Place of Service Crosswalk

Below is a table that shows how Place of Service codes have been crosswalked for PROMISe™ billing purposes. For provider specific place of service codes, please refer to the appropriate PROMISe Provider Handbooks and Billing Guides.

Previous (pre-PROMISe™) Medical Assistance (MA) Place of Service Codes	CMS-1500 PROMISe™ Place of Service Codes	837 P (Professional) PROMISe™ Place of Service Codes	837 D (Dental) PROMISe™ Place of Service Codes	ADA-2000 PROMISe™ Place of Service Codes
01 = Office	11 = Office	11 = Office	11 = Office	X "Office", block 49
01 = Office (with Comprehensive Outpatient Rehabilitation Facility)	62 = Comprehensive Outpatient Rehabilitation Facility	62 = Comprehensive Outpatient Rehabilitation Facility	N/A	N/A
02 = Patient's Home	12 = Patient's Home	12 = Patient's Home	12 = Patient's Home	X "Other", block 49, show remarks
02 = Patient's Home (with Non-JCAHO Residential Treatment Facility)	56 = Psychiatric Residential Treatment Facility	56 = Psychiatric Residential Treatment Facility	N/A	N/A
03 = Inpatient Hospital	21 = Inpatient Hospital	21 = Inpatient Hospital	21 = Inpatient Hospital	21 = Inpatient Hospital
04 = Renal Dialysis Center	65 = End Stage Renal Disease Treatment Facility	65 = End Stage Renal Disease Treatment Facility	N/A	N/A
05 = Outpatient Hospital	22 = Outpatient Hospital	22 = Outpatient Hospital	11 = Office	X "Office", block 49
06 = Independent Laboratory	81 = Independent Laboratory	81 = Independent Laboratory	N/A	N/A
07 = Hospital Special Treatment Room	99 = Other Unlisted Facility (Hospital Special Treatment Room)	99 = Other Unlisted Facility (Hospital Special Treatment Room)	N/A	N/A
08 - Nursing Facility	32 = Nursing Facility	32 = Nursing Facility	31 = Nursing Facility	X "ECF", block 49
09 = Independent Clinic (with Birthing Center)	25 = Birthing Center	25 = Birthing Center	N/A	N/A
09 = Independent Clinic (with Independent Medical/Surgical Clinic or Outpatient Psych Clinic)	49 = Independent Clinic	49 = Independent Clinic	N/A	N/A
09 = Independent Clinic (with Federally Qualified Health Center)	50 = Federally Qualified Health Center	50 = Federally Qualified Health Center	11 = Office	X "Office", block 49
09 = Independent Clinic (with Outpatient Drug & Alcohol Clinic)	57 = Non-residential Substance Abuse Treatment Facility	57 = Non-residential Substance Abuse Treatment Facility	N/A	N/A
09 = Independent Clinic (with Rural Health Clinic)	72 = Rural Health Clinic	72 = Rural Health Clinic	11 = Office	X "Office", block 49, show Remarks
10 = Free-standing Mental Health Establishment	52 = Psychiatric Facility Partial Hospitalization	52 = Psychiatric Facility Partial Hospitalization	N/A	N/A
11 = Community 99 = Other Unlisted Facility (Community)	99 = Other Unlisted Facility (Community)	99 = Other Unlisted Facility (Community)	12 = Home	X "Office", block 49, show Remarks
12 = Ambulatory Surgical Center (ASC) /Hospital Short Procedure Unit (SPU)	24 = Ambulatory Surgical Center	24 = Ambulatory Surgical Center	21 = Inpatient Hospital	X "Hosp", block 49
14 = Emergency Room	23 = Emergency Room	23 = Emergency Room	22 = Outpatient Hospital	X "Office", block 49, show Remarks
15 = State Mental Retardation Center (with State Mental Retardation Center)	54 = Intermediate Care Facility/Mentally Retarded	54 = Intermediate Care Facility/Mentally Retarded	31 = Nursing Facility	X "ECF", block 49
16 = Free-Standing Inpatient Hospice	34 = Hospice	34 = Hospice	N/A	N/A

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