Is it possible to submit claims for 90837, 90847, or 90853 along with IOP services?
Normally 90853 is not separated out from IOP per diem claims. Some of the below codes are what Medicare has suggested previously for IOP.
$20 per claim is the Medicare average on occasion because there are normally multiple patients being able to receive benefits in the group for that same service. So theoretically, as medicare and other carriers see this, the provider is being reimbursed for 8-20 patients for the same group 90853 service.
The Centers for Medicare & Medicaid Services (CMS) publish the Medicare Physician Fee Schedule (MPFS) every year, which includes the current procedural terminology (CPT) codes and reimbursement rates for various medical services, including intensive outpatient programs (IOP) for substance abuse.
However, the reimbursement rates may vary based on factors such as geographic location, individual patient characteristics, and other circumstances. It is recommended that you contact Medicare or consult with a healthcare billing professional for more specific information.
That being said, here are some CPT codes commonly used for IOP for substance abuse treatment that Medicare may accept:
H0015: Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including assessment, counseling; crisis intervention, and activity therapies or education
H0016: Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 6 hours/day and is based on an individualized treatment plan), including assessment, counseling; crisis intervention, and activity therapies or education
H0017: Alcohol and/or drug services; intensive outpatient (treatment program that operates less than 3 hours/day and less than 5 days/week), including assessment, counseling; crisis intervention, and activity therapies or education
Please let us know any questions!