• Submit partial hospitalization services with the following revenue codes: • 0912, 0913 or 0915 o If a separate contract for the hospital and psych DPU are in effect, submit partial hospitalization services and inpatient services on separate UB-04 claim forms. The HCPCS 2016 code is H0015, which is described as “Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including assessment, counseling; crisis intervention, and activity therapies or education. Revenue code 0916 should be billed under the specific patient, and not under the subscriber. 3) A message will display if diagnosis is not required. Revenue codes in medical billing used in hospital billing or institutional claim and used on UB-04 only. Revenue Code Code HCPCS Narrative Time Units 0914 90791 Psychiatric diagnostic. Does anyone have experience billing HCPCS code S0201 or H0035? When checking the HCPCS manual, H0035 is mental health oriented but Ive heard many substance abuse facilities are using this code regardless. Revenue Code 0892 Special Processed Drugs - FDA Approved Gene Therapy Added 04/01/2020 X Revenue Code 0907 Community behavioral health program (day treatment) Added 08/27/2015 X Revenue Code 0912 Partial hospitalization-less intensive Added 08/27/2015 X Revenue Code 0913 Partial hospitalization- intensive Added 08/27/2015 X 0007M. Behavioral Health Outpatient Revenue Codes. 2 Partial Hospitalization, Substance Use Disorders, Rehabilitation Treatment 0912 or 0913 H0035 H0035 3. We have updated the list of Revenue Codes for Medical Billingas per the latest information effective on 15 March 2020. Master Precertification List. UB04 Revenue Codes 0259 in section: 025X. It is outside of the scope of this Billing and Coding: Partial Hospitalization Programs A56685 article to list all circumstances where the services represented by CPT® code 96116 may be appropriately performed outside of the context of the Partial Hospitalization Programs L37633 LCD. Healthcare Common Procedure Coding System Code: H0035. This is generally used for private payers, as Medicare does not recognize these codes. The March 1, 2017 Medicaid Memo summarizes the ARTS program design and benefit changes that will be posted in the new ARTS Provider Manual in. Psych Care Services—Refer to the table below. The HCPCS 2016 code is H0015, which is described as “Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including assessment, counseling; crisis intervention, and activity therapies or education. 0913 Partial Hospitalization* - Intensive UB04 Revenue Code 0914 Individual Therapy UB04 Revenue Code 0915 Group Therapy UB04 Revenue Code 0916 Family Therapy UB04 Revenue Code 0917 Bio Feedback UB04 Revenue Code 0918 Testing UB04 Revenue Code 0919 Other Behavior Health Treatments/Services UB04 Revenue Code. The non -covered services defined in a member’s contract may include but are not limited to the following. We have been billing regular outpatient group therapy under rev code 0915 on the UB04. Revenue codes in medical billingare 4 digit numeric ids that are used in hospital bills to notify insurance companies that what type of services received by patients. REIMBURSEMENT POLICY Facility Based Mental Health Services. › Revenue Codes Requiring HCPCS Codes Stay informed. partial hospitalization regular - 4 hours 0912, 0913 partial hospitalization regular - 5 hours 0912, 0913 partial hospitalization regular - 6 hours 0912, 0913 partial hospitalization regular - 7 hours 0912, 0913 partial hospital collateral - 1 hour 0912, 0913 partial hospital collateral - 2 hours 0912, 0913. PROVIDER PRIOR AUTHORIZATION QUICK REFERENCE GUIDE. Revenue Code 0892 Special Processed Drugs - FDA Approved Gene Therapy Added 04/01/2020 X Revenue Code 0907 Community behavioral health program (day treatment) Added 08/27/2015 X Revenue Code 0912 Partial hospitalization-less intensive Added 08/27/2015 X Revenue Code 0913 Partial hospitalization- intensive Added 08/27/2015 X 0007M. Closer Look At IOP Billing For Behavioral Health Service. HCPCS Code for Alcohol and/or drug services; intensive. Payable revenue codes include 450, 451, and 452. The HCPCS 2016 code is H0015, which is described as “Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including assessment, counseling; crisis intervention, and activity therapies or education. Clarification on Partial Hospitalization Programs (PHP. Some payers will have specific requirements for how they want the revenue codes used to ensure correct reimbursement, so you can check your contracts and the claims filing instructions of the specific payers you work with, but I dont know of any industry standard for specific CPT codes being assigned to certain revenue codes. Revenue Codes in Healthcare for 2022. Partial Hospitalization • Submit partial hospitalization services with the following revenue codes: • 0912, 0913 or 0915 o If a separate contract for the hospital and psych DPU are in effect, submit partial hospitalization services and inpatient services on separate UB-04 claim forms. 0913 - Partial hospitalization - intensive 0914 - Individual therapy 0915 - Group therapy 0916 - Family therapy 0917 - Biofeedback 0918 - Testing 0919 - Behavioral health treatments: 092X: Other Diagnostic Services 0920 - General 0921 - Peripheral vascular. Molina Healthcare>Updated March 27, 2023 Provider Memorandum. Intensive Outpatient Program – IOP Billing Guidelines Explained. Some payers will have specific requirements for how they want the revenue codes used to ensure correct reimbursement, so you can check your contracts and the claims filing instructions of the specific payers you work with, but I dont know of any industry standard for specific CPT codes being assigned to certain revenue codes. Note:Revenue codes must be billed separately for each date of service. › Revenue Codes Requiring HCPCS Codes Stay informed. Rev Code 0905 w/HCPC S9480 Rev Code 0906 w/HCPC H0015 Rev Code 0912 or 0913 w/HCPC S0201 or H0035 Need to be billed with a GT or 95 modifier Telehealth (02) The place of service should be the regular place of service as if you saw the patient in-person (for facilities). Observation (OBV) revenue code This requirement stands on its own and will be independently edited by MCO as it relates to EAPG pricing. The January 2019 Integrated Outpatient Code Editor (I/OCE) will reflect the Healthcare Common Procedure Coding System (HCPCS), Ambulatory Payment Classification (APC), HCPCS Modifier, and Revenue Code additions, changes, and deletions identified in CR 11099. DMAS APPROVED CODES & RATES APPROVED BY CENTERS FOR MEDICARE. S0201 orrev 0913 with Partial HospitalizationS0201 20 or more hours of clinically intensive programming per week with a planned format of individualized and family therapies. HCPCS Code Short Name: Mh partial hosp tx under 24h. The HCPCS book says PHP, less than 24 hrs per diem for S0201. • Submit partial hospitalization services with the following revenue codes: • 0912, 0913 or 0915 o If a separate contract for the hospital and psych DPU are in effect, submit partial. Revenue code Definition: For inpatient services, the revenue code identifies the department in which the service was given, the types of services provided, and the supplies used. IOP (Intensive Outpatient Program) Outpatient Revenue Codes 0905 PHP(Partial Hospitalization Program) Outpatient Revenue Codes 0912 and/or 0913 Burn All DRG Codes 927-929 933-935 Primary diagnosis for Burn admission type overlaps into Trauma definition and will always group to Burn admission type. implemented in the January 2019 OPPS update. 0913 Partial Hospitalization* - Intensive UB04 Revenue Code 0914 Individual Therapy UB04 Revenue Code 0915 Group Therapy UB04 Revenue Code 0916 Family. Search for a Revenue Code X Last Updated Tue, 28 Jun 2022 17:25:39 +0000. Only one of these codes is payable per evaluee per day. TRICARE East policy updates and alerts. On a side note I find it funny that they are defining 0912 as SA and 0913 as MH PHP, when the NUCC classifies them as less/more intensive PHP for both SA and MH while at the same time linking the NUCC on their website. UB04 Revenue Codes 0913 in section: 091X - Behavioral Health Treatment/Services-Extension of 090X Home Codes UB04 viewing Wed Apr 26, 2023 0913 in section: 091X - Behavioral Health Treatment/Services-Extension of 090X UB04 Revenue Codes Code Information Subscribers will see UB04 condition/revenue codes and related material here. When billing PHP services, revenue codes 0913 or 0912 should be filed with the correct Healthcare Common Procedure Coding System (HCPC) code to allow. Revenue code Definition: For inpatient services, the revenue code identifies the department in which the service was given, the types of services provided, and the supplies used. Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including assessment, counseling; crisis intervention, and activity therapies or education H0015 - HCPCS Codes - Codify by AAPC Home Codes HCPCS HCPCS Codes. Revenue codes are a set of standardized 4-digit numbers used in medical billing. Revenue Code HCPCS Code Narrative Time. PDF REIMBURSEMENT POLICY Facility Based Mental Health Services. Get the latest information on COVID-19. Revenue Code (behavioral health setting): 0513, 0900, 0902-0905, 0907, 0911-0917, 0919 Telehealth visits with appropriate codes and any of above Mental Health Professionals is sufficient to qualify for this measures. UB04 Revenue Codes 0259 in section: 025X - Pharmacy (Also see 063X, an extension of 025X) Home Codes UB04 viewing Thu Apr 13, 2023 0259 in section: 025X - Pharmacy (Also see 063X, an extension of 025X) UB04 Revenue Codes Code Information Subscribers will see UB04 condition/revenue codes and related material here. Share this page HCPCS Modifiers In HCPCS Level II, modifiers are composed of two alpha or alphanumeric characters. There is a standard list of revenue codes in medical billing which is updated. Partial Hospitalization Program (PHP) services must be billed with below revenue codes and a CPT or HCPCS code descripting encounter. S9480 is a valid 2023 HCPCS code for Intensive outpatient psychiatric services, per diem or just “ Intensive outpatient psychia ” for short, used in Other medical items or services. It is outside of the scope of this Billing and Coding: Partial Hospitalization Programs A56685 article to list all circumstances where the services represented by CPT® code 96116 may be appropriately performed outside of the context of the Partial Hospitalization Programs L37633 LCD. 1 Intensive Outpatient, Psychiatric 0905 S9480 S9480 4. Procedure codes should match. com/_ylt=AwrhczTxPllkz3APVRBXNyoA;_ylu=Y29sbwNiZjEEcG9zAzIEdnRpZAMEc2VjA3Ny/RV=2/RE=1683599218/RO=10/RU=https%3a%2f%2fwww. Radiology - Therapeutic and/or Chemotherapy Admin - Chemo Admin - Oral. Observation (OBV) revenue code This requirement stands on its own and will be independently edited by Meridian, as it relates to EAPG pricing. This includes any code ranges that are considered Reserved for National Assignment. Services provided for a Medicare eligible member are billed with TOB 013X (Hospital Outpatient), condition code 41 and the Medicare allowed revenue codes with the. Revenue Code Definitions Note the revenue code definition for the following services—Acute Care, Rehab Care, and Psych Care: Acute Care Services—All other revenue code services outside of Rehab Care Services and Psych Care Services. com%2fcontent%2fhnfs%2fhome%2ftw%2fprov%2fclaims%2fbilling_tips%2fPHP_Claim_Tips. Billing and Coding: Psychiatric Partial Hospitalization Programs. Revenue code 0240 was inadvertently added to the listing of services not allowed and needs to be removed. 0900 - Behavioral Health Treatment/Services. These codes should be submitted on the same line for accurate claims processing. This is generally used for private payers, as Medicare does not recognize these codes. West Virginia prior authorization form Evernorth Behavioral. Revenue Code 0456 must be billed with one of the following HCPCS Codes: 99282, 99283, G0381, or G0382. Psychotherapy Institutional Services 0918 96118- 96119 Neuropsychological testing battery with interpretation or report 60 minutes 1 per hour Individual Behavioral Health Therapy. Clarification on Partial Hospitalization Programs (PHP) claims and codes. HCPCS Code Short Name: Mh partial hosp tx under 24h. Revenue Code 0890 Pharmacy - Extension Of 025X And 063X - Reserved (Use 0250 For General Classification) Revenue Code 0913 Partial hospitalization- intensive. Healthy Families, Healthy Start, ABD, Dual Options MyCare Ohio, or Adult Extension) prior to referencing this document. Revenue codes are a set of standardized 4-digit numbers used in medical billing. Billing and Coding: Partial Hospitalization Programs. The January 2019 Integrated Outpatient Code Editor (I/OCE) will reflect the Healthcare Common Procedure Coding System (HCPCS), Ambulatory Payment Classification (APC), HCPCS Modifier, and Revenue Code additions, changes, and deletions identified in CR 11099. All other services are non-covered services. 0913 ; Partial Hospitalization - intensive; 13X ; Hospital - Outpatient; 86X; Special Facility - Residential Facility; H0035; Revenue code ICD-10 CM code Date of birth Type of bill code; 0912 ; Partial Hospitalization - less intensive; 0913 ; Partial Hospitalization - intensive; 13X ; Hospital - Outpatient; 86X;. Radiology - Therapeutic and/or Chemotherapy Admin - Chemo Admin- IV. Revenue code Definition: For inpatient services, the revenue code identifies the department in which the service was given, the types of services provided, and the supplies used. Please be sure to identify the Medicaid program (e. October 6, 2022. Claims for all other members should be billed with TOB 013X (Hospital Outpatient), revenue codes 0912-0913 and HCPCS code H0035. Rev Code 0905 w/HCPC S9480 Rev Code 0906 w/HCPC H0015 Rev Code 0912 or 0913 w/HCPC S0201 or H0035 Need to be billed with a GT or 95 modifier Telehealth (02) The place of service should be the regular place of service as if you saw the patient in-person (for facilities). Use revenue code 0912 or 0913 Append CPT code H0035 for adults or H0035 HA for children or adolescent services as the procedure code Report the attending provider as the physician who has overall responsibility for the patient’s medical care and treatment PRIOR AUTHORIZATI0N, NOTIFICATION AND THRESHOLD INFORMATION. We have an outpatient SA facility in Florida. Florida Blue defines revenue code 0912 as partial hospitalization for chemical dependency and revenue code 0913 as partial hospitalization for psychiatric services. 0913 - Partial hospitalization - intensive 0914 - Individual therapy 0915 - Group therapy 0916 - Family therapy 0917 - Biofeedback 0918 - Testing 0919 - Behavioral health treatments: 092X: Other Diagnostic Services 0920 - General 0921 - Peripheral vascular lab 0922 - Electromyelogram 0923 - Pap smear 0924 - Allergy test 0925 - Pregnancy test. Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. Psychiatric Partial Hospitalization Programs. Billing and Coding: Partial Hospitalization >Article. USL # Standard Services Revenue Code CPT/HCPCS Codes HCPCS Modifier CPT/ HCPCS Codes HCPCS Modifier Place of Service Code Hospitalization 1. Billing For Behavioral Health Service >Closer Look At IOP Billing For Behavioral Health Service. BEHAVIORAL HEALTH HEDIS CODING GUIDE. UB04 Revenue Codes 0913 in section: 091X. partial hospitalization regular - 4 hours 0912, 0913 partial hospitalization regular - 5 hours 0912, 0913 partial hospitalization regular - 6 hours 0912, 0913 partial hospitalization regular - 7 hours 0912, 0913 partial hospital collateral - 1 hour 0912, 0913 partial hospital collateral - 2 hours 0912, 0913. If more than one HCPCS, CPT or NDC code is needed for a revenue code, the revenue code should also appear on a separate line. Revenue Code Description; 251 : Pharmacy, generic drugs : 252 : Pharmacy, non-generic drugs : 253 : Pharmacy, take home drugs : 254 : Pharmacy, less than effective. Revenue code 0916 should be billed under the specific patient, and not under the subscriber. Florida Blue defines revenue code 0912 as partial hospitalization for chemical dependency and revenue code 0913 as partial hospitalization for psychiatric services. Rev Code 0913Observation (OBV) revenue code This requirement stands on its own and will be independently edited by MCO as it relates to EAPG pricing. Aug 20, 2015. service. Behavioral Health Evaluation or Testing Testing (revenue code 0918) is compatible with all behavioral health diagnosis codes. partial hospitalization regular - 4 hours 0912, 0913 partial hospitalization regular - 5 hours 0912, 0913 partial hospitalization regular - 6 hours 0912, 0913 partial hospitalization. Rehab Care Services—Refer to the table below. Each component of the above requirements will be individually evaluated when processing an 837I institutional outpatient claim. revenue code 250) do not require the National Drug Code (NDC) to be billed on the corresponding revenue service line. Partial hospitalization - less intensive (revenue code 0912) Partial hospitalization - intensive (revenue code 0913) Adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care provider, face-to-face with one patient, each 15 minutes (CPT code 97153). A revenue code and corresponding supporting code must be compatible. Some payers will have specific requirements for how they want the revenue codes used to ensure correct reimbursement, so you can check your contracts and the claims filing instructions of the specific payers you work with, but I dont know of any industry standard for specific CPT codes being assigned to certain revenue codes. Revenue code list with description. must be coded with revenue code 0913. 99282 – Emergency room visit for the evaluation and management of a patient, which requires the following three components:. Revenue Code (behavioral health setting): 0513, 0900, 0902-0905, 0907, 0911-0917, 0919 Telehealth visits with appropriate codes and any of above Mental Health Professionals is sufficient to qualify for this measures. UB04 Revenue Codes 0913 in section: 091X - Behavioral Health Treatment/Services-Extension of 090X Home Codes UB04 viewing Wed Apr 26, 2023 0913 in section: 091X - Behavioral Health Treatment/Services-Extension of 090X UB04 Revenue Codes Code Information Subscribers will see UB04 condition/revenue codes and related material here. 0913 ; Partial Hospitalization - intensive; 13X ; Revenue code ICD-10 CM code Date of birth Type of bill code; 0912 ; Partial Hospitalization - less intensive; 0913 ;. I PROVIDER PRIOR AUTHORIZATION QUICK REFERENCE GUIDE. Psychiatric and Substance Abuse Facilities. This would include a cook, housekeeper, laundry worker, maid, butler, companion, nurse and babysitter. Continuing Stay Criteria The individual treatment plan should include documentation of diagnosis (DSM 5), discharge planning, individualized goals of treatment, and treatment modalities needed and provided on a two-hour basis. IOP (Intensive Outpatient Program) Outpatient Revenue Code 0906 PHP (Partial Hospitalization Program) Outpatient Revenue Codes 0912 and/or 0913 Chemotherapy All DRG code 837-839, 846-848 Excluded from Inpatient DRG Cap Dialysis Outpatient Hemodialysis Revenue Codes 0821, 0825, 0829 Peritoneal Dialysis Revenue Codes. Partial Hospitalization • Submit partial hospitalization services with the following revenue codes: • 0912, 0913 or 0915 o If a separate contract for the hospital and psych DPU are in effect, submit partial hospitalization services and inpatient services on separate UB-04 claim forms. The HCPCS book says PHP, less than 24 hrs. State: Illinois Line of Business: Medicaid Date: July 2018 Re. Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including assessment, counseling; crisis intervention, and activity therapies or education H0015 - HCPCS Codes - Codify by AAPC Home Codes HCPCS HCPCS Codes. Partial hospitalization - intensive (revenue code 0913) Adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care provider, face-to-face with one patient, each 15 minutes (CPT code 97153). These codes should be submitted on the same line for accurate claims processing. Code 0913 applies to domestics engaged exclusively in household or domestic work performed principally inside of the insured’s residence. HCPC, and REV code. Revenue code Definition: For inpatient services, the revenue code identifies the department in which the service was given, the types of services provided, and the. Revenue Code HCPCS Code Narrative Time. Preferred Codes Universal Services List for UB. For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim. Revenue Code: 0905, 0907, 0912, 0913 OR – CMHC Visit: Any of Following Outpatient Setting Unspecified CPTs OR – BH Outpatient Visits Codes Follow-Up After Hospitalization for Mental Illness (FUH) Age 6 and older OR – Observation Visit CPTs: 99217-20 OR – TCM Services CPT: 99495, 99496 With – With CMHC POS: 53 OR – Electroconvulsive Therapy CPT:. Please Note: Not all codes referenced in this document are covered services for Ohio Medicaid Programs or all sites of service. Florida Blue is now telling us that 0914 and 0915 are not reimbursable codes as of 6/1/15 and they never should have been. One thing I did think of is billing the correct CPT under rev code 0961, but I could not find out anything. Partial Hospitalization, Psychiatric 0912 or 0913 H0035 H0035 3. Addiction and Recovery Treatment Services (ARTS) Billing >Addiction and Recovery Treatment Services (ARTS) Billing. Hello everyone, I had a few questions regarding HCPCS and TOB. Partial hospitalization - intensive (revenue code 0913) Adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care provider, face-to-face with one patient, each 15 minutes (CPT code 97153). Florida Blue defines revenue code 0912 as partial hospitalization for chemical dependency and revenue code 0913 as partial hospitalization for psychiatric services. Master Outpatient Precertification List. Procedure codes may be subject to National Correct Coding Initiative (NCCI) edits or OPPS packaging edits. Code CPT H0015 or rev 0906 S0201 or rev 0913 H2034 H0010 Rev 1002 H0010 Rev 1002 H0010 Rev 1002 H2036 Rev 1002 H2036 Rev 1002 H2036 Rev 1002 H0011 Rev 1002 HCPCS and. The Plan requires outpatient facility providers and hospitals to indicate the most appropriate Healthcare Common Procedure Coding System (HCPCS), Current Procedural Terminology (CPT) code(s), and National Drug Codes (NDC) in addition to the revenue code for all electronic outpatient facility claims. 2: Partial Hospitalization, Substance Use Disorders, Rehabilitation Treatment 0912 or 0913 H0035 H0035 3. Be sure your billing staffs are aware of these. Services Requiring Prior Authorization. Services provided for a Medicare eligible member are billed with TOB 013X (Hospital Outpatient), condition code 41 and the Medicare allowed revenue codes with the appropriate HCPCS code. 0912 Partial Hospitalization* - Less Intensive 0913 Partial Hospitalization* - Intensive 0944 Drug Rehabilitation 0945 Alcohol Rehabilitation WHAT’S INCLUDED? What is included also varies by payer. Partial Hospitalization Programs (PHP) Claim Tips. Revenue Code Description 240 All inclusive ancillary, general 260 Intravenous (IV) therapy 261 Intravenous (IV) therapy, infusion pump 262 Intravenous (IV) therapy, pharmacy services 263. The Plan requires outpatient facility providers and hospitals to indicate the most appropriate Healthcare Common Procedure Coding System (HCPCS), Current Procedural Terminology (CPT) code(s), and National Drug Codes (NDC) in addition to the revenue code for all electronic outpatient facility claims. Behavioral Health Outpatient Revenue Codes: 0513,0520,0900 U ì õ í ð U ì õ í ò 1 HOUR 0912, 0913 PARTIAL HOSPITALIZATION CRISIS - 2 HOURS 0912, 0913 PARTIAL HOSPITALIZATION CRISIS - 3 HOURS 0912, 0913 PARTIAL HOSPITALIZATION CRISIS - 4 HOURS 0912, 0913. BCBSTX Admission Type Definitions – Grouper Version 30>BCBSTX Admission Type Definitions – Grouper Version 30. Revenue Codes Requiring HCPCS Codes These revenue codes will only be considered for reimbursement on outpatient claims if billed with appropriate HCPCS code (s). 2) Choose the appropriate code from the drop-down menu. 0912 Partial Hospitalization* - Less Intensive 0913 Partial Hospitalization* - Intensive 0944 Drug Rehabilitation 0945 Alcohol Rehabilitation WHAT’S INCLUDED?. Refer to NCCI and OPPS requirements prior to billing Medicare. Only one of these codes is payable per evaluee per day. Revenue Codes Requiring HCPCS Codes. These changes are effective for dates of services on or after April 1, 2017. October 6, 2022 / Clarification on Partial Hospitalization Programs (PHP) claims and codes When billing PHP services, revenue codes 0913 or 0912 should be filed with the correct Healthcare Common Procedure Coding August 4, 2022 / Abortion coverage guidelines for TRICARE beneficiaries. Revenue codes that do not require HCPC Pharmacy 0250-0259 M&S Supplies and device 0270-0273, 0275-0279 Anesthesia 0370-0379 Supplies 0620-0622 Recovery Room 0710, 0719 Accordingly, general pharmacies (e. Services provided for a Medicare eligible member are billed with TOB 013X (Hospital Outpatient), condition code 41 and the Medicare allowed revenue codes with the appropriate HCPCS code. In this case, a leading 0 is implied. HCPCS Coverage Code: Not payable by Medicare. Florida Blue defines revenue code 0912 as partial hospitalization for chemical dependency and revenue code 0913 as partial hospitalization for psychiatric services. Consult the member booklet for a complete listing of all non. H0015/0906: The per diem outpatient IOP code for all chemical dependency is H0015, and is always paired with revenue code 0906. Revenue Code Description 240 All inclusive ancillary, general 260 Intravenous (IV) therapy 261 Intravenous (IV) therapy, infusion pump 262 Intravenous (IV) therapy, pharmacy services 263. Revenue Codes Refer to National Uniform Billing Committee (NUBC) information for expanded definitions of codes. 98, Change Request #3343, July 23, 2004, revises Change Request #3194 by changing the effective date for the discontinuation of revenue code 0910 to dates of service on or after October 16, 2003. 0913 ; Partial Hospitalization - intensive; 13X ; Hospital - Outpatient; 86X; Special Facility - Residential Facility; H0035; Revenue code ICD-10 CM code Date of. 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. Revenue code 0240 was inadvertently added to the listing of services not allowed and needs to be removed. Master Precertification List April 2023. Does anyone have experience billing HCPCS code S0201 or H0035? When checking the HCPCS manual, H0035 is mental health oriented but Ive heard many substance abuse facilities are using this code regardless. These revenue codes will only be considered for reimbursement on outpatient claims if billed with appropriate HCPCS. Behavioral Health Treatments/Services–Extension of 090X– Partial Hospitalization–Intensive. October 6, 2022 / Clarification on Partial Hospitalization Programs (PHP) claims and codes When billing PHP services, revenue codes 0913 or 0912 should be filed with the correct Healthcare Common Procedure Coding August 4, 2022 / Abortion coverage guidelines for TRICARE beneficiaries. HCPC, and REV code. Usually presenting problems are self-limited or minor. IOP (Intensive Outpatient Program) Outpatient Revenue Codes 0905 PHP(Partial Hospitalization Program) Outpatient Revenue Codes 0912 and/or 0913 Burn All DRG Codes 927-929 933-935 Primary diagnosis for Burn admission type overlaps into Trauma definition and will always group to Burn admission type. Revenue Code 510 and CPT 99204 same date of service. Refer to NCCI and OPPS requirements prior to billing. Partial Hospitalization Program. Healthcare Common Procedure Coding System Code: H0035. CODES & RATES APPROVED BY CENTERS FOR MEDICARE >DMAS APPROVED CODES & RATES APPROVED BY CENTERS FOR MEDICARE. Florida Blue is now telling us that 0914 and 0915 are not reimbursable codes as of 6/1/15 and they never should have been. • Presence of the disorder(s) must be documented through the assignment of a DSM 5 code for the primary diagnosis. Intravenous (IV) therapeutic drug, supply and delivery 264 Intravenous (IV) therapy, supplies 269 Intravenous (IV) therapy, other 274. Inpatient Revenue Codes 1001 Partial Day: Half Day Outpatient Revenue Codes 0905, 0910 and/or 0914 Partial Day: Full Day Outpatient Revenue Codes 0912, 0913 and/or 0915 Intensive Outpatient Revenue Codes 0913 and/or 0905 Less Intensive Outpatient Revenue Codes 0912 Behavioral Health Contract Eff Date 8/01/2012 and After. BCBSTX Admission Type Definitions – Grouper Version 30. Billing Guide for partial hospitalization. Partial Hospitalization Program (PHP) services must be billed with below revenue codes and a CPT or HCPCS code descripting encounter. Use revenue code 0912 or 0913 Append CPT code H0035 for adults or H0035 HA for children or adolescent services as the procedure code Report the attending provider as the physician who has overall responsibility for the patient’s medical care and treatment PRIOR AUTHORIZATI0N, NOTIFICATION AND THRESHOLD INFORMATION. Revenue Code Definitions Note the revenue code definition for the following services—Acute Care, Rehab Care, and Psych Care: Acute Care Services—All other revenue code services outside of Rehab Care Services and Psych Care Services. Although codes are four digits, you may see codes with only three digits. We have updated the list of Revenue Codes for Medical Billingas per the latest information effective on 15 March 2020. Note: Any codes not listed within this table are not currently in use by CMS. CPT or NDC code with a revenue code unless otherwise specified in the provider contract. • Presence of the disorder(s) must be documented through the assignment of a DSM 5 code for the primary diagnosis. Outpatient Facility and Hospital Claims: Revenue Codes. List of Revenue Codes for Medical Billing (2023). Claims for all other members should be billed with TOB 013X (Hospital Outpatient), revenue codes 0912-0913 and HCPCS code H0035. Procedure codes may be subject to National Correct Coding Initiative (NCCI) edits or OPPS packaging edits. Maryland PBHS Provider Billing Appendix. Speech Therapy–Language Pathology–General. 0913 Partial Hospitalization* - Intensive UB04 Revenue Code 0914 Individual Therapy UB04 Revenue Code 0915 Group Therapy UB04 Revenue Code 0916 Family Therapy UB04 Revenue Code 0917 Bio Feedback UB04 Revenue Code 0918 Testing UB04 Revenue Code 0919 Other Behavior Health Treatments/Services UB04 Revenue Code. For visit level the facility uses an entirely different criteria than the physician so they do not necessarily match. Please Note: Not all codes referenced in this document are covered services for Ohio Medicaid Programs or all sites of service. Speech Therapy–Language Pathology–Visit Charge. Revenue Code Description; 251 : Pharmacy, generic drugs : 252 : Pharmacy, non-generic drugs : 253 : Pharmacy, take home drugs : 254 : Pharmacy, less than effective. Revenue code 913 for: Psychiatric Partial Hospitalization - all-inclusive per diem payment of six or more hours (full day); or Substance Use Disorder Partial Hospitalization - all inclusive per diem payment of six or more hours (full day) Note: Revenue codes must be billed separately for each date of service. Revenue Code 0912 Partial Revenue Code 0913 Partial hospitalization- intensive Added 08/27/2015 X X 0007M Oncology (gastrointestinal neuroendocrine tumors), real-. 99281 – Emergency room visit for the evaluation and management of a patient. 3 Partial Hospitalization, Eating Disorders 0912. Behavioral Health Evaluation or Testing Testing (revenue code 0918) is compatible with all behavioral health diagnosis codes. Revenue Code 0907 Community behavioral health program (day treatment) Added 08/27/2015 X Revenue Code 0912 Partial hospitalization-less intensive Added 08/27/2015 X Revenue Code 0913 Partial hospitalization- intensive Added 08/27/2015 X 0007M Oncology (gastrointestinal neuroendocrine tumors), real-time. CMS R167CP - Centers for Medicare & Medicaid Services. Mar 15, 2020. UB04 Revenue Codes 0913 in section: 091X - Behavioral Health Treatment/Services-Extension of 090X Home Codes UB04 viewing Wed Apr 26, 2023 0913 in section: 091X - Behavioral Health Treatment/Services-Extension of 090X UB04 Revenue Codes Code Information Subscribers will see UB04 condition/revenue codes and related material here. Testing (revenue code 0918) is compatible with all behavioral health diagnosis codes. Additional billing 0907 0912 0913 093x 0941 0943 0944. 1) Begin by entering your CPT/REV/HCPCS Code (with the exception of J codes) or a keyword in the “Procedure” field. • Use revenue code 0912 or 0913 • Append CPT code H0035 for adults or H0035 HA for children or adolescent services as the procedure code • Report the attending provider as the physician who has overall responsibility for the patients medical care and treatment. Partial hospitalization program (PHP) claims must be coded with revenue code 0912. Revenue codes are set by the National Uniform Billing Committee (NUBC). 4) If a diagnosis is required, select a diagnosis from the drop-down menu. One thing I did think of is billing the correct CPT under rev code 0961, but I could not find out anything. Revenue Code: 0905, 0907, 0912, 0913 OR – CMHC Visit: Any of Following Outpatient Setting Unspecified CPTs OR – BH Outpatient Visits Codes Follow-Up After Hospitalization for Mental Illness (FUH) Age 6 and older OR – Observation Visit CPTs: 99217-20 OR – TCM Services CPT: 99495, 99496 With – With CMHC POS: 53 OR – Electroconvulsive Therapy CPT:. Revenue codes and procedure code combinations that are submitted on outpatient claims should reflect the services that were provided to the member on that date of service. 3 Partial Hospitalization, Eating Disorders 0912 or 0913 H0035 H0035 Intensive Outpatient Treatment 4. PHP Services: H0035 (+Rev code 0912, 0913) IOP Services : 90899 (+Rev Code 0905, 0906) SUD Residential Treatment Facility Services: H2034-U1, H2034-U2, H0010-U1,. 0912 Partial Hospitalization* - Less Intensive 0913 Partial Hospitalization* - Intensive 0944 Drug Rehabilitation 0945 Alcohol Rehabilitation WHATS INCLUDED? What is included also varies by payer. Many include professional services in the per diem rate, but most have exceptions. For example, revenue code 761 is the same as revenue code 0761. 0913 - Partial hospitalization - intensive 0914 - Individual therapy 0915 - Group therapy 0916 - Family therapy 0917 - Biofeedback 0918 - Testing 0919 - Behavioral health treatments: 092X: Other Diagnostic Services 0920 - General 0921 - Peripheral vascular lab 0922 - Electromyelogram 0923 - Pap smear 0924 - Allergy test 0925 - Pregnancy test. 0913 H0035 H0035 3. Procedure codes may be subject to National Correct Coding Initiative (NCCI) edits or OPPS packaging edits. Revenue Code 0451 must be billed with the following HCPCS Code: 99281 or G0380. HCPC, and REV code. Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including assessment, counseling; crisis intervention, and activity therapies or education H0015 - HCPCS Codes - Codify by AAPC Home Codes HCPCS HCPCS Codes. IOP (Intensive Outpatient Program) Outpatient Revenue Codes 0905 PHP(Partial Hospitalization Program) Outpatient Revenue Codes 0912 and/or 0913 Burn All DRG Codes 927-929 933-935 Primary diagnosis for Burn admission type overlaps into Trauma definition and will always group to Burn admission type. Be sure your billing staffs are aware of these changes. Only the basic emergency room fee is payable. Revenue code 450 is not payable with revenue codes 451 or 452; however, both 451 and 452 are payable for the same episode of service: a. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Reimbursement Rates for Addiction and Recovery Treatment. UB 04 (92) Revenue code list with description. If the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the Contracting Officer, in writing or by e-mail, and request formal directions regarding continued performance requirements. Revenue codes in medical billingare 4 digit numeric ids that are used in hospital bills to notify insurance companies that what type of services received by patients. implemented in the January 2019 OPPS update. Radiology - Therapeutic and/or Chemotherapy Admin - Radiation Therapy. CMS Publication 100-20, One-Time Notification Manual, Transmittal No. Centers for Medicare & Medicaid Services>CMS Manual System. If the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the Contracting Officer, in writing or by e-mail, and request formal directions regarding continued performance requirements. Each component of the above requirements will be individually evaluated when processing on an 837I – Institutional outpatient claim. Use these codes when billing behavioral health family and group therapy services on an 837I claim format. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. CMS Publication 100-20, One-Time Notification Manual, Transmittal No. html/RK=2/RS=LI8eCx_y8XSjKfUFBKfKOw6R3KQ- referrerpolicy=origin target=_blank>See full list on tricare-west. These are 4 digit number always starting with “0 (Zero)”. 98, Change Request #3343, July 23, 2004, revises Change Request #3194 by changing the effective date for the discontinuation of revenue code 0910 to dates of service on or after October 16, 2003. Complete absence of all Revenue. 00* 5 Hours per day minimum of clinical programming and minimum of 20 service hours per week. October 6, 2022 / Clarification on Partial Hospitalization Programs (PHP) claims and codes When billing PHP services, revenue codes 0913 or 0912 should be filed with the correct. Partial Hospitalization • Submit partial hospitalization services with the following revenue codes: • 0912, 0913 or 0915 o If a separate contract for the hospital and psych DPU are in effect, submit partial hospitalization services and inpatient services on separate UB-04 claim forms. Use these codes when billing behavioral health family and group therapy services on an 837I claim format. UB04 Revenue Codes 0913 in section: 091X - Behavioral Health Treatment/Services-Extension of 090X Home Codes UB04 viewing Wed Apr 26, 2023. 2: Partial Hospitalization, Substance Use Disorders, Rehabilitation Treatment 0912 or 0913 H0035 H0035. Observation (OBV) revenue code This requirement stands on its own and will be independently edited by MCO as it relates to EAPG pricing. We have been billing regular outpatient group therapy under rev code 0915 on the UB04. Procedure Codes 1. Revenue Code: 0905, 0907, 0912, 0913 OR – CMHC Visit: Any of Following Outpatient Setting Unspecified CPTs OR – BH Outpatient Visits Codes Follow-Up After Hospitalization for Mental Illness (FUH) Age 6 and older OR – Observation Visit CPTs: 99217-20 OR – TCM Services CPT: 99495, 99496 With – With CMHC POS: 53 OR – Electroconvulsive. This memo notifies providers of reimbursement rates for Addiction and Recovery Treatment Services (ARTS). • Use revenue code 0912 or 0913 • Append CPT code H0035 for adults or H0035 HA for children or adolescent services as the procedure code • Report the. The revenue code is usually accompanied by a CPT code to indicate the level of the service provided. Healthcare Common Procedure Coding System Code: H0035. Hospitalization, Psychiatric 0114, 0124, 0913 H0035 H0035 3. Revenue Codes reflect the four-digit field and approved by the National Uniform Billing Committee, USA. Revenue code 913 for: Psychiatric Partial Hospitalization – all-inclusive per diem payment of six or more hours (full day); or Substance Use Disorder Partial Hospitalization – all inclusive per diem payment of six or more hours (full day) Note: Revenue codes must be billed separately for each date of service. HCPCS Coverage Code: Not payable by Medicare. PROCEDURE CODE BENEFIT LOOKUP INSTRUCTIONS. S0201 orrev 0913 with Partial HospitalizationS0201 20 or more hours of clinically intensive programming per week with a planned format of individualized and family therapies. 0913 ; Partial Hospitalization - intensive; 13X ; Revenue code ICD-10 CM code Date of birth Type of bill code; 0912 ; Partial Hospitalization - less intensive; 0913 ;. Similar Article: 5 Insurance Billing Errors Drug Treatment Centers Can Avoid Pre-authorization, clinical and IOP all go hand in hand. In most instances Revenue Codes are purely advisory. These are 4 digit number always starting with 0 (Zero). Family Therapy (revenue code 0916) may be subject to specific contract exclusions for some self-insured groups. Services provided for a Medicare eligible member are billed with TOB 013X (Hospital Outpatient), condition code 41 and the Medicare allowed revenue codes with the appropriate HCPCS code.