PHP billing services

PHP billing services for partial hospitalization programs.

HRI bills PHP programs end to end: verification, authorization, claims built to each payer's codes and hour rules, payment posting, denials, and appeals.

Updated September 2026

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What PHP billing runs on

Revenue codes 0912 / 0913, payer-specific
Per diem or hourly, minimum daily-hour thresholds
Authorization plus concurrent review on frequency
Every claim reported every Friday

Where PHP claims break

Level-of-care denials are usually the costliest: a payer decides PHP was not the right setting for a day, and that day's claim goes with it. Authorization is the second failure point — a claim goes out before enrollment or review is confirmed, or a review lapses mid-stay, and the days after are unpaid regardless of how the patient was doing.

The other two patterns are quieter. Hours not documented to a payer's threshold get a claim downgraded or denied, and per-diem claims billed like separate services, or the reverse, get kicked back on unit logic alone. In each case the care was delivered and the claim still failed.

The codes and the minimum hours

PHP bills on UB-04 revenue code 0912 or 0913, paired with an HCPCS code that varies by payer and diagnosis. Confirm each plan's current hour thresholds and code pairings before you submit.

Revenue code 0912: Partial hospitalization — less intensive
Revenue code 0913: Partial hospitalization — intensive
HCPCS H0035: Mental health partial hospitalization, treatment, less than 24 hours
HCPCS S0201: Partial hospitalization services, less than 24 hours, per diem
Billing unit: One payer's published policy requires 0912 or 0913 on every date of service, one unit per date — a per-diem structure, not per-service
Medicare's minimum: 20 hours per week of therapeutic services in the plan of care, plus physician certification at admission, first recertification by day 18, then at least every 30 days

What we do about it

HRI runs PHP billing under HRI Managed: benefit verification, authorization and concurrent review tracked to the date, and claims built to each payer's revenue code, HCPCS pairing, and hour documentation before they go out. A denied or stuck claim runs through the same seven-point diagnostic we apply to every claim. Every claim is reported to you every Friday, status, age, and next action included.

What it costs

PHP billing runs under the same published model as every level of care: a monthly minimum or a percentage of what we collect, whichever is greater, never both, with no setup fee when your operation is ready as it stands. Your exact numbers are set on a written quote after a billing review.

What HRI will not do

We will not promise a payer's authorization decision, a reimbursement rate, or how a plan will read your documentation — those calls belong to the payer and the reviewer. We will not bill a PHP claim before authorization and enrollment are confirmed.

Start with a billing review →

PHP billing, answered

What providers ask about PHP claims.

How is PHP billing different from IOP billing?

PHP typically bills per diem or hourly against a minimum daily-hour threshold; IOP bills per session or per day against a weekly frequency cap. The codes and denial patterns differ between the two.

Do you bill Medicaid PHP claims?

Yes. Medicaid PHP codes, hour thresholds, and prior-authorization rules are set state by state, so we confirm your state's current rules before any claim goes out.

What if PHP denials are already piling up?

Aged AR recovery is part of the engagement. We score every open PHP claim for what is still collectible, then correct and re-file the ones worth working while filing and appeal windows are still open.

Do you track authorization and concurrent review for us?

Yes, as part of HRI Managed. Authorization and concurrent review dates are tracked on our side, not left to surface as a denial later.

Does the billing review cost anything?

No. Tell us your PHP volume and payers, and where claims stall, and we come back with what to fix first. It needs no patient data.

Running PHP claims today?

Start with a billing review.

The review costs nothing, and you do not need to share any patient data to start.

Request a Billing Review → See PHP billing detail →

Last updated: September 25, 2026