FITLU01
New
HELP! I am looking for peer insight on a behavioral health billing issue we are encountering.
We are receiving denials when outpatient services (e.g., 90832–90838, 90839 for crisis, and psychological testing 96132–96133, 96136–96137) are billed on dates of service where the patient is actively enrolled in a PHP or IOP program at a separate facility. The payer’s rationale is that any services performed on those dates are considered included in the PHP/IOP facility per diem and are therefore not separately reimbursable, even when rendered by an independent provider under a separate contract different TIN/NPIs. Outpatient.
We are receiving denials when outpatient services (e.g., 90832–90838, 90839 for crisis, and psychological testing 96132–96133, 96136–96137) are billed on dates of service where the patient is actively enrolled in a PHP or IOP program at a separate facility. The payer’s rationale is that any services performed on those dates are considered included in the PHP/IOP facility per diem and are therefore not separately reimbursable, even when rendered by an independent provider under a separate contract different TIN/NPIs. Outpatient.
- Is this a common denial you are seeing?
- Do you avoid scheduling/billing these services on active PHP/IOP program days?
- Have you seen payer policies or contract language that clearly support or contradict this position?