIPAA standard claim transaction. In accordance with HIPAA, Medicare will be able to recognize POS code 17 as valid by May 1, 2010, with plans to do so by March 11, 2010.

Medicare has instructed physicians and other providers/suppliers to continue to use the billing instructions for immunizations described in the Medicare Claims Processing Manual, Chapter 18, Section 10:  http://www.cms.hhs.gov/manuals/downloads/clm104c18.pdf

If one thing is a constant in this industry, it is that it is like the weather in Texas, “if you don’t like the way things are now, stick around…..it will soon change!”  So prepare now for changes coming and your practice should feel little to no negative impact as result.

Happy Billing!