POS 58 — Non-Residential Opioid Treatment Facility

What Is POS 58?

POS 58 is the place of service code for a non-residential opioid treatment facility. CMS describes it as “a location that provides treatment for opioid use disorder on an ambulatory basis.” That includes methadone and other medication-assisted treatment. The code started on January 1, 2020, the same day Medicare began paying opioid treatment programs (OTPs) directly.

In practice, POS 58 belongs to one kind of provider: a certified opioid treatment program enrolled with Medicare as an OTP. A doctor treating opioid use disorder in a normal office is not an OTP and does not use it. Mixing these up is the most common mistake with this code.

POS 58 vs POS 57, 55 and 11

Four codes cover places that treat substance use. They are not interchangeable:

Code	Setting (CMS descriptor, abbreviated)	Use it for
58	Non-residential opioid treatment facility — ambulatory treatment for opioid use disorder, including methadone and other MAT	Services of an enrolled opioid treatment program (OTP)
57	Non-residential substance abuse treatment facility — ambulatory treatment for alcohol and drug abuse	Outpatient substance use programs that are not OTPs
55	Residential substance abuse treatment facility — treatment for live-in residents who do not need acute medical care	Residential programs
11	Office	Office-based opioid treatment by a physician or other practitioner

The line between 58 and 11 matters most. CMS says plainly that clinicians cannot use OTP codes to bill for office-based treatment. Office-based treatment has its own monthly codes under the physician fee schedule: G2086, G2087 and G2088. Use the place of service where the visit really happened, which is usually POS 11.

How Medicare OTP Claims Are Billed

Medicare pays enrolled OTPs one bundled payment per week of care, not a payment per service. CMS’s OTP billing guidance says:

Weekly bundles are G2067 through G2075. A week is 7 days in a row. To bill a bundle, the patient must get at least one service that week, from either the drug or the non-drug part. If the patient gets no medication that week, bill the non-drug bundle (G2074).

Add-on codes cover extra services. Examples are G2076 for intake, G2077 for periodic assessments and G2080 for extra counseling or therapy. CMS has added more add-ons since.

Professional claims go on the CMS-1500 with POS 58 and the organizational NPI as the billing provider. Institutional claims go on the CMS-1450 with type of bill 087x and revenue codes instead of a place of service code.

Telehealth does not change the place of service. CMS tells OTPs to use POS 58 for all OTP services, even when they are delivered by video or by phone (audio-only). Remote counseling and therapy add-ons get modifier 95 for video or 93 for audio-only.

This rule surprises billers used to POS 02 and 10. For an OTP, the modifier shows it was telehealth, not the place of service. Changing an OTP telehealth claim to POS 02 or 10 can get a valid service denied for the wrong place of service.

Medicaid and Commercial Plans

POS 58 is part of the national code set, so any payer can accept it. But the weekly OTP bundle is a Medicare idea. State Medicaid programs and commercial plans have their own opioid treatment rules. Some pay daily or per dose, some use their own codes, and some expect a different place of service. Check the payer’s OTP billing guide first. Sending Medicare’s G-code bundles to a plan that does not use them is an easy way to get denials.

Getting POS 58 Claims Paid

Confirm OTP enrollment first. POS 58 with OTP codes is only payable for a program enrolled with Medicare as an OTP. A practice that is not enrolled as an OTP should not bill the bundle at all.

Keep the place of service at 58 for every OTP service, including telehealth, and use modifiers 95 or 93 where CMS requires them.

Bill the right weekly bundle. Drug and non-drug bundles are not interchangeable, and a week with no service at all cannot be billed.

Fix place of service denials with a corrected claim. A denial for the wrong place of service is usually fixed with a corrected claim, not an appeal (see CO-58). The claim frequency code tool tells you whether the correction is a 7 or an 8.

Sources

Definitions come from the CMS Place of Service Code Set and billing rules from CMS’s Opioid Treatment Program billing and payment page. CMS revises OTP codes most years, so confirm the current code list before a new year’s claims.

All place of service codes, POS 11 (office), POS 02 and POS 10 for telehealth outside an OTP, POS 53 (community mental health center), and the POS code decision tree.

Frequently Asked Questions

What is place of service 58?

POS 58 is a non-residential opioid treatment facility: a location that provides treatment for opioid use disorder on an ambulatory basis, including methadone and other medication-assisted treatment. CMS made it effective January 1, 2020.

What is the difference between POS 57 and POS 58?

POS 57 is a non-residential substance abuse treatment facility for alcohol and drug treatment generally. POS 58 is specifically a non-residential opioid treatment facility, used by enrolled opioid treatment programs. An OTP billing Medicare OTP services uses 58, not 57.

Do OTP telehealth services use POS 02 or 10?

No. CMS instructs opioid treatment programs to use POS 58 on claims for all OTP services, including those delivered by audio-video or audio-only technology. Remote counseling and therapy add-ons carry modifier 95 or 93 instead.

Can a physician office bill POS 58?

Not for office-based treatment. CMS says clinicians cannot use OTP codes to bill for office-based treatment. Office-based opioid use disorder treatment is billed under the physician fee schedule with codes G2086 to G2088 and the place of service where the visit happened, usually POS 11.

Which claim form uses POS 58?

The professional claim. OTPs billing on the CMS-1500 report POS 58 with the OTP HCPCS codes and the organizational NPI. Institutional claims on the CMS-1450 use type of bill 087x and revenue codes rather than a place of service code.