Forum - Questions & Answers

Jul 17th, 2015 - lkeen4314 5 

Intensive Outpatient Program, Office setting

With IOP we have certain contracts as "group" or "facility" contracts with specific codes to bill insurances/medicaids for the service. However some individual insurances that we bill 90853 with 3 units are denying as "to many units billed". However if 1 unit is sent on a corrected claim then they only pay for 1 unit which is a very minimal amount. Is there a universal bill code for IOP? I see codes H0015 and S9480 which I'm assuming would need to bill on a UB not a HCFA.

Jul 17th, 2015 - Kat31477 56 

re: Intensive Outpatient Program, Office setting

90853 is the code for group psychotherapy, so you would only bill 1 unit per group member. Are you performing group therapy, individual therapy, etc?

Jul 17th, 2015 - jvosfernea 66 

re: Intensive Outpatient Program, Office setting

actually, this may depend on your state (or other insurance) contract. Such situations may be managed differently depending on the level of the practitioner and/or the reimbursement level.
In the state of MT, an LCPC or LCSW may bill for the entire length of the group session, for each attendee present, at the specific Group reimbursement rate. Though an ACM may not bill for ANY group process unless/until certain parameters have been met [* specific type of group, and the completion of specific training completed by the ACM, to allow ACM billing; * billing only one unit billed per Clt (up to 4 Clts for a one-hr group, regardless of how many attended), as had been written in another reply; * no more than 8 Clts/attendees in any group - whether therapist-led or approved ACM-led; etc].

So I would check your state Administrative Rules and whatever the insurance contract coverage of the Clt to see what is allowed on Group billing.

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