What POS 13 Means
POS 13 tells the payer you saw the patient in an assisted living facility. CMS describes it as a group residential facility with private living units. It assesses each resident's needs and gives on-site support 24 hours a day, 7 days a week. It can also provide or arrange some health care and other services.
Put the code in box 24B of the CMS-1500, or in the place of service field of the electronic claim.
Which Codes to Bill at POS 13
Since January 1, 2023, visits in assisted living use the home or residence visit codes. The old domiciliary and rest home visit codes (99324 to 99337) were deleted.
| Patient | Codes | Medicare 2026 (national) |
|---|---|---|
| New | 99341, 99342, 99344, 99345 | $49.10, $78.83, $146.63, $210.09 |
| Established | 99347, 99348, 99349, 99350 | $46.09, $78.83, $132.27, $193.06 |
You pick the level by medical decision making or by total time, the same way as office visits. Long visits can add prolonged time: Medicare uses G0318 from 140 minutes with 99345 and from 110 minutes with 99350. See our prolonged services calculator.
Which level fits
| Medical decision making | New patient | Established patient |
|---|---|---|
| Straightforward | 99341 | 99347 |
| Low | 99342 | 99348 |
| Moderate | 99344 | 99349 |
| High | 99345 | 99350 |
Code 99343 was deleted in 2023, so new patient codes jump from 99342 to 99344.
Example claim
A physician visits an established patient at an assisted living community. The patient has heart failure that is getting worse, and the physician adjusts two prescriptions. A long-term illness that is getting worse makes the problems moderate, and prescription changes make the risk moderate. The claim line is 99349 with POS 13, which pays $132.27 nationally under Medicare in 2026.
How POS 13 Is Paid
POS 13 is a non-facility setting under the Medicare physician fee schedule. The practice is paid the full practice expense, as it would be in an office. The facility itself bills Medicare nothing for your visit.
POS 13 vs Similar Codes
| POS | Setting | Rate |
|---|---|---|
| 12 | The patient's private home | Non-facility |
| 13 | Assisted living facility | Non-facility |
| 14 | Group home with shared living areas and supervision | Non-facility |
| 32 | Nursing facility | Facility |
| 33 | Custodial care facility: room, board and personal help, no medical part | Non-facility |
| 31 | Skilled nursing facility (Part A stay) | Facility |
Some guidance tells you to use POS 33 for assisted living. The safest rule is to use the code that matches how the facility is licensed, and to check your payer's policy. Not sure which code fits? Try the POS code decision tree.
Common POS 13 Mistakes
- Office visit codes with POS 13. Billing 99212 to 99215 for an assisted living visit can be denied as CO-5 (procedure and place of service do not match).
- POS 12 for an assisted living resident. A room in assisted living is not a private home for coding.
- POS 32 or 31 for an assisted living resident. These are facility settings and pay a lower rate. Using them by mistake underpays you.
- No note of the setting. Write the facility name and that the visit took place there.
Related
See the full POS code list, POS 11 (office) and Medicare fee lookup.
Frequently Asked Questions
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.
Facility gives room, board and personal help with no medical care at all? That is POS 33 (custodial care facility).
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