Intensive Outpatient/Day Treatment/Partial Care

Billing and Reimbursement
Policy Number: RP-PI-002

Last Updated: Feb. 21, 2024

Intensive, medically necessary day and evening programming services that include: treatment programs, group/ individual therapy, psychiatric, psychological, nursing and social work assessments.

Provision of these services in an organized program serves as an alternative to hospitalization for those who need a structured, psychiatrically directed, multi-disciplinary treatment program.   

These program services must be provided in a hospital or facility licensed by the relevant state agency or Commission on Accreditation of Rehabilitation Facilities. 

Free-Standing Intensive Outpatient/Day Treatment/Partial Care Programs 

For billing guidelines, please reference your contract.    

Hospital-Based Intensive Outpatient/Partial Care/Day Treatment Services 

Billing for hospital-based services is done on a UB-04 claim form.    

All claims for day treatment, partial care and outpatient programs from a hospital-based program must be billed according to the UB-04 billing guidelines.    

Special Note: A provider must be certified and a participating provider to be payable under federal mental illness and drug abuse guidelines (i.e., 42 C.F.R. Part 2).  

  • One revenue code and one unit may be billed for each day of program attendance.  
  • Services must be billed by line item and each line must have a date of service.  
  • Do not submit psychological testing by a hospital employee on a CMS-1500 claim form.  
  • Separate claims may not be submitted by or for program personnel.  

  If an employee is doing the psychiatric evaluation, it is included in the per diem rate.