POS 33: Custodial Care Facility

What Is POS 33?

POS 33 is the place of service code for a custodial care facility. CMS defines it as: "A facility which provides room, board and other personal assistance services, generally on a long-term basis, and which does not include a medical component."

The key words are no medical component. Residents get help with daily living, such as meals, bathing and medicines, but the facility does not give skilled nursing care. Physicians and other practitioners come in to see residents, much like a home visit.

Which Visit Codes to Use

Since January 1, 2023, there is one code family for visits in a home or residence. The old domiciliary, rest home and custodial care codes (99324 to 99337) were deleted. The CMS E/M guide (May 2026) lists five settings that use the merged codes: a private home (POS 12), assisted living (POS 13), a group home (POS 14), a custodial care facility (POS 33) and a residential substance abuse facility (POS 55).

You pick the level by medical decision making or by total time, the same way as office visits. Straightforward decision making is 99341 or 99347, low is 99342 or 99348, moderate is 99344 or 99349, and high is 99345 or 99350. Code 99343 was deleted in 2023, so new patient codes jump from 99342 to 99344.

Rates are national 2026 amounts from the CMS fee schedule at the $33.4009 conversion factor. These codes pay the same in every setting. Check your local rate in our Medicare fee lookup.

Why POS 33 Pays the Non-Facility Rate

Medicare pays some services at two rates. The non-facility rate is higher, because the practitioner carries the cost of staff, supplies and equipment. The Medicare Claims Processing Manual (Chapter 12, Section 20.4.2) lists custodial care facilities with homes, assisted living and group homes as non-facility settings. For home or residence visit codes, the two rates are the same anyway, but for procedures done during the visit the POS can change the payment.

G2211 and Prolonged Time

• G2211. From January 1, 2026, Medicare allows the G2211 add-on with home or residence visit codes. Use it when you are the patient's ongoing source of care for a serious or complex condition.
• Medicare prolonged time. Bill G0318 when total time reaches 140 minutes with 99345, or 110 minutes with 99350.
• Other payers. Most commercial plans follow CPT and use 99417 from 90 minutes with 99345, or 75 minutes with 99350.

Our prolonged services calculator works out the right code and units for any visit.

POS 33 vs Similar Settings

POS 33 or POS 32? How to Decide

This is the mistake we see most. The word "custodial" describes the type of care, but the POS code follows the type of facility. Ask the facility how it is licensed:

• Licensed nursing facility or nursing home? Use POS 32, even for long-term residents who only need custodial care. Use POS 31 during a Medicare Part A skilled stay.
• Licensed as assisted living? Use POS 13.
• A group home with shared living areas and supervision? Use POS 14.
• Room, board and personal help only, with no medical care? Use POS 33.

Write the facility type in your patient record once, so every claim for that patient uses the same code. Not sure? Our POS code decision tree walks you through it.

Common POS 33 Mistakes

• Billing deleted codes 99334 to 99337. They were removed in 2023 and will deny.
• Billing office visit codes (99202 to 99215) for a visit at the facility. Use the home or residence codes.
• Using POS 33 for a licensed nursing home. That is POS 32.
• Using POS 11 because the visit felt like an office visit. The POS is where the patient was seen.
• Missing G2211 on visits for ongoing care of complex conditions in 2026.

Sources: CMS Place of Service Code Set; Medicare Claims Processing Manual, Chapter 12, Sections 20.4.2 and 30.6; CMS MLN006764, Evaluation and Management Services (May 2026); CMS 2026 Medicare Physician Fee Schedule.

Frequently Asked Questions