Table 4.
Centers for Medicare & Medicaid Services designations of place of service and applicable reimbursement.43,44
| Place of service | CMS designation for place of service | Commercial payors | CMS covers | Facility CMS reimbursement | Provider CMS reimbursement |
|---|---|---|---|---|---|
| Inpatient hospital care | Place of service 21 | All PCI | All PCI | DRG + | CPT |
| Outpatient hospital procedures | Place of service 22 | All PCI (excluding CTO, STEMI) | All PCI (excluding CTO, STEMI) | APC | CPT |
| Ambulatory surgical centers | Place of service 24 | Similar to CMS coverage with some contractual exceptions | Ambulatory PCI excluding CTO, bypass grafts, atherectomy | ASC | CPT |
| Physician office-based laboratory | Place of service 11 | PCI in many states | Diagnostic heart cath only | CPT global payment | |
APC, ambulatory payment classifications; ASC, ambulatory surgery center; cath, catheterization; CMS, Centers for Medicare & Medicaid Services; CPT, Current Procedural Terminology; CTO, chronic total occlusion; DRG, diagnosis-related group; STEMI, ST-elevation myocardial infarction.