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Intensive Outpatient Billing (IOP)

elena Posted Wed 31st of October, 2018 16:28:17 PM
I am a billing service that just acquired a Substance Abuse Treatment Facility. How do I bill for IOP (3 hour sessions, 3x per week)? Please provide the Codes, Place of Service & if billed on a CMS1500 or UB04 form.
SuperCoder Answered Thu 01st of November, 2018 07:24:54 AM

Hi Elena,

 

This is a complicated question. Our experts are working on this. Please be patient.

 

Thanks for your patience.

 

Regards

SuperCoder Team

SuperCoder Answered Fri 02nd of November, 2018 07:00:13 AM

Hi Elena,

 

Thanks again for your patience. Please find below, the answer to your query.

 

Please note that there are no standard guidelines for IOP billing. We are providing you the information regarding billing, coding, claim form, and POS. for IOP.

 

  • Please obtain the billing guidelines from your individual payers prior to rendering these services.
  • The following CPT/HCPCS codes may be reported to non-Medicare payers:
    • H0015 - Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week…
    • H2019 - Therapeutic behavioral services, per 15 minutes
    • H2020 - Therapeutic behavioral services, per diem
    • H2035 - Alcohol and/or other drug treatment program, per hour
    • H2036 - Alcohol and/or other drug treatment program, per diem
    • S9475 - Ambulatory setting substance abuse treatment or detoxification services, per diem
    • S9480 - (ntensive outpatient psychiatric services, per diem
  • Services covered in IOPs:
    • Individual psychotherapy (codes 90832-90838)
    • Group psychotherapy (codes 90853, G0410, G0411)
    • Family psychotherapy (codes 90846, 90847)
    • Multi-family psychotherapy (codes 90849)
  • Many payers need prior-authorization before rendering services.
  • Claim Form:- Since this is a facility, you should use claim form UB-04.
  • POS: The place of service depends upon the type of facility that the patient has received services.

 

Please feel free to write if you have any question.

 

Thanks

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