Intensive Outpatient/Day Treatment/Partial Care

Billing and Reimbursement
Policy Number: RP-PI-002

Last Updated: Sept. 26, 2022

Intensive, medically necessary day/evening programming services, such as treatment programs, group and individual therapy and 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 UB04 claim form.     

All claims for day treatment, partial care and outpatient programs from a hospital-based program must be billed according to the UB04 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.