Medical billing can be tricky, especially when it comes to getting claims approved by insurance providers. One of the most essential parts of this process is using the correct Place of Service (POS) code. These codes help explain where the care was given. Among them, 33 pos in medical billing is often misunderstood but plays an important role, especially in cases involving long-term personal care.
This article will help you fully understand what 33 pos in medical billing means, how and when to use it, how it compares to other POS codes, and why getting it right is so important. Whether you are a medical biller, healthcare manager, or part of a billing team, this guide provides you with everything you need to know.
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What Is POS in Medical Billing?
POS codes in medical billing are two-digit numbers that show where a patient received their care. These codes are added to claim forms sent to insurance companies, such as Medicare and Medicaid. Without them, insurance providers can’t properly evaluate or pay claims.
Each code represents a specific location. For example:
- POS 11 stands for a doctor’s office
- POS 21 stands for an inpatient hospital
- POS 33 refers to a custodial care facility
Using the correct POS code ensures accurate billing and helps avoid delays, denials, or incorrect payments from insurers.
What does 33 pos in medical billing Mean?
When you see 33 POS in medical billing, it refers to a custodial care facility. These are places where people receive help with daily living activities, such as bathing, dressing, or eating, but they don’t receive any medical care.
Custodial care is long-term, non-medical support. Patients may have chronic conditions, disabilities, or old age-related issues, but they don’t need active treatment. These facilities have aides instead of nurses or doctors.
According to the Centres for Medicare and Medicaid Services (CMS), POS 33 means:
“A facility that provides room, board, and other personal assistance services, generally on a long-term basis, and which does not include a medical component.”
This means that POS 33 is strictly for non-medical care and is not equivalent to hospital or nursing care.
Why Is POS 33 Important in Medical Billing?
Using 33 POS in medical billing properly is very important because it directly affects whether a claim gets approved or denied. Insurance programs, such as Medicare and Medicaid, use POS codes to determine the type of services provided and whether they’re covered.
If you misuse POS 33 — like billing for skilled nursing services at a custodial facility — the claim may be denied. That’s because medical care isn’t supposed to happen at a custodial care location under this code.
Also, many insurance plans, including Medicare, don’t cover custodial care, so it’s critical to use this code only when it’s accurate. This helps you stay compliant with insurance rules, avoid audits, and reduce billing errors.
When Should You Use 33 POS in Medical Billing?
Use POS 33 when billing for services provided in a custodial care setting — a place where people live because they can’t care for themselves, but don’t need medical treatment.
Examples include:
- Elderly people living in an assisted living home who need help with bathing and meals
- Patients with Alzheimer’s or dementia receiving supervision but not medical care
- Disabled individuals who need daily support but no ongoing treatment
If the patient receives any form of medical attention, such as therapy or nursing, then POS 33 should not be used. Instead, a code like POS 31 (Skilled Nursing Facility) might be appropriate.
Difference Between POS 33 and Other Facility Codes
To use 33 POS in medical billing correctly, it’s essential to know how it differs from similar codes:
- POS 31 is for Skilled Nursing Facilities (SNFs) where patients receive medical care or rehab under a doctor’s supervision.
- POS 32 refers to Nursing Facilities, which might provide some medical support but not intensive care.
- POS 34 is for Hospice settings where terminally ill patients receive end-of-life medical care.
In contrast, POS 33 is strictly non-medical. If medical treatment is involved, using POS 33 can lead to rejections and even regulatory penalties.
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Challenges and Limitations of Using POS 33
Even though custodial care is essential, it’s often not covered by insurance. Medicare and many private insurers usually exclude non-medical care. This makes it hard for billing teams and patients to get reimbursement for POS 33 services.
As a result, patients often have to pay out of pocket or rely on long-term care insurance. Submitting claims to the wrong payer or with the wrong code increases the chances of denial.
Sometimes, providers mistakenly use POS 33 for medical visits simply because the patient resides in a custodial facility. That’s a billing error. If a doctor visits to treat the patient, the POS code should reflect the medical service, not just the location.
Documentation and Compliance Tips
To avoid issues, it’s essential to maintain proper documentation that supports the use of 33 POS in medical billing. Make sure your records include:
- The type of facility
- The actual services provided
- Proof that no skilled or medical services were given
This documentation will help ensure claims are processed correctly and meet insurance policies. Staying updated with CMS guidelines and payer rules will also reduce mistakes and improve approval rates.
Conclusion
Knowing how to use 33 POS in medical billing is essential for those handling claims in long-term care settings. This specific code applies only to custodial care facilities, where patients receive personal support but not medical treatment.
Using this code properly helps avoid claim denials, ensures compliance with insurance policies, and improves billing accuracy. As the number of people needing long-term personal care grows, understanding how and when to use POS 33 is becoming more critical than ever.
By documenting clearly and staying informed, healthcare providers and billing staff can confidently manage claims involving POS 33 and make sure services are billed correctly.
Frequently Asked Questions (FAQs)
1. What is 33 POS in medical billing?
It’s the code for a custodial care facility — a place where people receive personal support, such as help with eating and bathing, but no medical care is provided.
2. Is POS 33 covered by Medicare or a private insurance plan?
Typically, Medicare doesn’t cover POS 33 because it involves non-medical care. Some long-term care insurance or private plans might offer partial coverage. Always check the policy details.
3. What’s the difference between POS 31 and POS 33?
POS 31 is for Skilled Nursing Facilities, which provide medical treatment. POS 33 is for custodial care only; no medical treatment is allowed.
4. Can I bill a doctor’s visit under POS 33?
No. If a medical service is provided, even in a custodial facility, use the appropriate POS code that corresponds to the type of service and setting. POS 33 is only for non-medical support.
5. Why is it so important to use the correct POS code?
Using the incorrect code can result in claim denials, delays, or compliance issues. The correct code ensures smooth processing and timely payment.
