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Friday, December 12, 2014

WCH Account Specialist Julia Kruglova

APG CPT /HCPCS Billing Code

S9480 – Intensive Outpatient psychiatric services, per diem.

NOTE: The S9480 code went into effect 1/1/2011; priorto that date if a program utilized a specific IOS trackthe program could claim two group services on onevisit date. After 1/1/2011 programs may only bill forIOS using S9480.

Programs without a specific IOS track are not for anydate of service permitted to bill two groups for thesame patient on the same visit date.

Category Specific Medicaid Billing Limits

Intensive outpatient treatment is a time-limited service and should not exceed 6 weeks without clinical justification. Programs may not bill for more than 6 weeks of intensive outpatient service without a clinical rationale included in the patient’s record in either a progress note or in the treatment / recovery plan. (e.g. ASAM or LOCADTR and in accordance with Part 822 regulations.).

Programs bill for IOS daily and patients must attend at least 3 hours of service on any given day. Patients must be scheduled for 9 hours of service each week to meet the level of care requirement, however, IOS is billed on a daily basis regardless of the total weekly attendance of any individual patient. Programs can bill for medication administration, medication management, complex care, peer services and collateral contacts in addition to IOS but may not bill other service categories while a patient is in the IOS service. The only exception to this is if a patient attends IOS services for less than 3 hours on a given day, in which case, the program may bill for the discrete services delivered.

NOTE: Programs that do not have a formal IOS program or have patients who cannot attend the IOS, may meet this level of care, admit and treat patients in need of IOS services, through a more intensive group, individual and family counseling at the outpatient clinic level of care providing the increased intensity/ frequency of services is adequate to meet the needs of the patient. In this circumstance the program would not use the single IOS code S9480, but instead deliver; document and bill for the individual services delivered during the visit date. HOWEVER, in no event may the program bill for two of the same services on a single visit date e.g program may not bill for two individual or two groups service to the same patient on the same visit date.

Time Requirements

The patient is scheduled to attend at least 9 hours of treatment sessions per week provided in 3 hours of daily service.\

Delivering Staff

Clinical staff (including medical staff) as defined in Part 822 (working within their scope of practice).


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