Billing IOP for Medicare Patients

Arnkpc

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Local Chapter Officer
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16
Location
Denver, CO
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Does anyone have any tips for getting Medicare to Reimburse for Intensive Outpatient Programs (IOP)? I've been reading and looking over guidelines and I can't find anything useful. To make matters complicated, I believe my organization is technically in the process of getting credentialed now as a facility. (and waiting approval for the Rural Provider designation). But I waiting to get more information on that change.

For the record, I am in Colorado. And we are credentialed to do Substance abuse counseling and therapy. We have no problem billing Medicaid (technically CO RAE program) using H0015. But Medicare appears to be this elusive monster. From what I have read, Medicare prefers to treat IOP the same as counseling??? But that doesn't make much sense to me. While I am familiar with the CPT group therapy code 90853, the definition doesn't include time based units. So one hour group is the same as 3 hour groups. The Medicare allowable for 90853 is only $28.28. I try to use HCPCS H-codes for Substance abuse services as much as I can. But of course Medicare doesn't want those. So I keep just reading more and more Medicare data, but I still don't know what I should do.

Any advice or resources to get them to reimburse for IOP would be very appreciated. Even if it is more general information on other IOP details. For example, the more I read about Medicare Partial Hospitalization benefits, the more I feel like we fit that description. Especially if the Facility credential is finalized. Unfortunately, I have no idea how to bill using Partial hospitalization benefits. But, once I can confirm the Facility Credential, we match the POS 52 description to a T.

Thanks for the help.
 

Arnkpc

Contributor
Local Chapter Officer
Messages
16
Location
Denver, CO
Best answers
0
No, I don't believe we are enrolled as an OTP. Right now, we have someone who is working on some of our contracts and credentialing and I am waiting for them to respond to a fairly long email and provide some new/updated contracts. I will have to look into whether we could enroll since we are licensed with the State as a substance use disorder Facility, but we can't provide Methadone to treat opioid disorders since we aren't a methadone clinic. But we do Vivitrol, Suboxone, Probuphrine etc.... I don't know.

Anyways, thank you for all the information. I really appreciate it.
 
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