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January 2, 2024

Intensive Outpatient Program Services

On or after January 1, 2024, Medicare Part B covers Intensive Outpatient Program (IOP) services for individuals with mental health needs provided in:

  • Hospital outpatient departments
  • Community Mental Health Centers (CMHCs)
  • Critical Access Hospital (CAH) outpatient departments
  • Rural Health Clinics (RHCs)
  • Federally Qualified Health Centers (FQHCs)
  • Opioid Treatment Programs (OTPs)

Hospitals, CMHCs and CAHs

  • General Billing Requirements
    Claims for IOP services must include the following:
    • Type of Bill:
      • Hospital = TOB 13X
      • CMHC = TOB 76X
      • CAH = TOB 85X
    • Condition Code 92
    • Revenue Code (and charge for each individual covered service furnished under an IOP)
    • HCPCS Codes (not required for CAHs)
    • Modifier PN or PO (when IOP services are furnished in off-campus provider-based departments of a hospital)
  • Interim Billing Requirements
    Submit daily, weekly or monthly claims as follows:
    • Sequential Billing
      • Submit claims in the same sequence in which the IOP services are furnished.
      • You must receive a remittance advice for the prior bill before you submit the next bill.
    • TOB Frequency & Patient Discharge Status Codes
      TOB Description Patient Discharge Status Code
      131, 761 or 851 Admit through Discharge Claim Other than 30
      132, 762 or 852 Interim – First Claim 30 (still a patient)
      133, 763 or 853 Interim – Continuing Claim 30 (still a patient)
      134, 764 or 854 Interim – Last Claim Other than 30
  • Additional Guidance

Other Providers

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