LCD for Partial Hospitalization (L1379)

 

Contractor Information

Contractor Name 

BlueCross BlueShield of Tennessee (Riverbend Government Benefits Administrator) 

Contractor Number 

00390 

Contractor Type 

FI 

 

LCD Information

LCD ID Number 

L1379 

 

LCD Title 

Partial Hospitalization 

 

Contractor's Determination Number 

1379 

 

AMA CPT / ADA CDT Copyright Statement 

CPT codes, descriptions and other data only are copyright 2007 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.  

 

CMS National Coverage Policy 

HCFA Transmittal Number A-99-39 for Medicare coverage of Partial Hospitalization benefit.

Title XVIII of the Social Security Act, Section 1862 (a)(1)(A). This section excludes coverage of items or services that are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

Title XVIII of the Social Security Act, Section 1833 (e). This section prohibits Medicare payment for any claim that lacks the necessary information to process the claim.

The Social Security Act, section 1861 (ff) and 1832(a) These sections define the partial hospitalization benefit and provide coverage of partial in a hospital or CMHC setting

The Social Security Act, section 1861(s)(2)(B) This section references partial hospitalization in a hospital outpatient setting.

The Social Security Act, section 1835(a) This section references physician certification
 

 

Primary Geographic Jurisdiction 

New Jersey
Tennessee
 

 

Secondary Geographic Jurisdiction 

Alaska
Alabama
Arkansas
Arizona
California
Colorado
Connecticut
Florida
Georgia
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Mississippi
North Carolina
North Dakota
Nebraska
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
Tennessee
Texas
Utah
Virginia
Vermont
Washington
Wisconsin
West Virginia
Wyoming
 

 

Oversight Region 

Region IV
 

 

 

Original Determination Effective Date 

For services performed on or after 07/19/1995  

 

Original Determination Ending Date 

 

 

Revision Effective Date 

For services performed on or after 07/27/2005  

 

Revision Ending Date 

 

 

Indications and Limitations of Coverage and/or Medical Necessity 

A Medicare Partial Hospitalization Program (PHP) is a comprehensive, structured program. A PHP uses a multi-disciplinary team to provide comprehensive, coordinated services within an individualized treatment plan to individuals diagnosed with one or more psychiatric disorders. PHP requires admission and certification of need by a physician (M.D./D.O.) trained in the diagnosis and treatment of psychiatric illness.

These programs are designed to treat patients who exhibit severe or disabling conditions related to an acute psychiatric/psychological condition or an exacerbation of a severe and persistent mental disorder. The psychiatric condition must require active treatment.

Partial Hospitalization programs are furnished by a hospital or community mental health center (CMHC) as a distinct and organized intensive ambulatory treatment.

At a minimum, the program should have available twenty hours (20 hrs.) of scheduled programming extending over five (5) days per week.

The length of stay in a PHP is dependent upon the patient’s psychiatric problems, clinical needs, types of treatment and response to treatment. Many factors affect the outcome of treatment; among them are the nature of the illness, the prior history, the goals of treatment and the patient’s response. It is anticipated that a patient accepted into the PHP would be promptly evaluated within 24 hours of admission and expediently treated, then be maintained in an outpatient setting.

A partial hospitalization program differs from inpatient hospitalization and outpatient management in day programs (i.e., adult day programs or psychosocial programs), and periodic office visits for management of medication and psychotherapy in:

 

  • The intensity of the treatment programs and frequency of participation by the patient; and
  • The comprehensive structured program of services provided that are specified in an individualized treatment plan. The individualized treatment plan is formulated by a physician and a multi-disciplinary team with the patient’s involvement. The individualized treatment must be active.

    Active Treatment refers to the ongoing provision of clinically recognized therapeutic interventions that are goal-directed and based on a documented treatment plan. Examples of active treatment include, but are not limited to, pharmacotherapy, individual therapy, and group therapy.

    In order to be considered active treatment the following criteria must be met:

 

    • Treatment is directed toward the alleviation of the impairment that precipitated entrance in the program or which required continued level of intervention
    • Treatment enhances the patient’s coping abilities; and
    • Treatment is individualized to address the specific clinical needs of the patient



Active treatment does not include services to maintain generally independent clients who are able to function with little supervision, or in the absence of a continuous active treatment program.

A Medicare partial hospitalization program is an appropriate level of active treatment intervention for individuals who:

 

    • Are likely to benefit from a coordinated program of services and require more than isolated sessions of outpatient treatment. Partial hospitalization is the level of intervention that falls between inpatient hospitalization and episodic treatment on the continuum of care for the mentally ill;
    • Do not require 24 hour care and have an adequate support system outside the hospital setting while not actively engaged in the program;
    • Have a diagnosis that falls within the range of ICD-9 codes for mental illness (290-319). However the diagnosis itself is not the sole determining factor for coverage;
    • Are not judged to be dangerous to self or others.



A Medicare partial hospitalization program is not appropriate for the following indications:

 

  • Patients who refuse or who cannot participate with the active treatment process or who cannot tolerate the intensity of the partial hospitalization program;
  • Meals
  • Transportation
  • Activity therapy if primarily recreational and diversional
  • Programs that are social, recreational or diversional are not covered. Supervision of older adults in a "geriatric day care" setting is not covered.
  • Community support groups for chronic mental illness provided in a non-medical setting, or programs that provide only social interaction are not covered.
  • Activities that are primarily recreational or diversional in nature for which the individual participating does not have a specific, individual treatment goal. Examples of these activities include social hours, lunch, television, shopping trips and attending or participating in sports.
  • General education programs or education of the general public.
  • Vocational training is not covered if related to employment, work skills or work setting.
  • Any service that does not have a specific treatment goal.</UL

    1. Medicare provides benefits for Partial Hospitialization:

 

    • Reasonable and necessary for the diagnosis or active treatment of the individual’s condition; and
    • Reasonably expected to improve or maintain the individual's condition and functional level to prevent relapse or hospitalization. (See 1861 (ff)(2)(I) of the Social Security Act.)


2. Two critical points affect the determination of coverage for partial hospitalization services:

 

    • The initial decision as to the medical appropriateness of entrance into the program for treatment; and
    • The decision about discharge



Both determinations should take into account both the diagnosis and the individual's treatment needs.

3. Medicare does not have a separate category for substance abuse.

4. The Medicare benefit categories are partial hospitalization services or outpatient hospital psychiatric services.

5. As there is no separate benefit category for substance abuse programs, any substance abuse program must meet requirements established for partial hospitalization programs in order to receive partial hospitalization reimbursement.

6. Medicare does not have benefit categories for "intensive outpatient programs" and continuing day treatment programs".

7. The services must be billed as, and meet the requirements of outpatient hospital psychiatric services or a partial hospitalization program.

8. Partial hospitalization may occur in lieu of either:

 

    • Admission to an inpatient hospital (there must be evidence of failure at or inability to benefit from a less intensive outpatient program); or
    • A continued inpatient hospitalization (patients must require PHP services at levels of intensity and frequency comparable to patients in an inpatient setting for similar psychiatric illnesses).


9. Treatment may continue until the patient has improved sufficiently to be maintained in the outpatient or office setting on a less intense and less frequent basis. This is an individual determination.

10. Patients who require a low frequency of participation may indicate that the partial program is no longer reasonable and necessary, and the patient could be managed in an outpatient setting and should no longer be covered in the partial program.

11. Partial hospitalization services may be covered under Medicare when they are provided in a hospital outpatient department or a community mental health (CMHC). A CMHC is a Medicare provider of services only with respect to the furnishing of partial hospitalization services.

CMS defines a CMHC as an entity that provides:

 

    • Outpatient services, including specialized outpatient services for children, the elderly, individuals who are chronically mentally ill, and residents of its mental health facility.
    • 24-hour a day emergency care services
    • Screening for patients being considered for admission to State mental health facilities to decide the appropriateness of such admission; and
    • Consultation and education service.

 

Individualized Treatment



A physician must order the partial hospitalization services, establish the plan of treatment and recertify the need for continued care. Partial hospitalization services must be prescribed by a physician and furnished under the supervision of a physician.

Partial hospitalization is active treatment that incorporates an individualized treatment plan, a coordination of services wrapped around the clinical needs of the patient and a multi-disciplinary team approach to patient care. The individualized treatment plan must include, but is not limited to:

 

    • Physician’s Diagnosis, Axis I through V
    • Treatment goals under the plan
    • Type of services
    • Amount of services
    • Duration of services
    • Frequency of services
    • Rationale for services
    • Current functional impairments (psychological, social, occupational)
    • Specific cause of functional impairments (cognitive, communicative, emotional, psychosocial, behavioral)
    • The expected functional outcome
    • Long-term goals for each service provided, including activity therapy, that are directly related to functional impairments and the expected outcomes.
    • Short-term goals for each service provided that are measurable (e.g symptomatic improvements), functionally pertinent (e.g., ability for ADL’s), time framed and directly related to long-term goals
    • Medications
    • Discharge planning to begin, and be documented, at the time of admission
    • The involvement of the patient, patient’s family, and/or significant other should be documented and incorporated into the treatment plan, and
    • Community resources that will facilitate outcome>



The treatment goals are the basis for evaluating the patient’s response to treatment and should be designed to measure the impact of treatment. Treatment goals that are measurable and aiming to improve function are the vital source for the determination of whether a PHP is the appropriate level of intervention for the individual’s condition.

The level at which treatment goals are accomplished with active treatment, helps determine the length of the stay in PHP.

The individualized treatment plan is to be established by a physician with the first 7 days of a patient’s participation in the program. The individualized treatment plan is to be reviewed weekly by a physician in consultation with appropriate staff participating in the program. The physician determines the frequency and duration of services, taking into account accepted norms of medical practice and a reasonable expectation of improvement in the patient's condition.

Partial hospitalization is active treatment pursuant to an individualized treatment plan, prescribed and signed by a physician, which identifies treatment goals, describes a coordination of services, is structured to meet the particular needs of the patient, and includes a multidisciplinary team approach to patient care. The treatment goals described in the treatment plan should directly address the presenting symptoms and are the basis for evaluating the patient's response to treatment. The plan should document ongoing efforts to restore the individual patient to at higher level of functioning that would permit discharge from the program, or reflect the continued need for the intensity of the active therapy to maintain the individual's condition and functional level and to prevent relapse or hospitalization. Activities that are primarily recreational and diversionary, or provide only a level of functional support that does not treat the serious presenting psychiatric symptoms placing the patient at risk, do not qualify as partial hospitalization services.

12. The program must be prepared to appropriately treat the co-morbid substance abuse disorder (dual diagnosis patients), when it exists. Dual diagnosed individuals suffer from concomitant mental illness and chemical dependency.

13. A patient under the influence of a chemical substance is not capable of actively participating in PHP..... (random drug screening, AA/NA attendance and sponsorship, and goals/limit setting are reasonable treatment modalities)

14. For coverage purposes, the key to whether a particular type or group of services and activities may be covered as a PHP depends primarily on the services provided in the program and how the services are being utilized in the care of the individual patient:

 

    • Individual and group therapy with physicians or psychologists or mental health professionals to the extent authorized under State Law;
    •  
    • There is a need to observe the patient’s interaction with a family member and/or
    • There is a need to assess the capability of family members to aid the patient and aid in the patient’s management.


Patient training and education, to the extent the training and educational activities are closely and clearly related to the individual’s care and treatment.

 

 

Coverage Topic 

Mental Health Care (Partial Hospitalization)
 

 

Coding Information

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 policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.

 

 

 

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 policy 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 policy should be assumed to apply equally to all Revenue Codes.

 

090X

Psychiatric/psychological treatments-general classification

0910

Psychiatric/psychological services-general classification

0914

Psychiatric/psychological services-individual therapy

0915

Psychiatric/psychological services-group therapy

0916

Psychiatric/psychological services-family therapy

0918

Psychiatric/psychological services-testing

 

 

CPT/HCPCS Codes 

Note: The listing of HCPCS Codes does not assure coverage of the specific service. Current coverage criteria applies.

90801

Psy dx interview

90802

Intac psy dx interview

90816

Psytx, hosp, 20-30 min

90817

Psytx, hosp, 20-30 min w/e&m

90818

Psytx, hosp, 45-50 min

90821

Psytx, hosp, 75-80 min

90823

Intac psytx, hosp, 20-30 min

90826 - 90828

Intac psytx, hosp, 45-50 min - Intac psytx, hosp, 75-80 min

90846

Family psytx w/o patient

90847

Family psytx w/patient

90849

Multiple family group psytx

90853

Group psychotherapy

90857

Intac group psytx

90899

Psychiatric service/therapy

97532

Cognitive skills development

97533

Sensory integration

G0129

Partial hosp prog service

G0176

OPPS/PHP;activity therapy

G0177

OPPS/PHP; train & educ serv

 

 

ICD-9 Codes that Support Medical Necessity 

ICD-9 Codes that fall within the range of the following codes is not the sole determining factor for coverage.

290.10 - 319

PRESENILE DEMENTIA UNCOMPLICATED - UNSPECIFIED MENTAL RETARDATION

 

 

Diagnoses that Support Medical Necessity 

 

 

ICD-9 Codes that DO NOT Support Medical Necessity 

 

 

 

 

ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation 

 

 

Diagnoses that DO NOT Support Medical Necessity 

 

 

General Information

Documentation Requirements 

Physician certification and recertification requirements.

A physician must initially certify a patient's need for partial hospitalization services and recertify the continued need for this intensive level of treatment. Because partial hospitalization is the outpatient substitute for inpatient psychiatric care, the standard currently used for inpatient psychiatric care has been adopted. The OPPS Final Rule has Amended 42 CFR 424.24 (e) to establish physician recertification requirements for partial hospitalization services.

Initial Certification

The initial physician certification establishing the need for partial hospitalization must be received by the partial hospitalization program upon admission. Services provided to establish a patient's need for partial services should continue to be billed to the carrier as professional services.

Recertification

The physician recertification must be signed by a physician who is treating the patient, and has knowledge of the patient's response to treatment.. The new recertification time frames are:

 

  • The first recertification is required as of the 18th day of services
  • Subsequent recertification is required no less frequently than every 30 days


In addition, each recertification must specify:

 

  • That the patient would otherwise require inpatient psychiatric care in the absence of continued stay in the partial hospitalization program
  • The patient's response to the intensive, therapeutic interventions provided by the active treatment program which make up partial hospitalization services
  • Charges in functioning and status of the serious psychiatric symptoms that place the patient at risk of hospitalization
  • Treatment plan and goals for coordination of services to facilitate discharge from the partial hospitalization program, such as community supports and less intensive treatment options



Certifications may use any format desired and may be part of the treatment plan. However, the following statement must be used:

Certification/Recertification Language:

"I certify/recertify that the patient would require inpatient psychiatric care if the Partial Hospitalization services were not provided, and services will be furnished under the supervision and care of a physician, and under an individual, written plan of treatment."

Physician signature:_____________________________Date:________________


Certifications are prospective; the physician certifies that future services are required. A physician certification must cover all periods of services, upon admission, the first recertification is required as of the 18th day of services. Subsequent recertification is required no less frequently than every 30 days.

A physician Certification/Recertification is required but does not guaranty approval of services.

All entries in the medical record should be legible, dated and signed with credentials listed.

Chart entries should be made with each therapeutic encounter (by the team member rendering the service) and should reflect, but not be limited to the following:

 

  • Observation of the patient’s status and responses during therapeutic contacts
  • The patient's response to treatment as it relates to the individualized active treatment goals


Progress notes should reflect, but not be limited to:

 

  • The time the session began and ended
  • A brief summary of each specific group and/or therapy
  • Identification of what was done in each group
  • Identification of how the services are benefiting the patient
  • Identification of how the patient reacted and behaviors exhibited
  • Identification of the specific treatment goal addressed



Progress notes should always reflect the patient’s response to treatment. It is not sufficient to note that the patient participated in all groups. Examples of symptoms and behaviors that may be noted, but not limited to, are as follows:

 

  • Thoughts-slowness; blocking of thoughts; racing thoughts; autistic thinking; suspiciousness; hallucinations; distorted, illogical thinking; delusions; fears; obsessions.
  • Cognition-disorientation; impaired memory; poor concentration; inability to comprehend; confusion.
  • Anxiety-intense apprehension; palpitations; chest discomfort; dizziness; panic feelings.
  • Mood-sadness; hopelessness; suicidal thoughts; grandiosity; euphoria.
  • Activity -Withdrawal from relationships and contacts with others; impairment in goal-directed activity; purposeless movement such as pacing and mannerism; unpredictable behavior that may be related to delusions or hallucinations; fatigue, weakness; impairment or absence of social skills; difficulty at work; impulsive or reckless behavior; compulsive.
  • Self Care -Neglectfulness; lack of motivation; lack of hygiene and/or grooming.
  • Nutrition -Unawareness of hunger or thirst; apathy to food at mealtime; fear of eating; recent weight loss or gain; compulsive eating.
  • Sleep-Disturbed sleep patterns; inability to fall asleep; frequent awakenings inability to awaken in morning; excessive sleeping.
  • Interpersonal -Violence; anger; blame; conflicts; inability to sustain relationships; lack of friendships.
  • Medication -Benefits, adverse effects; compliance; rationale for change or adjustment.


Medical Review of Partial Hospitalization Claims

The following information must be submitted when requested:

 

  • The initial and most recent psychiatric evaluation and plan of treatment (this also includes the Psychosocial, Nursing Assessment and all evaluations pertinent to the patient.)
  • The physician orders
  • The physician certification that covers the period billed on the claim
  • All progress notes and log sheets for the period billed on the claim. (each session billed must be documented as rendered)
  • Any additional information to document that the services are reasonable and necessary
  • An itemized bill, showing each service rendered and the charge for each



Please return all of the requested information at one time.

Please do not submit documentation until it is requested. 

 

Appendices 

LINK TO QUESTIONS AND ANSWERS (COMMENTS) ABOUT THIS
POLICY:

Frequently Asked Questions


 

 

Utilization Guidelines 

 

 

Sources of Information and Basis for Decision 

Coverage Issues Manual 35-147

NCD Manual Ch.1.3 §170.1

CMS Pub 100-4 4-§260, 100-2 6-§70

Medicare Hospital Manual 210.9

Transmittal A-99-39

OPT/CORF Manual

Outpatient Prospective Pay System 

 

Advisory Committee Meeting Notes 

This policy does not reflect the sole opinion of the contractor or contractor medical director. Although the final decision rests with the contractor, this policy was developed in cooperation with advisory groups, which includes representatives from appropriate specialties as well as provider (facility) representatives. 

 

Start Date of Comment Period 

07/12/2000 

 

End Date of Comment Period 

 

 

Start Date of Notice Period 

08/28/2000 

 

Revision History Number 

1379a 

 

Revision History Explanation 

07/28/2004 Crosswalked references to Online Manuals

07/19/2003 HCPCS codes 90875 and 90876 are deleted from CPT/HCPCS Code section [PM, Transmittal No. A-03-020, April 2, 2003. Hospital OPPS update. "HCPCS codes 90875 and 90876 are not covered by Medicare and should not be billed for partial hospitalization program (PHP) patients."]

07/24/2002 Formatted

03/14/2001 Procedure codes changed (added and deleted) to reflect changes in CPT and HCPCS code books.

09/28/2000 added clarification on Certification/Recertification language

Start of Comment Period:
05/04/1995

Start Date of Notice Period:
06/19/1995

09/04/2004 - This policy was updated by the ICD-9 Code Annual Update for 2004-2005.

This LCD was converted from an LMRP on 7/26/2005

09/04/2005 - This policy was updated by the ICD-9 2005-2006 Annual Update.

11/26/2005 - CPT/HCPCS code 96100 was deleted from group 1
11/26/2005 - CPT/HCPCS code 96115 was deleted from group 1
11/26/2005 - CPT/HCPCS code 96117 was deleted from group 1

09/03/2007 - This policy was updated by the ICD-9 2007-2008 Annual Update.

09/27/2007 - Frequently asked Questions restored to Appendices

11/10/2007 - The description for CPT/HCPCS code 97532 was changed in group 1

11//29/2007 - CPT/HCPCS code G0176 added to group 1 

 

Reason for Change 

HCPCS Addition/Deletion
 

Last Reviewed On Date 

11/29/2007 

 

Related Documents 

Article(s)
A35140 - Partial Hospitalization

 

LCD Attachments 

FAQ - Comment and Response (1,630 bytes)

 

Other Versions