Hospital-based PHP Billing Guide - JF Part A
Hospital-based PHP Billing Guide
Requirement | Description |
---|---|
Bill Types | Hospitals
Critical Access Hospital (CAHs)
|
Condition Code | Hospitals and CAHs report condition code 41 to indicate claim is for partial hospitalization services |
Community Mental Health Center (CMHC) Revenue Codes |
Partial Hospitalization Program (PHP) services must be billed with below revenue codes and a CPT or HCPCS code descripting encounter
|
CPT/HCPCS for PHP Reimbursement CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 3, Section 260.1.1C |
Hospitals other than CAHs are also required to report these CPT/HCPCS
|
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 |
Effective January 1, 2013
|
Eligible Professionals |
|
PHP Services |
A PHP is furnished by a hospital to outpatients that provides parital 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:
|
Non-PHP Services |
Below items are not PHP services and are paid according to Medicare provisions for each type of service
|
Payment for PHP CMS Internet Only Manual, Publication 100-04, Medicare Claims Processing Manual, Chapter 4, Section 260.1 |
APC payment rate for PHP
|
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 |
Last Updated Fri, 12 Aug 2022 20:08:09 +0000