Assisted Living Billing Services

Assisted living billing is split across several payers. Residents often pay privately for housing and personal care. Medicare covers many medical services from visiting providers, but not room and board or most personal care. Medicaid waivers may cover some services in some states.

That mix makes billing hard to manage. Who bills what depends on the service, the provider, and the resident's coverage. Westmont Revenue Partners connects assisted living communities, long-term care operators, and visiting clinicians with vetted medical billing experts. They can sort out which payer is responsible and keep claims, resident statements, and state program paperwork organized.

Who this is for

• Assisted living communities and memory care operators
• Long-term care organizations with more than one setting
• Physicians, nurse practitioners, and physician assistants who visit residents
• Visiting podiatry, behavioral health, and therapy providers
• Community managers and business office staff who handle resident accounts

What gets billed

• Visits by physicians and advanced practice providers to residents
• Care plan oversight and care coordination
• Annual wellness and preventive visits
• Behavioral health visits on site
• Podiatry and routine foot care when it meets coverage rules
• Therapy services provided by outside therapy companies
• Lab draws and mobile diagnostic services
• Medicaid waiver or home and community based services, where the state allows
• Resident charges for rent, care levels, and add-on services
• Hospice coordination for residents who elect hospice

Commonly billed codes

Code	Type	What it covers
99341	CPT	Home or residence visit, new patient, straightforward decision making
99342	CPT	Home or residence visit, new patient, low-level decision making
99345	CPT	Home or residence visit, new patient, high-level decision making
99347	CPT	Home or residence visit, established patient, straightforward decision making
99348	CPT	Home or residence visit, established patient, low-level decision making
99349	CPT	Home or residence visit, established patient, moderate-level decision making
POS 13	Place of service	Assisted living facility
POS 33	Place of service	Custodial care facility
POS 32	Place of service	Nursing facility, where nursing facility visit codes generally apply instead
Q5002	HCPCS	Hospice care provided in an assisted living facility

Note

Codes are examples for orientation, not a complete list, and do not guarantee coverage or payment. Always check current code sets and payer policy.

Billing challenges in assisted living

Knowing which payer is responsible. Medicare does not pay for room and board or most daily personal care. A biller separates resident-paid charges from covered medical services so claims go to the right place.

Choosing the right place of service. Assisted living, custodial care, and nursing facility settings use different place-of-service codes. A wrong choice can cause a denial or an incorrect payment. Billers confirm the resident's setting before they code the visit.

Medicaid waiver rules. Waiver programs differ by state, with their own authorizations and service plans. Experienced billers track approval dates and units so services are not delivered without authorization.

Visit documentation. Home or residence visit codes rely on documented medical decision making or time. Billers review notes to make sure the level of service is supported.

Mixed settings in one organization. Communities that also have memory care, skilled units, or home care need separate billing paths. A biller keeps each line of business distinct.

Resident statements and collections. Families and responsible parties often need clear statements. Billers help produce accurate invoices and follow up on balances in a respectful way.

Hospice residents. When a resident elects hospice, some billing shifts to the hospice. Billers check for conflicts before submitting claims for other providers.

How Westmont can help

• Match you with vetted billing experts who understand assisted living and long-term care payers
• Support end-to-end revenue cycle work for visiting providers and care operators
• Help with denial management and place-of-service questions
• Connect you with experts for credentialing and payer enrollment questions
• Give you a path to compare billing partners before you decide

Frequently asked questions

Does Medicare cover assisted living?

Medicare generally does not pay for room and board or most personal care in assisted living. It may cover medical services from enrolled providers, such as visits, certain therapy, and some equipment. Medicaid waivers may cover other services in some states. Check current Medicare and state rules for your residents.

What place of service code applies to assisted living?

POS 13 is the code for an assisted living facility. Some residents live in settings that payers classify differently, such as custodial care or nursing facility. Your billing team should confirm the setting and check each payer's policy before the visit is coded.

How do visiting providers bill for assisted living residents?

Many visiting providers use home or residence visit codes with the assisted living place of service. Documentation must support the visit level, either by decision making or time. Payers may have their own rules on frequency and need, so check current policy.

Who bills for rent and care levels?

The community usually bills residents or their families directly for rent and care levels. Those charges are separate from medical claims. A billing partner can help with resident invoicing, but this is different from claims for medical services.

Can an assisted living community outsource billing?

Yes. Westmont does not submit claims itself. We connect you with vetted billing experts who can help with medical claims, waiver billing, and follow-up. Ask each expert which functions they handle and how they will work with your records.

Related billing services

• Nursing Home Billing
• Hospice Billing
• Home Health Billing
• Geriatrics Billing
• Palliative Care Billing