POS 32: Nursing Facility
POS 32 is the place of service code for nursing facility residents who are not in a Medicare Part A covered SNF stay, including long-term custodial residents and those who exhausted their 100 days. Under the Physician Fee Schedule it maps to the non-facility payment rate, unlike POS 31.
- Setting
- Nursing facility resident, no Part A SNF stay
- Rate type
- Non-facility under the PFS
- Common pairing
- Nursing facility E/M 99304-99310
- Watch out for
- Same building as POS 31; benefit status decides the code
What does POS 32 mean?
POS 32 identifies a nursing facility: per CMS, a facility that primarily provides skilled nursing care and related services, rehabilitation, or health-related care above the level of custodial care to residents, but is not a hospital or SNF context under Part A. In billing practice it covers NF residents and SNF residents whose Part A coverage has ended or never applied.
POS 32 and POS 31 describe the same hallway; the difference is whether Medicare Part A is paying the facility a bundled per-diem for that resident on that date. The full code table is in our Place of Service reference.
When do you use POS 32?
Use POS 32 for professional services to nursing facility residents outside a Part A covered stay:
- Long-term custodial residents (often Medicaid-funded room and board, Medicare Part B for physician services).
- Residents who exhausted their 100 Part A days or whose stay stopped meeting skilled criteria.
- Medicare Advantage members whose plan classifies the stay as non-skilled, per plan records.
The visit codes stay in the 99304-99316 nursing facility family. What changes at the 31-to-32 boundary is payment mapping and bundling: consolidated billing rules relax, and ancillary providers can bill Medicare directly again.
How does POS 32 affect payment?
Under the Physician Fee Schedule, POS 32 is one of the settings CMS pays at the non-facility rate; POS 31 pays the facility rate. For codes carrying both values, the identical visit pays more the day after Part A exhausts than the day before, purely because the practice-expense assumption changes. The direction is reliable even though the spread varies by code; check your common codes at both rates with the Medicare fee calculator.
The second payment effect is the end of consolidated billing. Labs, imaging, and therapy for a POS 32 resident bill Medicare directly instead of invoicing the SNF. For ancillary vendors, the 31/32 status of each resident on each date literally determines who owes them money, which is why sophisticated mobile x-ray and lab companies run daily eligibility on entire facility censuses.
What are the common POS 32 errors and denials?
- Stale status coding: billing POS 32 while the resident re-entered a covered stay after a hospital trip, which converts your directly-billable ancillary into a CO-109 consolidated billing denial. Decode remits with the denial code lookup.
- CARC 5: office E/M or home visit codes billed with POS 32 instead of the nursing facility family.
- ALF confusion: assisted living visits coded POS 32; the setting is POS 13 and the payer knows the facility's licensure.
- MA plan skilled-status disputes: the plan considers the stay skilled (their version of POS 31 rules) while you billed POS 32; resolve against the plan's authorization records.
Frequently asked questions
Check Part A SNF stay status for the specific date of service: eligibility systems and the facility's billing office both track it. In a covered stay (within the benefit period's 100 days after a qualifying hospital admission), use POS 31. Custodial residents, Medicaid long-term care residents, and those who exhausted benefits are POS 32. Status changes mid-month constantly, so verify per visit, not per resident.
Under the Medicare Physician Fee Schedule, POS 32 maps to the non-facility rate while POS 31 maps to the facility rate, so for codes valued at both rates the POS 32 payment is the higher of the two. The E/M codes are the same 99304-99310 family either way. More importantly, POS 32 claims escape SNF consolidated billing, so ancillary services bill Medicare directly again.
No. Residents of SNFs and NFs are seen with the nursing facility E/M family 99304-99316 regardless of Part A status. The POS code (31 or 32) tells the payer the benefit context; the code family tells it the setting type. Office codes 99202-99215 with POS 31 or 32 fail place-of-service edits and come back as CARC 5.
Assisted living is POS 13, not 32, and uses home or domiciliary visit code rules rather than nursing facility codes. POS 32 requires a licensed nursing facility providing round-the-clock nursing to residents. Practices covering mixed campuses (SNF wing, ALF wing, independent living) need the resident's unit and licensure, not the campus address, driving the POS.
Sources & further reading
Reviewed by the ImmediCare Solutions RCM team
Certified billers and coders handling claims across 50+ specialties nationwide. This entry is reviewed against current payer policy and CMS rules. Last review: Jul 5, 2026.
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