SUPERSEDED LCD Reference Article Billing and Coding Article

Billing and Coding: Partial Hospitalization Programs

A56685

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.
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To see the currently-in-effect version of this document, go to the section.

Document Note

Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A56685
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Partial Hospitalization Programs
Article Type
Billing and Coding
Original Effective Date
07/11/2019
Revision Effective Date
01/01/2023
Revision Ending Date
12/31/2023
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

Copyright © 2023, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

Title XVIII of the Social Security Act, §1833(e) states that no payment shall be made to any provider for any claim which lacks the necessary information to process the claim.

CMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 4, §260.1 Special Partial Hospitalization Billing Requirements for Hospitals, Community Mental Health Centers, and Critical Access Hospitals

Article Guidance

Article Text

The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Partial Hospitalization Programs L37633.

Limitations

Noncovered-Reasonable and Necessary Denials

  1. CPT® codes 90875 and 90876

Response To Comments

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description
N/A

Revenue Codes

Code Description
N/A

CPT/HCPCS Codes

Group 1

(26 Codes)
Group 1 Paragraph

The CPT®/HCPCS codes listed in Group 1: Codes describe covered services when performed in the context of partial hospitalization. It is outside of the scope of this Billing and Coding: Partial Hospitalization Programs A56685 article to list all circumstances where the services represented by CPT® code 96116 may be appropriately performed outside of the context of the Partial Hospitalization Programs L37633 LCD. Absence of a diagnosis code in this Billing and Coding: Partial Hospitalization Programs A56685 article for other conditions for which these evaluations may be medically necessary does not imply non-coverage in those circumstances.

Group 1 Codes
Code Description
90785 Psytx complex interactive
90791 Psych diagnostic evaluation
90792 Psych diag eval w/med srvcs
90832 Psytx w pt 30 minutes
90833 Psytx w pt w e/m 30 min
90834 Psytx w pt 45 minutes
90836 Psytx w pt w e/m 45 min
90837 Psytx w pt 60 minutes
90838 Psytx w pt w e/m 60 min
90846 Family psytx w/o pt 50 min
90847 Family psytx w/pt 50 min
90899 Unlisted psyc svc/therapy
96116 Nubhvl xm phys/qhp 1st hr
96130 Psycl tst eval phys/qhp 1st
96131 Psycl tst eval phys/qhp ea
96132 Nrpsyc tst eval phys/qhp 1st
96133 Nrpsyc tst eval phys/qhp ea
96136 Psycl/nrpsyc tst phy/qhp 1st
96137 Psycl/nrpsyc tst phy/qhp ea
96138 Psycl/nrpsyc tech 1st
96139 Psycl/nrpsyc tst tech ea
G0129 Partial hosp prog service
G0176 Opps/php;activity therapy
G0177 Opps/php; train & educ serv
G0410 Grp psych partial hosp 45-50
G0411 Inter active grp psych parti

Group 2

(2 Codes)
Group 2 Paragraph

The following CPT® codes are Noncovered:

Group 2 Codes
Code Description
90875 Psychophysiological therapy
90876 Psychophysiological therapy
N/A

CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(225 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
Code Description
F06.0 Psychotic disorder with hallucinations due to known physiological condition
F06.2 Psychotic disorder with delusions due to known physiological condition
F06.30 Mood disorder due to known physiological condition, unspecified
F06.31 Mood disorder due to known physiological condition with depressive features
F06.32 Mood disorder due to known physiological condition with major depressive-like episode
F06.33 Mood disorder due to known physiological condition with manic features
F06.34 Mood disorder due to known physiological condition with mixed features
F06.4 Anxiety disorder due to known physiological condition
F10.132 Alcohol abuse with withdrawal with perceptual disturbance
F10.14 Alcohol abuse with alcohol-induced mood disorder
F10.150 Alcohol abuse with alcohol-induced psychotic disorder with delusions
F10.151 Alcohol abuse with alcohol-induced psychotic disorder with hallucinations
F10.159 Alcohol abuse with alcohol-induced psychotic disorder, unspecified
F10.180 Alcohol abuse with alcohol-induced anxiety disorder
F10.20 Alcohol dependence, uncomplicated
F10.232 Alcohol dependence with withdrawal with perceptual disturbance
F10.24 Alcohol dependence with alcohol-induced mood disorder
F10.250 Alcohol dependence with alcohol-induced psychotic disorder with delusions
F10.251 Alcohol dependence with alcohol-induced psychotic disorder with hallucinations
F10.259 Alcohol dependence with alcohol-induced psychotic disorder, unspecified
F10.280 Alcohol dependence with alcohol-induced anxiety disorder
F10.932 Alcohol use, unspecified with withdrawal with perceptual disturbance
F10.94 Alcohol use, unspecified with alcohol-induced mood disorder
F10.950 Alcohol use, unspecified with alcohol-induced psychotic disorder with delusions
F10.951 Alcohol use, unspecified with alcohol-induced psychotic disorder with hallucinations
F10.959 Alcohol use, unspecified with alcohol-induced psychotic disorder, unspecified
F10.980 Alcohol use, unspecified with alcohol-induced anxiety disorder
F11.14 Opioid abuse with opioid-induced mood disorder
F11.150 Opioid abuse with opioid-induced psychotic disorder with delusions
F11.151 Opioid abuse with opioid-induced psychotic disorder with hallucinations
F11.159 Opioid abuse with opioid-induced psychotic disorder, unspecified
F11.188 Opioid abuse with other opioid-induced disorder
F11.20 Opioid dependence, uncomplicated
F11.24 Opioid dependence with opioid-induced mood disorder
F11.250 Opioid dependence with opioid-induced psychotic disorder with delusions
F11.251 Opioid dependence with opioid-induced psychotic disorder with hallucinations
F11.259 Opioid dependence with opioid-induced psychotic disorder, unspecified
F11.94 Opioid use, unspecified with opioid-induced mood disorder
F11.950 Opioid use, unspecified with opioid-induced psychotic disorder with delusions
F11.951 Opioid use, unspecified with opioid-induced psychotic disorder with hallucinations
F11.959 Opioid use, unspecified with opioid-induced psychotic disorder, unspecified
F12.122 Cannabis abuse with intoxication with perceptual disturbance
F12.150 Cannabis abuse with psychotic disorder with delusions
F12.151 Cannabis abuse with psychotic disorder with hallucinations
F12.159 Cannabis abuse with psychotic disorder, unspecified
F12.180 Cannabis abuse with cannabis-induced anxiety disorder
F12.222 Cannabis dependence with intoxication with perceptual disturbance
F12.250 Cannabis dependence with psychotic disorder with delusions
F12.251 Cannabis dependence with psychotic disorder with hallucinations
F12.259 Cannabis dependence with psychotic disorder, unspecified
F12.280 Cannabis dependence with cannabis-induced anxiety disorder
F12.29 Cannabis dependence with unspecified cannabis-induced disorder
F12.922 Cannabis use, unspecified with intoxication with perceptual disturbance
F12.950 Cannabis use, unspecified with psychotic disorder with delusions
F12.951 Cannabis use, unspecified with psychotic disorder with hallucinations
F12.959 Cannabis use, unspecified with psychotic disorder, unspecified
F12.980 Cannabis use, unspecified with anxiety disorder
F13.132 Sedative, hypnotic or anxiolytic abuse with withdrawal with perceptual disturbance
F13.14 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced mood disorder
F13.150 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced psychotic disorder with delusions
F13.151 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced psychotic disorder with hallucinations
F13.159 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced psychotic disorder, unspecified
F13.180 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced anxiety disorder
F13.232 Sedative, hypnotic or anxiolytic dependence with withdrawal with perceptual disturbance
F13.24 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced mood disorder
F13.250 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced psychotic disorder with delusions
F13.251 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced psychotic disorder with hallucinations
F13.259 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced psychotic disorder, unspecified
F13.280 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced anxiety disorder
F13.932 Sedative, hypnotic or anxiolytic use, unspecified with withdrawal with perceptual disturbances
F13.94 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced mood disorder
F13.950 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced psychotic disorder with delusions
F13.951 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced psychotic disorder with hallucinations
F13.959 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced psychotic disorder, unspecified
F13.980 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced anxiety disorder
F14.122 Cocaine abuse with intoxication with perceptual disturbance
F14.14 Cocaine abuse with cocaine-induced mood disorder
F14.150 Cocaine abuse with cocaine-induced psychotic disorder with delusions
F14.151 Cocaine abuse with cocaine-induced psychotic disorder with hallucinations
F14.159 Cocaine abuse with cocaine-induced psychotic disorder, unspecified
F14.180 Cocaine abuse with cocaine-induced anxiety disorder
F14.222 Cocaine dependence with intoxication with perceptual disturbance
F14.24 Cocaine dependence with cocaine-induced mood disorder
F14.250 Cocaine dependence with cocaine-induced psychotic disorder with delusions
F14.251 Cocaine dependence with cocaine-induced psychotic disorder with hallucinations
F14.259 Cocaine dependence with cocaine-induced psychotic disorder, unspecified
F14.280 Cocaine dependence with cocaine-induced anxiety disorder
F14.922 Cocaine use, unspecified with intoxication with perceptual disturbance
F14.94 Cocaine use, unspecified with cocaine-induced mood disorder
F14.950 Cocaine use, unspecified with cocaine-induced psychotic disorder with delusions
F14.951 Cocaine use, unspecified with cocaine-induced psychotic disorder with hallucinations
F14.959 Cocaine use, unspecified with cocaine-induced psychotic disorder, unspecified
F14.980 Cocaine use, unspecified with cocaine-induced anxiety disorder
F15.122 Other stimulant abuse with intoxication with perceptual disturbance
F15.14 Other stimulant abuse with stimulant-induced mood disorder
F15.150 Other stimulant abuse with stimulant-induced psychotic disorder with delusions
F15.151 Other stimulant abuse with stimulant-induced psychotic disorder with hallucinations
F15.159 Other stimulant abuse with stimulant-induced psychotic disorder, unspecified
F15.180 Other stimulant abuse with stimulant-induced anxiety disorder
F15.222 Other stimulant dependence with intoxication with perceptual disturbance
F15.24 Other stimulant dependence with stimulant-induced mood disorder
F15.250 Other stimulant dependence with stimulant-induced psychotic disorder with delusions
F15.251 Other stimulant dependence with stimulant-induced psychotic disorder with hallucinations
F15.259 Other stimulant dependence with stimulant-induced psychotic disorder, unspecified
F15.280 Other stimulant dependence with stimulant-induced anxiety disorder
F15.922 Other stimulant use, unspecified with intoxication with perceptual disturbance
F15.94 Other stimulant use, unspecified with stimulant-induced mood disorder
F15.950 Other stimulant use, unspecified with stimulant-induced psychotic disorder with delusions
F15.951 Other stimulant use, unspecified with stimulant-induced psychotic disorder with hallucinations
F15.959 Other stimulant use, unspecified with stimulant-induced psychotic disorder, unspecified
F15.980 Other stimulant use, unspecified with stimulant-induced anxiety disorder
F16.122 Hallucinogen abuse with intoxication with perceptual disturbance
F16.14 Hallucinogen abuse with hallucinogen-induced mood disorder
F16.150 Hallucinogen abuse with hallucinogen-induced psychotic disorder with delusions
F16.151 Hallucinogen abuse with hallucinogen-induced psychotic disorder with hallucinations
F16.159 Hallucinogen abuse with hallucinogen-induced psychotic disorder, unspecified
F16.180 Hallucinogen abuse with hallucinogen-induced anxiety disorder
F16.183 Hallucinogen abuse with hallucinogen persisting perception disorder (flashbacks)
F16.24 Hallucinogen dependence with hallucinogen-induced mood disorder
F16.250 Hallucinogen dependence with hallucinogen-induced psychotic disorder with delusions
F16.251 Hallucinogen dependence with hallucinogen-induced psychotic disorder with hallucinations
F16.259 Hallucinogen dependence with hallucinogen-induced psychotic disorder, unspecified
F16.280 Hallucinogen dependence with hallucinogen-induced anxiety disorder
F16.283 Hallucinogen dependence with hallucinogen persisting perception disorder (flashbacks)
F16.94 Hallucinogen use, unspecified with hallucinogen-induced mood disorder
F16.950 Hallucinogen use, unspecified with hallucinogen-induced psychotic disorder with delusions
F16.951 Hallucinogen use, unspecified with hallucinogen-induced psychotic disorder with hallucinations
F16.959 Hallucinogen use, unspecified with hallucinogen-induced psychotic disorder, unspecified
F16.980 Hallucinogen use, unspecified with hallucinogen-induced anxiety disorder
F16.983 Hallucinogen use, unspecified with hallucinogen persisting perception disorder (flashbacks)
F18.14 Inhalant abuse with inhalant-induced mood disorder
F18.150 Inhalant abuse with inhalant-induced psychotic disorder with delusions
F18.151 Inhalant abuse with inhalant-induced psychotic disorder with hallucinations
F18.159 Inhalant abuse with inhalant-induced psychotic disorder, unspecified
F18.180 Inhalant abuse with inhalant-induced anxiety disorder
F18.24 Inhalant dependence with inhalant-induced mood disorder
F18.250 Inhalant dependence with inhalant-induced psychotic disorder with delusions
F18.251 Inhalant dependence with inhalant-induced psychotic disorder with hallucinations
F18.259 Inhalant dependence with inhalant-induced psychotic disorder, unspecified
F18.280 Inhalant dependence with inhalant-induced anxiety disorder
F18.94 Inhalant use, unspecified with inhalant-induced mood disorder
F18.950 Inhalant use, unspecified with inhalant-induced psychotic disorder with delusions
F18.951 Inhalant use, unspecified with inhalant-induced psychotic disorder with hallucinations
F18.959 Inhalant use, unspecified with inhalant-induced psychotic disorder, unspecified
F18.980 Inhalant use, unspecified with inhalant-induced anxiety disorder
F19.122 Other psychoactive substance abuse with intoxication with perceptual disturbances
F19.132 Other psychoactive substance abuse with withdrawal with perceptual disturbance
F19.14 Other psychoactive substance abuse with psychoactive substance-induced mood disorder
F19.150 Other psychoactive substance abuse with psychoactive substance-induced psychotic disorder with delusions
F19.151 Other psychoactive substance abuse with psychoactive substance-induced psychotic disorder with hallucinations
F19.159 Other psychoactive substance abuse with psychoactive substance-induced psychotic disorder, unspecified
F19.180 Other psychoactive substance abuse with psychoactive substance-induced anxiety disorder
F19.232 Other psychoactive substance dependence with withdrawal with perceptual disturbance
F19.24 Other psychoactive substance dependence with psychoactive substance-induced mood disorder
F19.250 Other psychoactive substance dependence with psychoactive substance-induced psychotic disorder with delusions
F19.251 Other psychoactive substance dependence with psychoactive substance-induced psychotic disorder with hallucinations
F19.259 Other psychoactive substance dependence with psychoactive substance-induced psychotic disorder, unspecified
F19.280 Other psychoactive substance dependence with psychoactive substance-induced anxiety disorder
F19.922 Other psychoactive substance use, unspecified with intoxication with perceptual disturbance
F19.932 Other psychoactive substance use, unspecified with withdrawal with perceptual disturbance
F19.94 Other psychoactive substance use, unspecified with psychoactive substance-induced mood disorder
F19.950 Other psychoactive substance use, unspecified with psychoactive substance-induced psychotic disorder with delusions
F19.951 Other psychoactive substance use, unspecified with psychoactive substance-induced psychotic disorder with hallucinations
F19.959 Other psychoactive substance use, unspecified with psychoactive substance-induced psychotic disorder, unspecified
F19.980 Other psychoactive substance use, unspecified with psychoactive substance-induced anxiety disorder
F20.0 Paranoid schizophrenia
F20.1 Disorganized schizophrenia
F20.2 Catatonic schizophrenia
F20.3 Undifferentiated schizophrenia
F20.5 Residual schizophrenia
F20.81 Schizophreniform disorder
F22 Delusional disorders
F23 Brief psychotic disorder
F24 Shared psychotic disorder
F25.0 Schizoaffective disorder, bipolar type
F25.1 Schizoaffective disorder, depressive type
F25.8 Other schizoaffective disorders
F25.9 Schizoaffective disorder, unspecified
F28 Other psychotic disorder not due to a substance or known physiological condition
F29 Unspecified psychosis not due to a substance or known physiological condition
F30.11 Manic episode without psychotic symptoms, mild
F30.12 Manic episode without psychotic symptoms, moderate
F30.13 Manic episode, severe, without psychotic symptoms
F30.2 Manic episode, severe with psychotic symptoms
F30.3 Manic episode in partial remission
F30.8 Other manic episodes
F31.11 Bipolar disorder, current episode manic without psychotic features, mild
F31.12 Bipolar disorder, current episode manic without psychotic features, moderate
F31.13 Bipolar disorder, current episode manic without psychotic features, severe
F31.2 Bipolar disorder, current episode manic severe with psychotic features
F31.31 Bipolar disorder, current episode depressed, mild
F31.32 Bipolar disorder, current episode depressed, moderate
F31.4 Bipolar disorder, current episode depressed, severe, without psychotic features
F31.5 Bipolar disorder, current episode depressed, severe, with psychotic features
F31.61 Bipolar disorder, current episode mixed, mild
F31.62 Bipolar disorder, current episode mixed, moderate
F31.63 Bipolar disorder, current episode mixed, severe, without psychotic features
F31.64 Bipolar disorder, current episode mixed, severe, with psychotic features
F31.71 Bipolar disorder, in partial remission, most recent episode hypomanic
F31.72 Bipolar disorder, in full remission, most recent episode hypomanic
F31.73 Bipolar disorder, in partial remission, most recent episode manic
F31.75 Bipolar disorder, in partial remission, most recent episode depressed
F31.77 Bipolar disorder, in partial remission, most recent episode mixed
F31.81 Bipolar II disorder
F32.0 Major depressive disorder, single episode, mild
F32.1 Major depressive disorder, single episode, moderate
F32.2 Major depressive disorder, single episode, severe without psychotic features
F32.3 Major depressive disorder, single episode, severe with psychotic features
F32.4 Major depressive disorder, single episode, in partial remission
F33.0 Major depressive disorder, recurrent, mild
F33.1 Major depressive disorder, recurrent, moderate
F33.2 Major depressive disorder, recurrent severe without psychotic features
F33.3 Major depressive disorder, recurrent, severe with psychotic symptoms
F33.41 Major depressive disorder, recurrent, in partial remission
F50.01 Anorexia nervosa, restricting type
F50.02 Anorexia nervosa, binge eating/purging type
F50.2 Bulimia nervosa
F53.0 Postpartum depression
F53.1 Puerperal psychosis
F68.A Factitious disorder imposed on another
F94.0 Selective mutism
F94.1 Reactive attachment disorder of childhood
F94.2 Disinhibited attachment disorder of childhood
F94.9 Childhood disorder of social functioning, unspecified
F98.8 Other specified behavioral and emotional disorders with onset usually occurring in childhood and adolescence
N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph

Any ICD-10-CM code that is not listed in the ICD-10 Codes that Support Medical Necessity section of this Billing and Coding: Partial Hospitalization Programs A56685 article.

Group 1 Codes

N/A

N/A

ICD-10-PCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description
N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code Description
N/A

Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A N/A
N/A
Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation
01/01/2023 R5

Under CPT/HCPCS Codes Group 1: Codes the description was revised for 90899. This revision is due to the 2023 Annual/Q1 CPT/HCPCS Code Update and is retroactive effective for dates of service on or after 1/1/23.

11/10/2022 R4

Under CMS National Coverage Policy updated section headings and deleted Program Memorandum, June 2000, A-00-36 and Program Memorandum, September 2001, A-01-111.

10/01/2020 R3

Under ICD-10 Codes that Support Medical Necessity Group 1: Codes added F10.150, F10.232, F10.250, F10.94, F10.950, F13.232, F13.932, F19.232, F19.932 and F20.5 and deleted F10.188, F10.288, F10.988, F11.222, F11.288, F11.922, F11.988, F12.188, F12.23, F12.288, F12.93, F12.988, F13.188, F13.20, F13.288, F13.988, F14.188, F14.20, F14.288, F14.988, F15.188, F15.20, F15.288, F15.988, F16.188, F16.288, F16.988, F18.188, F18.288, F18.988, F19.188, F19.20, F19.222, F19.288, F19.988, F20.9, F31.70, F31.9, F32.9, F43.0, F50.00, F91.1, F91.2, F91.3, F91.9 and F93.8. This revision will become effective 10/1/20.

Under ICD-10 Codes that Support Medical Necessity Group 1: Codes added F10.132, F10.932, F13.132 and F19.132. This revision is due to the Annual ICD-10 Code Update and is effective on 10/1/20.

10/17/2019 R2

This article is being revised in order to adhere to CMS requirements per chapter 13, section 13.5.1 of the Program Integrity Manual, to remove all coding from LCDs and incorporate into related Billing and Coding Articles. Regulations regarding billing and coding were removed from the CMS National Coverage Policy section of the related Partial Hospitalization Programs L37633 LCD and placed in this article. Under ICD-10 Codes that DO NOT Support Medical Necessity Group 1: Paragraph updated section heading.

07/11/2019 R1

All coding located in the Coding Information section has been removed from the related Partial Hospitalization Programs L37633 LCD and added to this article.

N/A

Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L37633 - Partial Hospitalization Programs
Related National Coverage Documents
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SAD Process URL 1
N/A
SAD Process URL 2
N/A
Statutory Requirements URLs
N/A
Rules and Regulations URLs
N/A
CMS Manual Explanations URLs
N/A
Other URLs
N/A
Public Versions
Updated On Effective Dates Status
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01/17/2023 01/01/2023 - 12/31/2023 Superseded You are here
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