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  • Reimbursement in Office v. Facility

    Question: Some of our physicians perform laser procedures in our office laser suite while others take patients to an outpatient facility. Since we have a designated procedure room should we be getting reimbursed nonfacility or facility rates at our office location? What factors determine this?

    Answer: Your site/place of service (POS) determines the rate. Office is POS 11, off-site outpatient is POS 19, on-site outpatient is POS 22 and ambulatory surgery center (ASC) is POS 24. This information is placed in box 24b on the CMS-1500 form.
    Most surgical procedures are assigned higher relative value units (RVUs) when performed in an office setting than in a hospital or an ambulatory surgery center (ASC). This is known as the site-of-service differential. The office setting is given a higher allowable than a facility due to overhead expenses.
    Some commercial payers may not cover surgery performed in the office if greater than 50% of the time it is performed in a facility. When performing procedures in the office you want to be sure you meet any Occupational Safety and Health Administration (OSHA) and medical liability requirements.