Clarification on Partial Hospitalization Programs (PHP) claims and codes

December 29, 2021

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.

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.

Policy Reference: TRICARE Policy Manual, Chapter 11, Section 2.5 and TRICARE Systems Manual, Chapter 2, Addendum N