Covered POS and Modfier list on Ambulance service

PLACE OF SERVICE (POS) CODES

The POS code must be one of the following:

21 – Inpatient hospital

23 – Emergency room – hospital

26 – Military treatment facility

51 – Inpatient psychiatric facility

55 – Residential substance abuse treatment facility

56 – Psychiatric residential treatment center

61 – Comprehensive inpatient rehabilitation hospital


Please keep the following in mind when submitting claims:

• HCY services are not limited to the above places of service

• POS codes 55, 56, and 61 are not valid for air transport

• POS codes 41 (land) and 42 (air/water) are Medicare codes and not valid MO HealthNet POS codes


VALID AMBULANCE MODIFIERS

EP – HCY services for participants under 21 years of age

GM – Ground transport for multiple participants

HH – Hospital to hospital transfer

HD – Specialized testing and treatment

SC – Medically necessary service or supply