PHP Billing Guidelines: Streamlining Revenue Cycle in Behavioral Health Facilities

Documentation Requirements

PHP, or Partial Hospitalization Programs, offer structured care for individuals transitioning between inpatient and outpatient treatment. To ensure proper reimbursement, behavioral health facilities must utilize the correct PHP billing codes. This article provides comprehensive PHP billing guidelines and commonly used codes to minimize errors and maximize revenue.

Certification

Certification is a crucial requirement for PHP programs. Behavioral health organizations must certify that clients would require inpatient hospitalization if not enrolled in partial hospitalization. Certification documents should be signed by a physician or clinical therapist.

Recertification

Recertification proves that a patient still needs PHP to mitigate the risk of inpatient hospitalization. Documents for recertification are signed by therapists or physicians treating the client. The first recertification occurs on the 18th day of partial hospitalization, with subsequent recertifications every 30 days.

PHP Billing Codes

Billing codes describe the services provided to clients and are essential for reimbursement purposes. PHP billing codes include CPT/HCPCS codes, sometimes accompanied by revenue codes and billing type codes as required by payers.

Common PHP Billing Codes (CPT/HCPCS codes):

  • 90785: Interactive complexities (list separately, accompanied by the primary procedure code).
  • 90791: Diagnostic evaluation.
  • 90832: Psychotherapy services lasting 30 minutes.
  • 90834: Psychotherapy lasting 45 minutes with the patient.
  • 90837: Psychotherapy services lasting 60 minutes.
  • 90846: Family psychotherapy without the patient present for 50 minutes.
  • 90847: Family psychotherapy with the patient present for 50 minutes.
  • 90849: Multiple-family group psychotherapy.
  • 90899: Unlisted service or procedure.
  • 96112: Developmental assessment for the first hour.
  • 96113: Developmental assessments for each additional 30 minutes.
  • 96116: Neurobehavioral status exam for the first hour.
  • 96121: Neurobehavioral status exam for each additional hour.
  • G0129: Occupational therapy services provided by a qualified occupational therapist for each 45-minute session.
  • G0176: Activity music, dance, art, or play therapies provided to the client.
  • G0177: Training and educational services.
  • G0410: Group therapy.
  • G0411: Interactive group therapies.
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General HCPCS Codes:

  • H0015: Alcohol or drug services, partial hospitalization per diem.
  • H0035: Mental health partial hospitalization treatment, less than 24 hours.
  • S0201: Partial Hospitalization, per diem.

Revenue Codes

Billing staff should accompany the CPT/HCPCS codes with relevant revenue codes:

  • 0250: Drugs and biologicals.
  • 043X: Occupational therapy.
  • 0900: Behavioral health services.
  • 0904: Activity therapy.
  • 0912: Behavioral health services – less intensive PHP.
  • 0913: Behavioral health services – Intensive PHP.
  • 0914: Individual therapy.
  • 0915: Group therapy.
  • 0916: Family therapy.
  • 0918: Testing services.
  • 0942: Other therapeutic services, such as training or education.
  • 0961: Professional fees.

Bill Type Codes

Payers may require bill-type codes for classification. Common bill-type codes include:

  • 131: Patients joining the program through discharge from an inpatient plan.
  • 132: Interim first admission.
  • 133: Continuing admission.

Non-Medicare Billing

While the codes described above apply to Medicare reimbursement claims, non-Medicare payers may have slight variations. However, there are general billing codes commonly used:

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

Enhance PHP Billing Accuracy

Memorizing and correctly entering PHP billing codes can be challenging, especially with manual billing systems. Implementing PHP billing software can significantly enhance accuracy, productivity, and efficiency in your behavioral health organization.

Revolutionize Your PHP Billing with ProgramMatek

At ProgramMatek, we understand the critical role of PHP billing codes in optimizing your revenue cycle. Errors in billing codes can lead to reimbursement denials and negatively impact profits. Our comprehensive billing software eliminates human errors, streamlining your admission, billing, and reimbursement processes. Schedule a free demo today!

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