POS 13: assisted living facility.

What CMS says POS 13 means

Congregate residential facility with self-contained living units providing assessment of each resident's needs and on-site support 24 hours a day, 7 days a week, with the capacity to deliver or arrange for services including some health care and other services.

Code name: Assisted Living Facility. CMS lists it as effective October 1, 2003. Source: CMS Place of Service Codes for Professional Claims, retrieved 2026-11-02.

How POS 13 differs from the settings around it

• POS 12, home: a location, other than a hospital or other facility, where the patient receives care in a private residence.
• POS 14, group home: a residence with shared living areas where clients receive supervision and other services such as social or behavioral services, custodial service and minimal services such as medication administration.
• POS 32, nursing facility: a facility that primarily provides skilled nursing care and related services for rehabilitation, or on a regular basis health-related care above the level of custodial care.
• POS 33, custodial care facility: a facility providing room, board and other personal assistance, generally long term, with no medical component.

Picking between 12 and 13

The CMS definitions turn on the facility's features. A facility that offers self-contained living units with on-site support around the clock and the capacity to deliver or arrange services fits POS 13. A private residence with no such facility fits POS 12. A resident's apartment inside a community that matches the CMS wording for 13 generally falls under 13 rather than 12. If the facility's licensing or description is unclear, ask the facility how it is classified and bill the code that matches the CMS wording.

Coverage points that often come up

A POS code names the setting. It does not make a service covered. Original Medicare excludes custodial care (42 CFR 411.15(g)), which CMS defines there as any care that does not meet the requirements for coverage as SNF care. Room, board and personal assistance in a residential setting are therefore not what a professional claim pays for. The professional service furnished to the resident is billed with the setting code. A denial that cites a non-covered charge (see CARC 96) needs the remark code read before anything is appealed.

What to check before you submit

• Confirm the place where the patient was seen, and whether it matches the CMS wording for 13 rather than 12, 14, 32 or 33.
• CMS tells billers to check each payer for its reimbursement policy for each code, so confirm how the payer treats POS 13 for the procedure you bill.
• If the place of service was wrong, correct it and resubmit as the payer directs. For Medicare, a party can ask the contractor to reopen within 1 year for any reason (42 CFR 405.980(c)).

Worked example (hypothetical)

A physician visits a resident in a licensed community where each resident has their own apartment and staff are on site around the clock. The visit is billed with POS 13. A visit to a patient living alone in a house is POS 12, and a visit in a SNF is POS 31.

Sources

• CMS: Place of Service Codes for Professional Claims — code names and descriptions (retrieved 2026-11-02)
• eCFR: 42 CFR 411.15 (particular services excluded from coverage) — regulation text as of the eCFR issue dated 2026-10-29, retrieved 2026-11-02
• eCFR: 42 CFR 405.980 — regulation text as of the eCFR issue dated 2026-10-29, retrieved 2026-11-02

Every code description and rule above was retrieved from these pages on November 2, 2026. X12 code text is copyrighted by X12 and quoted only for the codes explained here; the complete lists are at x12.org. Payers revise code lists, contracts and policies, so confirm anything that affects a claim or a deadline with the payer.