Reminder: Blue Cross now covers partial hospitalization program services for substance use disorders

Effective July 1, 2023, Blue Cross Blue Shield of Michigan will cover partial hospitalization program, or PHP, services for substance use disorders, as announced in a May Record article.

This is an enhancement to behavioral health benefits for our commercial members.

Coding

Outpatient psychiatric care providers should report partial hospitalization program services for substance use disorders using HCPCS code S0201.

A quantity of one unit per date of service will be allowed for members of Blue Cross fully insured and self-funded groups. Quantities greater than one will reject back to the psychiatric provider as “daily max met, provider liable.”

For PHP services for substance use disorders provided in an outpatient hospital setting,  revenue code 0913 (partial hospitalization-intensive and more than four hours per day) should be reported with a substance use disorder diagnosis and a valid CPT/HCPCS procedure code combination.

About revenue code 0913

This code:

• Is considered fee-based reimbursement and processes under the “All-Other Remainder” category in the Participating Hospital Agreement.

• Is being added as payable when reported with a substance use disorder diagnosis in a freestanding residential substance abuse facility or outpatient substance abuse facility. Reimbursement in these locations will be based on an established rate.

Admission to a partial hospitalization program for substance use disorder will require preauthorization if the patient is admitted to a hospital or residential inpatient facility. Benefits may vary based on group specifics.