Electronic Visit Verification (EVV) Place of Service Reminders

Sep 26, 2022

Billing EVV Services with Place of Service (POS) 40, CR 106958   

This reminder replaces the previous instructions to use POS 10 from February 19, 2021. The use of POS 10 has changed and is not available to indicate claims submitted for services rendered in the three scenarios listed below. Please use POS 40 instead. 

You should only use POS 40 in the following scenarios. These services are excluded from EVV record requirements when the claims are submitted using POS 40.  

• For Section 28 services, when the service is not delivered one-to-one within the member’s home.  
• For Section 28 services, when the service does not include personal care/skill-building components (e.g. one-to-one for development or completion of a comprehensive assessment).   
• For Sections 12, 18, 19, 20, 21, 29, and 96 services, when the individual providing the service is a live-in caregiver. 

Providers who wish to correct the POS code on an EVV claim that is currently in pend status may take either of these steps:  

• Wait for the claim to deny, then resubmit the claim with the corrected information. Do not make a change to the claim that is currently pending.    

• Submit a new claim with the corrected information; the original claim will eventually deny if the EVV requirements are not met.     

If you have questions, please contact Provider Services by email or phone at 1-866-690-5585, option 3. 

EVV Place of Service (POS) Usage Guidelines 

Personal Care Services (PCS) claims are included or excluded from EVV record requirements based on the POS code and EVV service codes that are submitted on the CMS 1500 claim form.  

Claims for services delivered in the following locations are subject to EVV and require a verified EVV visit record:    

• POS 04:   Homeless Shelter 
  • Use this POS for EVV-related services provided in a homeless shelter. The services MUST be provided in the shelter to use this POS. If the MaineCare member is staying in a shelter but they receive the service in the community, providers should use POS 99 as noted below. 
• POS 12:  Home  
  • Use this POS for EVV-related services provided in the home. 
  • Provider type 86 (Section 28 providers) should use this POS for EVV-related services when the service is provided one-on-one in the member’s home AND when the service includes the delivery of skill building/personal care services to the member. 
• POS 16:   Temporary Lodging 
  • Use this POS for EVV-related services provided in locations that are not the member’s permanent residence (e.g. motels, hotels, etc.).                                 

Claims for services delivered in the following locations are not subject to EVV and do not require a verified EVV visit record: 

• POS 02: Telehealth provided other than in a patient’s home
  • Use this POS for Home Support-Remote Support: Monitor Only and Interactive services (including MaineCare policy Sections 18, 19, 20, 21, and 29).
  • Please refer to our additional telehealth billing guidance for PCS.
• POS 03: School
  • Use this POS when the service is delivered in a school setting.

• POS 10: Telehealth provided in patient’s home  

• POS 40: Unassigned (State EVV)
  • Use this POS for:
    • Section 28 services, when the service is not delivered one-to-one within the member’s home.
    • Section 28 services, when the service does not include personal care/skill-building components (e.g. one-to-one for development or completion of a comprehensive assessment).
    • Sections 12, 18, 19, 20, 21, 29, and 96 services, when the individual providing the service is a live-in caregiver.

In most instances, providers should not deliver PCS in the following locations: 

• 01 - Pharmacy    
• 11 – Office        
• 13 – Assisted Living Facility*  
• 14 – Group Home                                     
• 53 – Community Mental Health Center
• 99 – Other Place of Service

*This may be an appropriate POS for section 96 services for members eligible for Private Duty Nursing, level 9. 

Please contact your Provider Relations Specialist if you have any questions about appropriate billing or about allowable service locations.  

Personal Care Services (PCS) Providers: Billing Telehealth on CMS 1500 Claim Form - Place of Service (POS) 10, CR 96215

Telehealth PCS claims are excluded from Electronic Visit Verification (EVV) record requirements. When billing telehealth claims on the CMS 1500 Claim Form, you must use the POS code 02 or 10 and include the GT modifier, as this indicates you are providing services via telehealth and not in-person.

See the table below for affected codes.  UB04 claim lines submitted with telemedicine revenue code 078x are exempt from EVV editing.

Code	Description	Code	Description
G0151	PT services, home health or hospice, each 15 min	S5150	Unskilled respite care not hospice per 15 min
G0152	OT services, home health or hospice, each 15 min	T1000	Private duty/independent nursing up to 15 min
G0153	Speech\lang, home health or hospice, each 15 min	T1004	Services of a qualified nursing aide to 15min
G0155	Social work service, HH or hospice, each 15 min	T1005	Respite care services, up to 15 minutes
G0156	Home health aide, HH or hospice, each 15 min	T1019	Personal care serv, per 15 min, not for inpat
G0299	HHS/hospice of rn each 15 minutes	T1502	Administration of oral/IM/subcut med, /visit
G0300	HHS/hospice of lpn each 15 minutes	T2017	Habilitation, residential waiver, per 15 min
H2021	Community based wrap-around servs, per 15 min	T2042	Hospice routine home care, per diem
S5125	Attendant care services, per 15 min	T2043	Hospice continuous home care, per hour

Please contact your Provider Relations Specialist with questions.