# Assisted Living Encounters with Medicare



## sitstay (May 21, 2014)

My physician sees patients in an assisted living facility. The patients' have Medicare. The facility does not have an NPI, only a tax ID. How are we to bill for these encounters without a facility NPI? 
Thanks for any feedback.


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## CBlanton (May 21, 2014)

The Physician that seen the patient has an NPI. You would use his NPI for his visit to the assisted living facility.


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## N70QW (May 22, 2014)

I would love an answer to this question as well. We use our physicians NPI to bill his visit to the assisted living facility but Medicare denies it every time with the denial "service facility location NPI is invalid (since we do not have an NPI for the assisted living center and they are not required to have one. Any ideas? I am considering changing the location to 12 for patient home, which technically it is.


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## sitstay (Jun 3, 2014)

That is exactly the problem! I was also considering changing POS to 12, but was unsure. Wondering if anyone else has received reimbursement when using this POS?


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## N70QW (Jan 6, 2015)

I tried using the location 12 for home and still received the same denial, location NPI is invalid. Not sure what to do. Would sure appreciate some help if anyone has the answer,thanks


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## grabow (Jan 8, 2015)

We bill and are paid for assisted living visits using the following information:

- Place of service is 13 - Assisted Living Facility
- The provider's group NPI is used for location
- CPT codes are 99324-99337 for evaluation and management
- CPT codes 99339-99340 or 99374-99380 for care oversight
- Don't forget Hospice modifiers 

If you are still getting denials, contact Medicare and ask if your enrollment needs to be updated to include home visits (form 855r).

Here is a link to the Medicare LCD for medical necessity:

http://downloads.cms.gov/medicare-c...chments/31613_1/L31613_PHYS081_CBG_050111.pdf


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## kvonholten (Mar 11, 2021)

Is it really okay to put your providers group NPI as the service facility NPI for an ALF since the facility is not required to have one?  BCBS seems to be the only insurance I've come across that requires an NPI on their claims.


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## mscribetech (Jul 22, 2021)

So you are suggesting to use the ALF name and address in the location box with the providers NPI?


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## dama002 (Jul 23, 2021)

yes you use the facility name in the location box


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