Wiki Medicare IOP Billing for Mental Health

[mthompson86]

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.

 

[Pam Warren]

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.

 

[ecurtis]

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.