Place of Service 22 (On Campus Outpatient Hospital): What It Means and How It Changes Payment
Place of service (POS) 22 is the two-digit code that shows a payer a service was performed in an on-campus outpatient hospital department: a part of the hospital, on its main campus, that treats patients who are not admitted. It has a large effect on payment, because it determines whether the physician is paid the full non-facility rate or the lower facility rate, and whether the technical side of the service belongs to the physician or to the hospital.
If your practice treats patients inside a hospital, POS 22 is probably on most of your claims. If it is wrong, every one of those claims is paid at the wrong rate.
Where you see it
POS codes go in box 24B of the CMS-1500 claim form (loop 2400, segment SV1 in the 837P), one per service line. The full list is maintained by CMS as the Place of Service Code Set, and Medicare’s rules for choosing one are in the Medicare Claims Processing Manual, chapter 26. On a remittance the code appears in the POS column next to each date of service: the sample in our remittance walk-through shows POS 11 for an office; a hospital-based radiation oncologist would see 22 there.
The codes billers mix up
| POS | Name | Who owns the room and equipment | Physician paid at |
|---|---|---|---|
| 11 | Office | the practice | non-facility rate (higher) |
| 19 | Off Campus Outpatient Hospital | the hospital, at a location off the main campus | facility rate |
| 22 | On Campus Outpatient Hospital | the hospital, on the main campus | facility rate |
| 21 | Inpatient Hospital | the hospital; patient is admitted | facility rate |
| 23 | Emergency Room, Hospital | the hospital | facility rate |
| 24 | Ambulatory Surgical Center | the ASC | facility rate |
| 02 | Telehealth, patient not at home | wherever the patient is, other than home | facility rate for most services |
| 10 | Telehealth, patient at home | the patient’s home | non-facility rate for most services |
The on-campus versus off-campus line is 250 yards from the main hospital buildings, the definition CMS uses for provider-based departments. If a hospital-owned clinic sits across the street, it is usually POS 19, not 22.
Why the code changes the payment
Medicare’s physician fee schedule has two prices for most codes. The non-facility price includes the physician’s overhead: the room, the equipment, the nursing time. The facility price assumes a hospital or ASC is paying for all of that and billing its own facility claim, so it pays the physician less. POS 22 selects the facility price. The hospital then bills the facility side under the outpatient prospective payment system on a UB-04 claim.
For codes that have separate professional and technical components, the split is explicit: in POS 22 the physician reports the code with modifier 26 (professional component) and the hospital reports the technical component. Reporting the global code in POS 22 is one of the most common radiation oncology billing errors, and it is a denial or, worse, an overpayment that is recovered later.
A worked example from radiation oncology
A patient’s treatment plan needs a dosimetry calculation (CPT 77300, basic radiation dosimetry calculation), a code with separate professional and technical components.
| Setting | POS | What the physician bills | What the hospital bills |
|---|---|---|---|
| Freestanding center owned by the practice | 11 | 77300 with no modifier (global), paid at the non-facility rate | nothing |
| Hospital outpatient department on campus | 22 | 77300-26, professional component only | 77300 technical component on its UB-04 |
| Hospital-owned center across town | 19 | 77300-26 | 77300 technical component, often at a reduced site-neutral rate |
Image guidance works differently since January 1, 2026: 77387 is billable only with modifier 26 in every setting, including a freestanding center. Weekly treatment management, CPT 77427, has no technical component; it is a physician service wherever it happens. In POS 22 it is reported with no modifier but still paid at the facility rate, which for 77427 is the same as the non-facility rate because the code carries no practice-expense overhead to remove.
The payment amounts change too. For a code with a large technical component, the non-facility price might be ten times the professional price (illustrative: 325.00 global in POS 11 against 32.00 for the -26 component in POS 22), because the technical component pays for the equipment. Using POS 11 for a hospital-based service claims that equipment cost for a machine the practice does not own.
What to do
- Set the POS from the location, not from habit. A practice that treats in both its own center and the hospital needs two fee schedules and two place-of-service defaults, selected per visit. Iridium Suite does this with its site-of-service tracking, which picks global, professional or technical billing from the treatment location on the schedule.
- Match the modifier to the POS. POS 22 with a global-capable code and no modifier 26 is an error. Claim scrubbers should flag it before the claim is sent.
- Check for POS 19 situations. If the hospital has moved a department off campus, the code changes even though nothing else about the service did.
- When a payer denies for POS, read the remark code: a mismatch between POS and the service code (CARC 5 or 58) is a coding correction, not an appeal.
Related terms
- Global, professional and technical charges
- Modifiers 26 and TC
- Place of service codes, the full list
- CPT 77427, weekly radiation treatment management
- Site of service and the facility rate
Further reading: CMS Place of Service Code Set; CMS Transmittal 3315, Change Request 9231, which created POS 19 effective January 1, 2016 (PDF).
Frequently asked
What is POS 22 in medical billing?
POS 22 is the place of service code for a hospital outpatient department located on the hospital's main campus. It is reported in box 24B of the CMS-1500 claim for each service line.
What is the difference between POS 22 and POS 19?
Both are hospital outpatient departments. POS 22 is on the hospital campus; POS 19 is an off-campus location, more than 250 yards from the main buildings. Medicare created POS 19 in 2016 so it could pay off-campus departments differently.
What is the difference between POS 22 and POS 11?
POS 11 is a physician office, where the practice owns the equipment and staff and is paid the full non-facility rate. POS 22 is a hospital department, where the hospital bills for the facility side and the physician is paid the facility rate for professional work only.
Do I use modifier 26 with POS 22?
For procedures that have professional and technical components, yes. In POS 22 the hospital bills the technical component on its own claim, so the physician reports the code with modifier 26 for the professional component. Codes without a split, such as office visits, are reported without a modifier.