POS 55: Residential Substance Abuse Treatment Facility
Residential SUD treatment.
CMS description
“A facility which provides treatment for substance (alcohol and drug) abuse to live-in residents who do not require acute medical care.”
When to use POS 55
Residential SUD treatment.
Reimbursement
MHPAEA parity compliance. ASAM level of care criteria.
Common billing issues
- Coverage denials based on level-of-care criteria
- Out-of-network OON facilities very common
Frequently asked questions
What is POS 55?
Residential Substance Abuse Treatment Facility. A facility which provides treatment for substance (alcohol and drug) abuse to live-in residents who do not require acute medical care.
When do I use POS 55?
Residential SUD treatment.
How does POS 55 affect reimbursement?
MHPAEA parity compliance. ASAM level of care criteria.
What are common POS 55 billing issues?
Coverage denials based on level-of-care criteria; Out-of-network OON facilities very common.
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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