POS 09: Prison/Correctional Facility
Health services delivered to incarcerated individuals.
CMS description
“A prison, jail, reformatory, work farm, detention center, or any other similar facility maintained by either Federal, State or local authorities for the purpose of confinement or rehabilitation of adult or juvenile criminal offenders.”
When to use POS 09
Health services delivered to incarcerated individuals.
Reimbursement
Medicare/Medicaid coverage is limited — Social Security Act §1862(a)(2) generally excludes services in custody. Limited exceptions for inpatient hospital and pregnancy-related services.
Common billing issues
- Medicare denies most POS 09 claims — coverage extremely narrow
Frequently asked questions
What is POS 09?
Prison/Correctional Facility. A prison, jail, reformatory, work farm, detention center, or any other similar facility maintained by either Federal, State or local authorities for the purpose of confinement or rehabilitation of adult or juvenile criminal offenders.
When do I use POS 09?
Health services delivered to incarcerated individuals.
How does POS 09 affect reimbursement?
Medicare/Medicaid coverage is limited — Social Security Act §1862(a)(2) generally excludes services in custody. Limited exceptions for inpatient hospital and pregnancy-related services.
What are common POS 09 billing issues?
Medicare denies most POS 09 claims — coverage extremely narrow.
Other POS codes
- POS 01 — PharmacyUsed primarily for vaccines administered at a pharmacy and pharmacist-rendered s
- POS 02 — Telehealth Provided Other than in Patient's HomeSince 2022, POS 02 must be used for telehealth when the patient is anywhere OTHE
- POS 03 — SchoolUsed for services provided in a school setting — typically school-based health c
- POS 04 — Homeless ShelterHealth services provided at a homeless shelter, typically by mobile clinics, str
- POS 05 — Indian Health Service Free-standing FacilityIHS billing only. Special encounter rates apply.
- POS 06 — Indian Health Service Provider-based FacilityIHS billing only, provider-based hospital outpatient setting.
Sources
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