POS 11 is the place of service code for care given in a physician's office: a location, other than a hospital or another facility, where a health professional routinely sees patients on an ambulatory basis. It goes in Box 24B of the claim and tells Medicare and most other payers to pay the non-facility rate, which is generally higher than the facility rate. Use it only when the visit really happened in an office that isn't part of a hospital, because the code changes what you are paid.
What is Place of Service 11?
Place of Service (POS) Code 11 is defined by CMS as the location — other than a hospital, skilled nursing facility (SNF), military treatment facility, community health center, state or local public health clinic, or intermediate care facility (ICF) — where a health professional routinely provides health examinations, diagnosis, and treatment of illness or injury on an ambulatory basis.
In practice, POS 11 covers most of what a private practice does in its own office: routine visits, specialist consultations, follow-ups, minor procedures and preventive care.
It is reported for each service line in Box 24B of the CMS-1500 (or the matching field of the electronic 837P). The payer uses it to decide which fee schedule rate applies, so a wrong code means the wrong payment, a denial or a mismatch with the documentation if the claim is reviewed.
When to Use Place of Service Code 11?
Use POS 11 in medical billing when:
- The patient receives care at a physician-owned office or independently operated clinic
- Services are performed at the provider’s designated office location — not a hospital department (a separately maintained physician office on a hospital campus can still be POS 11)
- The encounter takes place in a non-facility setting rather than a hospital outpatient department
- The visit involves routine care such as evaluations, consultations, follow-up visits, or minor in-office procedures
- The office is not a provider-based department of a hospital or other institutional facility (who owns the practice does not decide it on its own)
For example: If a patient visits an internal medicine physician’s private clinic for a follow-up appointment or annual wellness exam, POS 11 is generally the correct place of service code. However, if the same physician sees the patient in a hospital-based outpatient clinic, POS 22 (on-campus outpatient hospital), POS 19 (off-campus outpatient hospital) or another applicable code may be required depending on facility affiliation and payer-specific rules.
How POS 11 Impacts Reimbursements in Medical Billing
Medicare, Medicaid and most commercial payers use the POS code to decide whether to pay the facility rate or the non-facility rate.
With POS 11, office-based services are paid at the non-facility rate, which is generally higher. In an office, the physician, not a facility, bears the cost of running the practice: staff, equipment, supplies and space. When the same service is given in a hospital outpatient department, the hospital bills its own facility charge on a UB-04, and the physician is paid the lower facility rate.
That cuts both ways for your practice:
- Paid too little: an office visit sent with a facility code is paid at the lower rate, and nobody notices unless someone compares payments with the fee schedule.
- Paid too much: POS 11 on a service actually given in a hospital department is paid at a rate the practice wasn't owed. That is an overpayment the payer can recover, often for many claims at once.
Common services billed under POS 11 include:
- Routine office visits and annual wellness exams
- Specialist consultations and follow-up appointments
- Minor in-office procedures and diagnostic evaluations
- Behavioral health and therapy sessions in a private clinic or outpatient practice
- Preventive care services delivered at a physician-owned location
Common POS 11 Billing Mistakes — And How to Avoid Them
Most POS errors happen when 11 is used as a default, or when nobody checks where the visit actually took place.
Common POS 11 billing mistakes include:
- Using POS 11 for telehealth services when POS 02 or POS 10 is required
- Reporting POS 11 for hospital-based or facility-affiliated outpatient services
- Submitting claims where the documented service location does not match the reported POS code
- Overlooking payer-specific place of service billing guidelines
- Applying POS 11 as a default code across different encounter types without location verification
- Omitting required telehealth modifiers such as Modifier 95 when applicable
- Failing to update the provider’s office address in the billing system after a practice relocation
Best Practices for Accurate POS 11 Billing
A short checklist for your billing team:
- Check where the service happened before assigning POS 11, every time.
- Use POS 11 only for services in a physician's office or independently operated clinic, not a provider-based hospital department.
- Make sure the location in the documentation matches the POS code on the claim.
- Set telehealth visits up with their own POS code (02 or 10), or the in-person code plus modifier 95 only where that payer says so.
- If a provider works at both an office and a hospital clinic, check that each location is set up separately in your billing system.
- Update the service address in the billing system when an office moves.
- Review CMS and payer POS rules each year, as they change.
- Spot-check a sample of claims for POS errors, especially for providers who see patients in more than one place.
Where Beeline fits
Beeline is a US company with a dedicated billing team. Its claims submission service checks place of service along with codes, modifiers and provider details when it scrubs each claim; the page's tool, "A claim's journey, stop by stop", shows where a claim can stall. If you're not sure your POS codes are right, book a free consultation.
Frequently Asked Questions
What is POS 11 in medical billing?
POS 11 identifies healthcare services delivered in a physician’s office or independently operated clinic. It signals to insurance payers that care was provided in a non-facility setting rather than a hospital or institutional outpatient facility.
When should I use Place of Service Code 11?
Use POS 11 when a patient is seen at a provider-owned office or private practice. It applies to routine office visits, consultations, follow-up appointments, and in-person services performed outside a hospital or institutional setting.
Can POS 11 be used for telehealth services?
In some cases, yes. Certain payers allow POS 11 for telehealth billing when appropriate modifiers — such as Modifier 95 — are included. Requirements vary by payer, state, and policy type. Always verify before submitting telehealth claims under POS 11.
How does POS 11 affect reimbursement rates?
POS 11 typically qualifies services for the non-facility reimbursement rate, which is higher than the facility rate because the provider bears the overhead costs of the office setting. Reporting an incorrect POS code can result in underpayment, denials, or delayed claim processing.
Does POS 11 apply to behavioral health billing?
Yes. POS 11 is commonly used for behavioral health services — including counseling, psychotherapy, psychiatric evaluations, and medication management — provided in a private clinic or outpatient therapy practice. Telehealth behavioral health billing requirements may vary by payer and state guidelines.
Does POS 11 qualify for the non-facility reimbursement rate?
Yes. Under CMS guidelines, POS 11 services qualify for the non-facility reimbursement rate because the provider — not a hospital or facility — bears the operational overhead of the office setting, which is why this rate is typically higher than the facility rate.
Does POS 11 apply to urgent care visits?
Usually not. CMS has a separate code, POS 20 (Urgent Care Facility), for locations distinct from a hospital emergency room, an office, or a clinic that treat unscheduled, walk-in patients. POS 11 fits only when the walk-in care is given in a physician’s office, and a hospital-based clinic uses a hospital outpatient code (POS 19 or 22). Payer rules vary, so confirm which code each payer expects.