Can Psych Visits be Billed Along with a Per Diem IOP Visit? How?

Whether psych visits can be billed alongside a per diem IOP visit varies by plan. When a plan allows it, the psych visit can be billed separately as a professional (physician) service on the CMS-1500, with the per diem (daily rate) IOP service billed as a facility service on the UB-04. Billing differs between weekly therapy visits on an ROP case and the once-a-month visits with a psychiatrist for medication management on a PHP/IOP basis. We have put this question to carriers directly many times.

Can you bill the H0015 code on a 1500 form?

No, H0015 is a “per diem” fee and must be billed on UB04.

Each payer may have its own rules on which services can be billed on the 1500 form and what documentation is required.

The CMS-1500 form is used for professional (physician) services, while the UB-04 form (also known as the CMS-1450 form) is used for institutional (facility) services. However, specific rules may vary depending on the payer and the type of service being provided.

If not what CPT code would you use for the physician fees?

H0015 is a HCPCS Level II code that describes alcohol and/or drug services. It is used to describe intensive outpatient treatment programs that operate at least 3 hours/day and at least 3 days/week and are based on an individualized treatment plan. The code includes assessment, counseling, crisis intervention, and activity therapies or education.

To identify the correct CPT code, consider the following information:

1. Procedure or service description: Determine the exact nature of the procedure or service provided by the physician. This may include diagnostic tests, surgeries, consultations, or other medical interventions.
2. Documentation and guidelines: Review the documentation and guidelines provided by the American Medical Association (AMA) in the Current Procedural Terminology (CPT) manual. The manual contains a comprehensive list of CPT codes along with descriptions, guidelines, and associated services.
3. Code selection: Based on the procedure or service description, identify the most appropriate CPT code that accurately represents the work performed by the physician. The code should align with the specific procedure, service, or evaluation provided.

Do you have to have both the UB-04 charges and the 1500 form or can you bill the physician charges without facility charges?

Whether S9480 is billed on the UB-04 or the CMS-1500 depends on the payer.

This depends on if you can separate out a psych visit at the IOP level. It would depend on if the plan requires psych visits included with IOP per diem. Some plans allow for outside provider psych visits to be done along with a coordination of care. However, when possible, the psych visit can be billed out separately- it would be billed on a HCFA-1500 as professional. IOP services are billed on UB04 since those are “per diem” fees. In some cases, this would need to be on a different day than the IOP service.

Again, here are a few scenarios to consider:

Professional services only: If the physician provided professional services without any facility-related services, you may bill only the physician charges using the CMS-1500 form.

Facility and professional services: If both facility-related services (such as hospital or clinic services) and physician services were provided, you may need to submit two separate claims. The facility charges would be billed on the UB-04 form, which is the institutional claim form, and the physician charges would be billed on the CMS-1500 form.

Facility-based professional services: In some cases, certain professional services may be considered facility-based, where the physician’s services are directly associated with a specific facility. In such instances, the facility charges and the associated professional services may be billed together on the UB-04 form.

Health Revenue Intelligence (HRI) also partners with behavioral-health providers on licensing, accreditation and billing.

Common codes are on the coding and billing cheat sheet.