When healthcare services are delivered in an assisted-living facility, correctly coding the place of service is crucial. At CareSolution MBS, we help providers navigate this often-overlooked area of billing for better claim accuracy and faster reimbursement.

What is POS 13?

The place of service code “13” is defined as an “Assisted Living Facility” — a congregate residential setting with self-contained living units providing 24/7 support and on-site health or other services.
This distinguishes it from home settings (POS 12) or standard office visits (POS 11).
When we at CareSolution MBS work with providers in assisted living settings, we emphasise that using POS 13 correctly ensures the claim aligns with the physical care environment and supports proper payment.

Why POS 13 Matters in Medical Billing

Accurate place of service coding is not just a formality — it affects compliance, reimbursement rates, and claim approvals.
For example, submitting a claim for services rendered in an assisted-living facility but coding it as POS 12 (home) or POS 11 (office) can raise red flags for payers and trigger denials or payment delays. At CareSolution MBS, we’ve seen claims corrected and approved once POS 13 is applied appropriately.

Key Scenarios for POS 13 Use

When should you use POS 13? Here are typical scenarios:

  • A clinician visits a resident in an assisted-living facility to provide physician services, therapy, or other covered services on-site.

  • Services include assessments and support as part of the assisted-living infrastructure (24/7 support, self-contained units, residential care).
    In these situations, CareSolution MBS recommends POS 13 to reflect the assisted-living environment, not a private residence or outpatient office.

On the other hand, if the service occurs at the resident’s private home (not within a facility) you would instead use POS 12.

Best Practices with POS 13 for Assisted-Living Billing

Here are actionable tips from CareSolution MBS to reduce errors and optimise claims:

  1. Verify the residence status – Confirm the setting is indeed an assisted-living facility (not just a private home).

  2. Ensure documentation aligns – The patient’s record should reflect the setting, and the claim should list POS 13 in Box 24B of the CMS-1500 form or the electronic equivalent.

  3. Train your billing team – Many denials stem from using the wrong POS code. Training and audits help catch these errors early.

  4. Review payer policies – Some insurers may have specific criteria for assisted-living claims. At CareSolution MBS we maintain payer-specific checklists.

  5. Audit for consistency – Periodically run reports comparing service location codes versus actual settings. This helps detect mis-alignments and potential compliance concerns.

Common Mistakes and How to Avoid Them

  • Using POS 12 instead of POS 13: Claims show services as “home” when they were at an assisted-living facility.

  • Mis-identifying the facility: If the setting lacks the on-site support or residential structure, it may not qualify as assisted living under POS 13.

  • Inaccurate documentation: The claim form, service note, and facility address must consistently reflect the assisted-living environment.
    By avoiding these pitfalls, the team at CareSolution MBS helps providers keep claim flow smooth and revenue cycles optimised.

Frequently Asked Questions (FAQs)

1. What exactly does POS 13 represent?
POS 13 corresponds to an Assisted Living Facility — a residential setting with 24/7 support and some on-site services.

2. Can I use POS 12 instead of POS 13?
Only if the service is rendered in a private home (residence) and not in a congregate assisted-living facility. If you are in an assisted-living facility, POS 13 is correct. 

3. Does using POS 13 alter reimbursement rates?
Yes — payers may reimburse differently based on setting, so correct use of POS 13 helps ensure appropriate payment and avoids under- or over-valuation.

4. How do I ensure my billing team uses POS 13 correctly?
At CareSolution MBS, we recommend training, clear documentation of setting, and claim audits comparing service location to the code used.

5. What happens if I submit a claim with the wrong POS code?
Wrong POS codes can trigger denials, audits, or lower reimbursement. Correcting to POS 13 when appropriate can recover eligible payments and reduce risk.

In conclusion, understanding and applying POS 13 medical billing properly is critical for services rendered in assisted-living settings. With the guidance and support of CareSolution MBS, your practice or facility can streamline its billing, reduce errors, and improve financial performance. Let's get your claims right the first time.