Partial Hospitalization Programs (PHP) offer a more structured level of care than intensive outpatient programs and can serve as a transitional step between inpatient and outpatient care following discharge. It is also appropriate for individuals who are at risk of requiring inpatient hospitalization. While the program is designed to improve patient outcomes, it is important to note that behavioral health facilities can generate revenue from PHP. However, to ensure proper reimbursement from various payers, it is crucial for these organizations to use the correct PHP billing codes. Failure to do so may result in delays or denials of reimbursement, which can negatively impact the facility’s revenue cycle. This article provides PHP billing guidelines and commonly used codes to assist billing staff and clinicians in minimizing errors that could lead to loss of revenue or unnecessary delays.

Documentations Requirements

PHP differs from outpatient and inpatient programs. It can be used to step down the care from an inpatient plan or upgrade it from outpatient care. PHP’s unique approach to behavioral health requires facilities to include specific documentation to show how their clients joined the program. These documentations include certification and recertification. 

Certification

Behavioral health organizations should certify that a client would require inpatient hospitalization if partial hospitalization is not offered. Certification is essential if the patient was previously on an outpatient plan. The certification documents should be signed by a physician or clinical therapist. 

Recertification 

Recertification shows that a patient requires to remain on the PHP program to reduce the risk of inpatient hospitalization. Recertification documents are signed by therapists or physicians treating the client. The first recertification is signed on the 18th day of partial hospitalization services. Subsequent recertification documents are signed at a 30-day interval. 

PHP Billing Codes 

A billing code describes the service offered to a client. They are used in claim submissions to show the reimbursement or payment needed for services rendered to a client. PHP billing codes consist of CPT/HCPCS codes, which are sometimes accompanied by revenue codes as may be required by the payer. Some payers also require a billing type code to accompany the CPT/HCPCS codes. 

Common PHP Billing Codes (CPT/ HCPCS codes)   

• 90785: Used for interactive complexities listed separately and accompanied by the primary procedure code.
• 90791: Used for diagnostic evaluation
• 90832: Used to bill psychotherapy services that last 30 minutes 
• 90834: Used for psychotherapy that lasts 45 minutes with the patient
• 90837: Use this code when billing psychotherapy services that last 60 minutes 
• 90846: Used for family psychotherapy offered without the patient present for 50 minutes
• 90847: Use this code to bill family psychotherapy with the patient present for 50 minutes
• 90849: Use this code to bill multiple-family group psychotherapy
• 90899: Use this code to bill unlisted service or procedure
• 96112: Use this code for developmental assessment for the first hour
• 96113: Used to bill developmental assessments for each additional 30 minutes
• 96116: Use this code for a neurobehavioral status exam for the first hour 
• 96121: Use this code for a neurobehavioral status exam for each additional hour  
• G0129: Use this code to bill occupational therapy services provided by a qualified occupational therapist for each 45-minute session.
• G0176: Bill activity music, dance, art, or play therapies provided to the client using this code
• G0177: For training and educational services 
• G0410: Used for group therapy 
• G0411: Bill interactive group therapies using this code

General HCPCS Codes

H0015: Used for alcohol or drug services, partial hospitalization per diem

H0035: Used for mental health partial hospitalization treatment, less than 24 hours

S0201: Partial Hospitalization, per diem      

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Revenue Codes

Billing staff should accompany the CPT or HCPCS with the relevant revenue code listed below. 

• 0250 for drugs and biologicals 
• 043X for occupational therapy 
• 0900 for behavioral health services 
• 0904 for Activity Therapy
• 0912 for behavioral health services – less intensive PHP
• 0913 for behavioral health Services – Intensive PHP
• 0914 used for individual therapy
• 0915 used for group therapy
• 0916 used for family therapy
• 0918 used to accompany CPT codes for testing services
• 0942 used for other therapeutic services, such as training or education 
• 0961 used for billing professional fees 

Bill Type Codes

Payers may also require behavioral health facilities to provide bill-type codes for classification. The bill type shows how a client enrolled in the PHP program. Some common bill-type codes include:

• 131 for patients joining the program through discharge from an inpatient plan 
• 132 for interim first admission 
• 133 for continuing admission 

Non-Medicare Billing

Most of the codes described above apply to Medicare reimbursement claims and may vary slightly depending on the payer. Behavioral health organizations offering PHP services should use the billing codes provided by the payer when Medicare is not the primary payer. However, the following general billing codes are common with Non-Medicare payers. 

• HCPCS code S9475 accompanied by bill type code 131 and revenue code 0912 for substance abuse treatment services, per diem.
• HCPCS code H0035 accompanied with bill type 131 and revenue code 0912 or 0913 for mental health PHP services, less than 24 hours. 

Enhance PHP Billing Accuracy 

There are numerous PHP billing codes that every behavioral health organization should know. Billing staff should memorize and enter the correct code to avoid reimbursement denials or delays. However, the risk of errors is high when facilities use manual billing systems. PHP billing software can enhance billing accuracy in your behavioral health organization. The software also improves productivity and efficiency since little time goes into memorizing or retrieving the PHP billing codes. 

Revolutionize Your PHP Billing with Logik Solution 

At Logik, we understand the role of PHP billing codes in your revenue cycle. Revenue from PHP services accounts for a considerable portion of your total earnings. Errors leading to reimbursement delays or denials affect your revenue cycle and profits.

Do not allow wrong PHP billing codes to eat into your revenue and profits. Eliminate the errors today with Logik’s comprehensive billing software. Logik improves your revenue cycle management by eliminating human errors that may lead to claim denials or delays. Moreover, our billing software simplifies the admission, billing, and reimbursement processes to allow you ample time to attend to other equally important issues in your organization. Schedule a demo today.