COT.003.264

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TMSIS Dataguide

Medicaid.gov

Version:

PLACE-OF-SERVICE

Data Element

DE Number

COT264

System DE Number

COT.003.264

File Name

COT - CLAIM OTHER

File Segment Number

File Segment Name

CLAIM-LINE-RECORD-OT

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	A pass-through data element meaning that the state should report the field in T-MSIS as reported by the provider on the claim form (i.e., 837P or 837D - Place of Service is only captured at the line level of the CMS-1500). If the claim is submitted on the 837p electronic claims form and the Facility Code Qualifier is reported with any value other than 'B', then the PLACE-OF-SERVICE value should be blank or space-filled. If the claim is submitted on the CMS-1450 (UB-04) institutional claims form, the PLACE-OF-SERVICE field should be blank or space-filled. Otherwise, if the claim is submitted with the place of service populated with any value other than the valid values listed in T-MSIS Data Guide for PLACE-OF-SERVICE values, that value should still be reported in the PLACE-OF-SERVICE data element. If the claim is submitted by a provider with the place of service fields blank, then the PLACE-OF-SERVICE on the T-MSIS OT claims file should be blank or space-filled.
Size	X(2)
FLF Start Position	1105
FLF Stop Position	1106
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must not be more than 2 characters 2. Value must be in Place of Service Code List (VVL) 3. Conditional 4. If value is populated, then Revenue Code must not be populated

Valid Value Code Set	Valid Value Code	Valid Value Name	Valid Value Description	Effective Start Date	Effective End Date

RULE ID	RULE Definition
RULE-8995	if a claim is a non-denied claim from an OT file, then the place of service value reported must be compatible with the specified T-MSIS picture format: X(2).
RULE-9120	If the place of service is populated on a non-denied claim from an OT file, then the place of service value reported must be in the list of valid values for PLACE-OF-SERVICE.

Measure ID	Measure Name

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
COT123	COT.002.123	PLACE-OF-SERVICE	COT00002	CLAIM-HEADER-RECORD-OT

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
06/05/2025	4.0.10	COT.003.264	UPDATE	Definition	A pass-through data element meaning that the state should report the field in T-MSIS as reported by the provider on the claim form (i.e., 837P or 837D - Place of Service is only captured at the line level of the CMS-1500). If the claim is submitted on the 837p electronic claims form and the Facility Code Qualifier is reported with any value other than �B�, then the PLACE-OF-SERVICE value should be blank or space-filled. If the claim is submitted on the CMS-1450 (UB-04) institutional claims form, the PLACE-OF-SERVICE field should be blank or space-filled. Otherwise, if the claim is submitted with the place of service populated with any value other than the valid values listed in T-MSIS Data Guide for PLACE-OF-SERVICE values, that value should still be reported in the PLACE-OF-SERVICE data element. If the claim is submitted by a provider with the place of service fields blank, then the PLACE-OF-SERVICE on the T-MSIS OT claims file should be blank or space-filled.	A pass-through data element meaning that the state should report the field in T-MSIS as reported by the provider on the claim form (i.e., 837P or 837D - Place of Service is only captured at the line level of the CMS-1500). If the claim is submitted on the 837p electronic claims form and the Facility Code Qualifier is reported with any value other than 'B', then the PLACE-OF-SERVICE value should be blank or space-filled. If the claim is submitted on the CMS-1450 (UB-04) institutional claims form, the PLACE-OF-SERVICE field should be blank or space-filled. Otherwise, if the claim is submitted with the place of service populated with any value other than the valid values listed in T-MSIS Data Guide for PLACE-OF-SERVICE values, that value should still be reported in the PLACE-OF-SERVICE data element. If the claim is submitted by a provider with the place of service fields blank, then the PLACE-OF-SERVICE on the T-MSIS OT claims file should be blank or space-filled.
05/29/2025	4.0.9	COT.003.264	UPDATE	Definition	A pass-through data element meaning that the state should report the field in T-MSIS as reported by the provider on the claim form (i.e., 837P or 837D - Place of Service is only captured at the line level of the CMS-1500). If the claim is submitted on the 837p electronic claims form and the Facility Code Qualifier is reported with any value other than â€œBâ€, then the PLACE-OF-SERVICE value should be blank or space-filled. If the claim is submitted on the CMS-1450 (UB-04) institutional claims form, the PLACE-OF-SERVICE field should be blank or space-filled. Otherwise, if the claim is submitted with the place of service populated with any value other than the valid values listed in T-MSIS Data Guide for PLACE-OF-SERVICE values, that value should still be reported in the PLACE-OF-SERVICE data element. If the claim is submitted by a provider with the place of service fields blank, then the PLACE-OF-SERVICE on the T-MSIS OT claims file should be blank or space-filled.	A pass-through data element meaning that the state should report the field in T-MSIS as reported by the provider on the claim form (i.e., 837P or 837D - Place of Service is only captured at the line level of the CMS-1500). If the claim is submitted on the 837p electronic claims form and the Facility Code Qualifier is reported with any value other than �B�, then the PLACE-OF-SERVICE value should be blank or space-filled. If the claim is submitted on the CMS-1450 (UB-04) institutional claims form, the PLACE-OF-SERVICE field should be blank or space-filled. Otherwise, if the claim is submitted with the place of service populated with any value other than the valid values listed in T-MSIS Data Guide for PLACE-OF-SERVICE values, that value should still be reported in the PLACE-OF-SERVICE data element. If the claim is submitted by a provider with the place of service fields blank, then the PLACE-OF-SERVICE on the T-MSIS OT claims file should be blank or space-filled.
01/16/2025	4.0.2	COT.003.264	UPDATE	Definition	A pass-through data element meaning that the state should report the field in T-MSIS as reported by the provider on the claim form (i.e., 837P or 837D - Place of Service is only captured at the line level of the CMS-1500). If the claim is submitted on the 837p electronic claims form and the Facility Code Qualifier is reported with any value other than â€śBâ€ť, then the PLACE-OF-SERVICE value should be blank or space-filled. If the claim is submitted on the CMS-1450 (UB-04) institutional claims form, the PLACE-OF-SERVICE field should be blank or space-filled. Otherwise, if the claim is submitted with the place of service populated with any value other than the valid values listed in T-MSIS Data Guide for PLACE-OF-SERVICE values, that value should still be reported in the PLACE-OF-SERVICE data element. If the claim is submitted by a provider with the place of service fields blank, then the PLACE-OF-SERVICE on the T-MSIS OT claims file should be blank or space-filled.	A pass-through data element meaning that the state should report the field in T-MSIS as reported by the provider on the claim form (i.e., 837P or 837D - Place of Service is only captured at the line level of the CMS-1500). If the claim is submitted on the 837p electronic claims form and the Facility Code Qualifier is reported with any value other than â€œBâ€, then the PLACE-OF-SERVICE value should be blank or space-filled. If the claim is submitted on the CMS-1450 (UB-04) institutional claims form, the PLACE-OF-SERVICE field should be blank or space-filled. Otherwise, if the claim is submitted with the place of service populated with any value other than the valid values listed in T-MSIS Data Guide for PLACE-OF-SERVICE values, that value should still be reported in the PLACE-OF-SERVICE data element. If the claim is submitted by a provider with the place of service fields blank, then the PLACE-OF-SERVICE on the T-MSIS OT claims file should be blank or space-filled.
12/19/2024	4.0.1	COT.003.264	UPDATE	Definition	PLACE-OF-SERVICE is a pass-through data element meaning that the state should report the field in T-MSIS as reported by the provider on the claims form (i.e., 837P, CMS-1500, or 837D). If the claim is submitted on the 837p electronic claims form and the Facility Code Qualifier is reported with any value other than “B”, then the PLACE-OF-SERVICE value should be blank or space-filled. If the claim is submitted on the CMS 1450 (UB04) institutional claims form, the PLACE-OF-SERVICE field should be blank or space-filled. Otherwise, if the claim is submitted with the place of service populated with any value other than the valid values listed in T-MSIS Data Guide for PLACE-OF-SERVICE values, that value should still be reported in the PLACE-OF-SERVICE data element. If the claim is submitted by a provider with the place of service fields blank, then the PLACE-OF-SERVICE on the T-MSIS OT claims file should be blank or space-filled.	A pass-through data element meaning that the state should report the field in T-MSIS as reported by the provider on the claim form (i.e., 837P or 837D - Place of Service is only captured at the line level of the CMS-1500). If the claim is submitted on the 837p electronic claims form and the Facility Code Qualifier is reported with any value other than â€śBâ€ť, then the PLACE-OF-SERVICE value should be blank or space-filled. If the claim is submitted on the CMS-1450 (UB-04) institutional claims form, the PLACE-OF-SERVICE field should be blank or space-filled. Otherwise, if the claim is submitted with the place of service populated with any value other than the valid values listed in T-MSIS Data Guide for PLACE-OF-SERVICE values, that value should still be reported in the PLACE-OF-SERVICE data element. If the claim is submitted by a provider with the place of service fields blank, then the PLACE-OF-SERVICE on the T-MSIS OT claims file should be blank or space-filled.
09/16/2024	4.0.0	COT.003.264	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.264	ADD	N/A		Created