Wiki Medicare IOP Billing for Mental Health

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mthompson86

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Hello,

My office offers an intensive outpatient mental health program. At the beginning of the year, Medicare added this as a covered benefit. Has anyone billed out for IOP this year to Medicare? If so, what code and claim form did you use? Where did you put condition code 92 at? The resources I have found from Medicare are not very helpful and my EMR contacts are not sure how to do this either.
 
You cannot bill IOP from an office setting, only FQHC, Community Mental Health Centers, and Psychiatric or Acute care hospitals only. Here's information from Medicare: https://www.medicare.gov/coverage/mental-health-care-intensive-outpatient-program-services

IOP stands for Intensive outpatient....typically performed in a hospital setting, and generally a step down from partial hospitalization. If you're trying to do this on a 1500 form, that's incorrect. Except for the professional charges, these belong on a UB. The condition code goes on the UB FL boxes 18-28.
 
I work for an FQHC and we've been trying to figure this out. We're not really finding anything helpful and end up with more questions.
 
I have a question if anyone has input ...
FQHC billing for Behavioral Health visit with students in a local school. If an FQHC Provider visits a school to Provide BH Services for Students. Assuming the Provider and the FQHC site are both credentialed with Medicaid.
Can you bill Medicaid correctly with the FQHC site NPI in Line 32a and the address of the school in in line 32? Similar to a the billing for a Provider visiting a Pt in a Nursing home?
Would you use Place of Service as 50 FQHC or 03 School?
 
Hello! I work for a community mental health center. We are a virtual IOP. I am finding mixed messages about a virtual program. Does Medicare pay for a virtual IOP? If so, do we use G0411? With all other insurances, we use S9480. Appreciate any help!! Thanks!
 
Susanw720 said:
Hello! I work for a community mental health center. We are a virtual IOP. I am finding mixed messages about a virtual program. Does Medicare pay for a virtual IOP? If so, do we use G0411? With all other insurances, we use S9480. Appreciate any help!! Thanks!
Click to expand...
Hi! I hope you can help me. Our practice was recently approved to bill as CMHC with Medicare, since we are new to this process, I need some guidance. I understand that CMHC claims must be submitted on a UB04, but I'm unsure how billing differs between Medicare part B and Medicare Advantage Plans. For example, recently saw an Aetna patient who had one Psychotherapy session and three group therapy sessions. We billed 90837 and G0176 (x3). Aetna paid for 90837 but denied the G0176 code with the message "Claim/service denied because procedure/treatment is deemed experimental/investigational by the payer." We typically bill as an Outpatient Hospital using S9480 or H0035, but I'm not sure if those same codes apply for CMHC billing under MA Plans. Could you please clarify which codes should be used for CMHC billing Medicare part B and MA plans? Any guidance or resources you could share would be greatly appreciated.
Thank you, Pam - pam@oascms.com
 
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