POS 11 — Office: Place of Service Code Explained

POS 11: What It Identifies

POS 11 identifies services performed in a physician's office — a location owned or rented by the practice, not part of a hospital campus. It's the most used place of service code in outpatient medicine, and because it triggers the higher non-facility payment rate, it's also the one payers audit when they suspect location games.

The distinction that matters isn't what the building looks like — a converted house, a strip-mall suite, and a medical office building can all be legitimate POS 11 locations. What matters is ownership and billing structure: does the practice bear the space, staff, and equipment costs directly, or does a hospital or health system bill separately for the facility component? That single question, not the building's appearance, is what a payer's audit team checks first.

Use POS 11 For

Services in your own practice location — owned or leased office space
Procedures performed in your office procedure room
Visits at a practice-operated clinic that is NOT hospital-owned or provider-based

Don't Use It For

Hospital-owned 'provider-based' clinics — even if they look like offices, those are POS 19 or 22
Telehealth visits (POS 02 or 10, depending on where the patient is)
Services at an ASC (POS 24) or in the patient's home (POS 12)

How POS 11 Affects Payment

POS 11 pays the Medicare non-facility rate — the higher physician payment, because your practice bears the overhead (staff, equipment, supplies). Billing POS 11 for services actually performed in a facility setting collects overhead money you didn't spend, which is why POS 11-in-a-facility is a classic overpayment audit with extrapolated refunds.

The gap between non-facility and facility rates isn't trivial — for many E/M and procedure codes, the non-facility practice expense RVU can run 30-60% higher than the facility PE RVU for the identical CPT code. Run your top billed codes through our RVU calculator at both facility and non-facility settings to see exactly how much is riding on getting this one field right on every claim.

POS 11 vs POS 22: What the Same Visit Pays in 2026

Here is the gap in real numbers. These are 2026 national Medicare physician rates from the CMS fee schedule. In an office (POS 11) the practice pays for the room, staff and supplies, so Medicare pays the higher non-facility rate. In a hospital outpatient department (POS 22 or POS 19), the hospital bills its own facility fee and the doctor gets the lower facility rate.

Code	Service	POS 11 (office)	POS 22 (hospital outpatient)	Difference
99213	Established patient visit, low	$95.19	$57.45	$37.74
99214	Established patient visit, moderate	$135.61	$84.50	$51.11
99215	Established patient visit, high	$192.39	$125.59	$66.80
99204	New patient visit, moderate	$177.36	$116.90	$60.46
20610	Large joint injection	$68.81	$39.75	$29.06
11042	Wound debridement, first 20 sq cm	$132.60	$55.78	$76.82

For a clinic that bills 20 established visits a day at 99214, the gap is about $1,022 a day. That is why payers check the place of service against where the practice is enrolled. Check your own codes and area in the Medicare fee lookup.

Source: CMS Physician Fee Schedule, 2026 RVU file (conversion factor $33.4009).

Common POS 11 Billing Errors

Hospital-acquired practices continuing to bill POS 11 after becoming provider-based — the highest-dollar POS error in the industry
Telehealth billed as POS 11 without payer-specific guidance allowing it
Satellite locations billed as POS 11 before being properly enrolled as practice locations

Documentation That Supports POS 11

The strongest audit defense for POS 11 is a clean paper trail showing the location is genuinely practice-owned or leased, not provider-based. Keep your CMS-855B enrollment on file showing the practice location's address and ownership structure, and if you've recently acquired or been acquired by a hospital system, confirm in writing whether each location retained independent (non-provider-based) status or converted. That single determination — independent vs. provider-based — is what decides whether POS 11 remains correct going forward, and it's worth revisiting any time a location changes ownership.

Real-World Scenario

A cardiology group is acquired by a regional health system. For the first three months post-acquisition, billing continues submitting POS 11 out of habit, unaware the location has been redesignated as hospital-outpatient (POS 19). Every claim in that window collected the higher non-facility rate it was no longer entitled to. When the error surfaces during a routine payer audit, the practice faces a repayment demand covering the full window — a completely avoidable cost that a single enrollment status check at the time of acquisition would have prevented.

Related POS Codes

POS 19 — Off-campus outpatient POS 22 — On-campus outpatient POS 10 — Telehealth home

← Back to the full POS code reference

Reviewed by Hassan Raza Awan, Founder — 4+ years of hands-on U.S. medical billing experience. General billing information — verify against current CMS guidance and your payer contracts.

Frequently Asked Questions

Why does POS 11 pay more than facility POS codes?

Because the non-facility rate reimburses your practice for overhead — staff, space, equipment, supplies. In a facility, the facility bills separately for that overhead, so the physician's share is lower. Same CPT code, two rates, and the POS code decides which one applies.

Our clinic was bought by a hospital. Do we keep billing POS 11?

Almost certainly not. Once a location becomes hospital provider-based, services there bill POS 19 (off-campus) or POS 22 (on-campus), typically with a facility claim alongside. Continuing POS 11 post-acquisition is a well-known overpayment pattern that audits find easily — fix it the day the designation changes.

Can a leased space inside a hospital building still be POS 11?

Sometimes, if the practice independently leases the space, bears its own overhead, and isn't provider-based to the hospital. This is a gray area worth confirming with your enrollment records rather than assuming based on the building's address alone.

How do I confirm a location's provider-based status?

Check the practice's CMS-855B enrollment and any provider-based attestation on file with your Medicare Administrative Contractor. If the location was recently acquired, ask your credentialing team directly rather than assuming the prior billing pattern is still correct.

How much more does POS 11 pay than POS 22?

For 99213 in 2026, Medicare pays the doctor $95.19 nationally at POS 11 and $57.45 at POS 22, a gap of $37.74. For 99214 the gap is $51.11. At POS 22 the hospital also bills its own facility fee.

POS 11: Office