The place of service or diagnosis may be considered when determining the appropriate TOS. The descriptors for each of the TOS codes listed in the following table are: | |
TOS Code |
TOS Description |
0 |
Whole blood |
1 |
Medical care |
2 |
Surgery |
3 |
Consultation |
4 |
Diagnostic radiology |
5 |
Diagnostic laboratory |
6 |
Therapeutic radiology |
7 |
Anesthesia |
8 |
Assistant at surgery |
9 |
Other medical items or services |
A |
Use DME |
B |
High risk screening mammography |
C |
Low risk screening mammography |
D |
Ambulance |
E |
Enteral/Parenteral nutrients/supplies |
F |
Ambulatory Surgical Center (facility usage for surgical services) |
G |
Immunosuppressive drugs |
H |
Hospice |
J |
Diabetic shoes |
K |
Hearing items and services |
L |
ESRD supplies |
M |
Monthly capitation payment for dialysis |
N |
Kidney donor |
P |
Lump sum purchase of DME, prosthetics, orthotics |
Q |
Vision items or services |
R |
Rental of DME |
S |
Surgical dressings or other medical supplies |
T |
Outpatient mental health treatment limitation |
U |
Occupational therapy |
V |
Pneumococcal/Flu vaccine |
W |
Physical therapy |
NOTE: For injection codes with more than one possible TOS designation, use the following guidelines when assigning the TOS: When the choice is L or 1, • Use TOS L when the drug is used related to ESRD; or • Use TOS 1 when the drug is not related to ESRD and is administered in the office. When the choice is G or 1: • Use TOS G when the drug is an immunosuppressive drug; or • Use TOS 1 when the drug is used for other than immunosuppression. When the choice is P or 1, • Use TOS P if the drug is administered through durable medical equipment (DME); or • Use TOS 1 if the drug is administered in the office. For a complete guide to the TOS indicators visit IOM 100-04 Chapter 26, section 10.7 – Type of Service (TOS) |