Changes to Billing for Partial Hospitalization Programs and Intensive Outpatient Programs

In reviewing claims for Partial Hospitalization Programs (PHP) and Intensive Outpatient Programs (IOP) services, Blue Cross and Blue Shield of North Carolina (Blue Cross NC), has recognized that providers are billing more than one unit for PHP and IOP services. Only one (1) unit for PHP on a facility claim or IOP on a facility or professional claim, is allowed per date of service as these services are defined as per diem.

PHP and IOP services are mutually exclusive on the same date of service. PHP (S0201 or H0035) is allowed on facility claims as a per diem and includes all facility, professional, ancillary, and other services rendered to the member at the site. IOP is allowed on facility or professional claims as a per diem and includes all facility, professional, ancillary, and other services rendered to the member at the site.

Reporting

• Provider should report S9480 for intensive outpatient treatment focused on mental health.
• Provider should report H0015 for intensive outpatient treatment focused on substance use disorder(s).

Please review our new reimbursement policy for further clarification on these requirements and limitations.