October 6, 2022

When billing PHP services, revenue codes 0913 or 0912 should be filed with the correct Healthcare Common Procedure Coding System (HCPC) code to allow the system to calculate the appropriate allowed amounts to ensure proper payment.

Note: Revenue codes must be billed separately for each date of service.

Partial Hospitalization Program (PHP) and Intensive Outpatient Program (IOP) claims are to be submitted per policy as listed below:

Non-OPPS payable providers

• Revenue code 0912 can be billed with HCPC H0035 or by itself for half-day service
• Revenue code 0913 can be billed with HCPC H0037 or by itself for full-day service
• Revenue code 0905 or 0906 can be billed with H0015 or S9480

OPPS payable providers

• HCPC G0410 (Group psychotherapy other than multifamily group in partial hospital setting approx. 40-45 minutes)
• HCPC G0411 (Interactive group psychotherapy in a partial hospital setting approximately 40-45 minutes)
• Revenue code 0905 or 0906 can be billed with H0015 or S9480
• All claims must be billed with condition code 41 on CMS 1450 UB-04 Claim Form

Reference:

Clarification on Partial Hospitalization Programs (PHP) claims and codes

TRICARE Manuals - Display Chap 13 Sect 2 (Change 64, Aug 3, 2022) (health.mil)