CMS Code Change Bolsters Street Medicine Programs

Oct. 4, 2023
Lack of place-of-service (POS) code has hampered reimbursement for programs that provide healthcare for unhoused people

In a change that went into effect on Oct. 1, the Centers for Medicare and Medicaid Services (CMS) officially recognized that medical care can be delivered on the street, making it possible for providers to be reimbursed for services provided to people who are currently unhoused.

For several years, leaders at the University of Southern California Keck School of Medicine’s Street Medicine Program and the nonprofit Street Medicine Institute have urged CMS to create a place-of-service (POS) code for the street. They say a lack of a POS code has caused numerous obstacles for the medical professionals who deliver care to patients outside of the walls of a typical healthcare facility.

“This is an important decision for the street medicine providers, but also for our patients,” said Brett Feldman, M.S.P.A.S., P.A.-C., director and co-founder of USC Street Medicine and an assistant professor of family medicine at the Keck School of Medicine, in a statement “Our patients rely on street medicine to survive and so by recognizing the street as a legitimate place to deliver healthcare, it recognizes their right to life.”

According to Feldman, who led an effort in 2018 to survey street medicine providers across the country, more than 70 percent of the nation's street medicine teams do not attempt to get reimbursed for services due to the lack of this code.

In addition, patients have often been unable to get additional services because insurers could not process their claims without a POS code. Because their claims went unprocessed, Feldman noted that patients were frequently denied the opportunity to see specialists, had difficulty obtaining medications and couldn't get access to devices like walkers or wheelchairs.

Prior to this decision, the only insurers that reimbursed care given by street medicine providers were the state Medicaid programs in California and Hawaii. This decision helped to streamline the process of submitting claims and allowed providers to order additional services for their patients in those states.

The new code will also make it possible for researchers to identify street medicine visits and patients, allowing them to collect data to gain a better understanding of the needs of people experiencing unsheltered homelessness. This type of research could lead to the creation of a more equitable care model.

Feldman first began researching this issue in 2015 when he was leading a street medicine team in Pennsylvania. When he joined the board of the Street Medicine Institute in 2017, he conducted additional research, including surveying members about billing practices.

The agency in charge of Medicaid in Pennsylvania, the Department of Human Services (DHS), is also stressing the impact of the billing change at CMS.

“At DHS, we are committed to helping medical providers better serve their communities in any space we can, to put more people on a path to good health,” said DHS Secretary Val Arkoosh, M.D., M.P.H, in a statement. “People experiencing homelessness can have complex needs and face many barriers to healthcare, but meeting people where they are can make a difference.  By creating a path for Medicaid to cover street medicine, we are making it easier for healthcare providers to offer the care they need and deserve.” 

“Street medicine is the delivery of healthcare directly to persons who live on the streets of our nation. This innovative health care delivery model has been evolving for decades in Pittsburgh, across the U.S., and across the globe. However, in most U.S. communities, street medicine has not been a reimbursable service,” said Jim Withers, M.D., medical director of Homeless Services at Pittsburgh Mercy, founder and medical director of Pittsburgh Mercy’s Operation Safety Net, and founder of the Street Medicine Institute, in a statement.

“The official change in Medicaid reimbursement which takes effect in October will allow Pittsburgh Mercy’s Operation Safety Net and other street medicine providers to sustain and improve the services that are so desperately needed on the streets,” Withers added. “This is a landmark event for which street medicine practitioners have advocated for decades. We are grateful to the governmental leaders who have made this possible. Healthcare is an essential part of solving the crisis of homelessness. All people deserve care that is dignified, effective, of high-quality, and sustainable.” 

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