part ii policies and procedures for rural health clinic services

PLACE OF SERVICE CODES11 – Office12 – Home21 – Inpatient Hospital Services Unit22 – Outpatient Hospital Services Unit23 – Emergency Room -Hospital24 – Ambulatory Surgical Center25 – Birthing Center31 – Skilled Nursing Facility32 – Nursing Facility33 – Custodial Care Facility34 – Hospice41 – Ambulance – Land42 – Ambulance Air or Water50 – Federally Qualified Health Center51 – Inpatient Psychiatric Facility52 – Psychiatric Facility Partial Hospitalization (Not a covered POS for Georgia Medicaid)53 – Community Mental Health Center54 – Intermediate Care Facility/Mentally Retarded55 – Residential Substance Abuse Treatment56 – Psychiatric Residential Treatment Center (Not a covered POS for Georgia Medicaid)61 – Comprehensive Inpatient Rehabilitation FacilityJanuary 2012Rural Health Clinic Services E-3