Bill a telehealth visit with a place-of-service code that says the patient walked into an office, and some payers will pay it at the wrong rate — or reject it outright once their telehealth edits catch the contradiction.
Quick answer
CLM05-1 is the Facility Code Value, the first component of the CLM05 composite in an X12 837P claim — it identifies the place of service where care was delivered, using the same two-digit codes as CMS place-of-service tables.
Common code values
11
Office — the most common outpatient professional setting
02
Telehealth (patient not in home) — became widely used after telehealth billing expanded
10
Telehealth (patient in home) — distinguishes home-based telehealth from other settings
21
Inpatient hospital — used when a professional service is rendered during an inpatient stay
81
Independent laboratory — used for lab-only claims
Example
Synthetic example Generated by Synthibase
CLM*ACCT52290*180.00***02:B:1*Y*A*Y*Y*P*
The 02 in the composite marks this as a telehealth visit where the patient was not at home. Synthetic claim data.
Where this trips people up
Test suites that treat CLM05-1 as a free-form field and default every claim to 11 (office) never exercise a payer's telehealth or facility-based reimbursement edits, so those edits go untested until they misfire in production against real place-of-service variety.
Test every place-of-service scenario, not just the office visit
Synthibase generates synthetic 837P claims across the full range of facility codes — office, telehealth, inpatient, lab — so place-of-service edits get exercised before go-live.
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