| Bill Types | Hospitals - 131 - Admit through discharge
- 132 - Interim - First
- 133 - Interim - Continuing
- 134 - Interim - Last
Critical Access Hospital (CAHs) - 851 - Admit through discharge
- 852 - Interim - First
- 853 - Interim - Continuing
- 854 - Interim - Last
|
| Condition Code | Hospitals and CAHs report condition code 41 to indicate claim is for partial hospitalization services |
| Community Mental Health Center (CMHC) Revenue Codes CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 4, Section 260.1.1C | Partial Hospitalization Program (PHP) services must be billed with below revenue codes and a CPT or HCPCS code descripting encounter - 0250 - Drugs and Biologicals
- 043x - Occupational Therapy
- 0900 - Behavioral Health Treatment/Services
- 0904 - Activity Therapy
- 0914 - Individual Therapy
- 0915 - Group Therapy
- 0916 - Family Therapy
- 0918 - Testing
- 0942 - Education Training
|
| CPT/HCPCS for PHP Reimbursement CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 4, Section 260.1.1C | Hospitals other than CAHs are also required to report these CPT/HCPCS - G0129 - Occupational Therapy (Partial Hospitalization)
- 90791 or 90792 - Behavioral Health Treatment/Services
- G0176 - Activity Therapy (Partial Hospitalization)
- 90785, 90832, 90833, 90834, 90836, 90837, 90838, 90845, or 90880 - Individual Psychotherapy
- G0410 or G0411 - Group Pyshcotherapy
- 90846 or 90847 - Family Psychotherapy
- 96116 - Psychiatric Testing
- G0177 - Education Training
|
| Service Units | Report number of times a service or procedure was performed as described by code descriptor |
| Line Item Date of Service (LIDOS) | Report LIDOS per revenue code |
| Interim Billing on PHP Claims CMS Medicare Learning Network (MLN) Matters (MM) 8048 | Effective January 1, 2013 - Submit claim in service date sequence as services are furnished
- Prior claim must be finalized or incoming claim with RTP
|
| Eligible Professionals | - Physicians
- Nurse practitioners (NP)
- Physician assistants (PA)
- Clinical nurse specialists (CNS)
- Certified nurse midwives (CNM)
- Clinical psychologist (CP)
- Clinical Social Worker (CSW)
- Independently Practicing Psychologists (IPP)
|
| PHP Services | A PHP is furnished by a hospital to outpatients that provides partial hospitalization services. Partial hospitalization services are a distinct and organized intensive ambulatory psychiatric treatment program that offers less than twenty-four hour daily care to patients who either: - Have been discharged from inpatient hospital treatment
- Would be at reasonable risk of requiring inpatient hospitalization in absence of partial hospitalization
- Active treatment is furnished that incorporates an individual plan of care with a coordination of services designed to needs of patient
- Treatment includes a multidisciplinary team approach to care under direction of a physician and for a minimum of 20 hours per week
- Treatment goals
- Patient requires comprehensive, highly structured and scheduled multimodal treatment that requires medical supervision and coordination under plan of care
- Patient is able to cognitively and emotionally participate in active treatment
|
| Non-PHP Services | Below items are not PHP services and are paid according to Medicare provisions for each type of service - Services to hospital inpatients
- Meals
- Self-administered medications
- Transportation
- Vocational Training (Career)
|
| Payment for PHP CMS Internet Only Manual, Publication 100-04, Medicare Claims Processing Manual, Chapter 4, Section 260.1 | APC payment rate for PHP - 5863 - Partial Hospitalization (3 or more services per day) for hospital-based PHPs
- 5853 - Partial Hospitalization (3 or more services per day) for CMHCs
|
| Frequency of Billing | Monthly claims in sequence date order |
| Treatment Limitation | Outpatient mental health treatment limitation does not apply to such mental health services billed by a hospital outpatient department as partial hospitalization services |
| PHP Deductible/Coinsurance | Part B deductible and coinsurance does apply |
