POS 56: Psychiatric Residential Treatment Center
PRTC for youth.
CMS description
“A facility or distinct part of a facility for psychiatric care which provides a total 24-hour therapeutically planned and professionally staffed group living and learning environment.”
When to use POS 56
PRTC for youth.
Reimbursement
Medicaid commonly. Commercial plan coverage varies.
Common billing issues
- Coverage denials for medical necessity
Frequently asked questions
What is POS 56?
Psychiatric Residential Treatment Center. A facility or distinct part of a facility for psychiatric care which provides a total 24-hour therapeutically planned and professionally staffed group living and learning environment.
When do I use POS 56?
PRTC for youth.
How does POS 56 affect reimbursement?
Medicaid commonly. Commercial plan coverage varies.
What are common POS 56 billing issues?
Coverage denials for medical necessity.
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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