New Condition Code 92: Billing Requirements for IOP Services

Related CR Release Date: December 20, 2023
Effective Date: January 1, 2024
Implementation Date: January 2, 2024
MLN Matters Number: MM13222
Related Change Request (CR) Number: CR 13222 & CR 13496
Related CR Transmittal Number: R12423CP, R12425GI, & R12425BP

CR 13222 tells you about:

  • New condition code "92" identifies claims for Intensive Outpatient Program (IOP) services
  • Intensive Outpatient Program (IOP) services will get per diem payments under the Outpatient Prospective Payment System (OPPS) when billed by an OPPS provider
  • Medicare covers and pay for these services for people with mental health needs who require this level of care
  • These billing requirements apply when IOP is provided by:
    • Hospital and CAH outpatient departments
    • CMHCs

Make sure your billing staff knows of these changes effective January 1, 2024.

View the complete CMS Medicare Learning Network (MLN) Matters (MM)13222.

Last Updated Jan 04 , 2024