Get paid for every program day. Intensive outpatient and partial hospitalization billing that keeps hours documented, authorizations active, and step-downs approved on time.
Nevada Medical Billing provides IOP and PHP billing services for intensive outpatient programs and partial hospitalization programs treating mental health and substance use disorders across Nevada. We handle what decides whether program days get paid: verification of benefits, initial and concurrent authorizations, per-diem and per-service coding, weekly hour requirements, physician certifications, step-down approvals, and denial appeals. We bill Nevada Medicaid and its five managed care plans, Medicare, Medicare Advantage, TRICARE, and commercial and out-of-network payers.
HIPAA and 42 CFR Part 2 compliant · No obligation
Share a few details and a program billing specialist will review your authorizations, hours documentation, and denials with you.
Intensive outpatient (IOP) and partial hospitalization (PHP) programs are separate levels of care with separate billing rules, even when the same organization runs both. Mixing their codes, hours, or authorizations is one of the fastest ways to get program days denied.
| Attribute | IOP (Intensive Outpatient Program) | PHP (Partial Hospitalization Program) |
|---|---|---|
| ASAM level | 2.1 | 2.5 |
| Medicare weekly minimum | At least 9 hours of services | At least 20 hours of services |
| Who it's for | Patients stable enough to live at home and often keep working | Patients who would otherwise need inpatient psychiatric care |
| Typical commercial and Medicaid codes | S9480 (psychiatric), H0015 (substance use), H2036 (hourly, some payers) | S0201 (per diem), H0035 (mental health) |
| Revenue codes (UB-04) | 0905 (psychiatric), 0906 (chemical dependency) | 0912 (less intensive), 0913 (intensive) |
| Medicare condition code | 92 | 41 |
| Usual payment model | Per diem for days that meet the payer's minimum hours | Per diem |
| Usual place in the continuum | Step-down from PHP or residential; also a direct entry point | Step-down from residential or inpatient |
Payers set their own hour rules, so Medicare's 9 and 20 hours don't automatically apply to commercial or Medicaid contracts.
Routine outpatient therapy is billed one session at a time. IOP and PHP are usually billed one program day at a time, and a day is only payable if it meets the payer's minimum hours and falls inside an approved authorization. The payer, the population (mental health or substance use), the claim form, and the setting all change which code pair applies, and the published rules don't agree with each other. A claim template built for one payer can fail at the next.
Psychiatric programs and substance use programs use different codes. Billing H0015 for a mental health IOP, or S9480 for a substance use track, gets denied, and some payers use different revenue codes again on facility claims.
A per diem is only payable when the day meets the payer's hour threshold. Short days billed as full program days are denied or recouped in audits, when individual services may have been billable instead.
IOP and PHP are approved a block of days at a time. When the next review isn't completed before the approval ends, every day after it goes unpaid.
When a patient steps down from PHP to IOP, the last PHP day and the first IOP day must not overlap, and the IOP level usually needs its own authorization. Medicare returns IOP claims that overlap a PHP claim.
Payers decide which services are included in the program per diem and which can be billed on top, such as a psychiatrist's medication visit. Billing included services separately triggers denials; missing separately billable ones loses revenue.
Many plans route behavioral health to a separate manager. Authorizations requested from, or claims sent to, the medical plan are denied before anyone reads them.
IOP billing services cover mental health, substance use, and co-occurring intensive outpatient programs. IOP is usually paid as a per diem for each day that meets the payer's minimum hours, and the code pair depends on the program's primary diagnosis.
| IOP billing element | Mental health (psychiatric) IOP | Substance use IOP |
|---|---|---|
| Common HCPCS | S9480, per diem | H0015, per diem (H2036 hourly for some payers) |
| Common revenue code (UB-04) | 0905 | 0906 |
| Hour rules | Set by the payer; many follow 3 hours a day, 3 days a week | H0015 descriptor: at least 3 hours a day, 3 days a week |
| Medical necessity criteria | Often LOCUS, MCG, or InterQual | ASAM Criteria |
| Claim form | UB-04 or CMS-1500, depending on licensure and payer | UB-04 or CMS-1500, depending on licensure and payer |
| Adolescent programs | Often lower weekly hours; verify per payer | Verify per payer |
What we get right on every IOP claim: the code pair matches the population; units match the payer's per-diem or hourly definition; each billed day meets the minimum hours; services included in the per diem aren't billed again; and separately billable visits are billed correctly. For co-occurring programs, the primary diagnosis drives the code, and some payers recognize modifier HH.
PHP billing services cover day programs for patients who need near-inpatient intensity without staying overnight. PHP is paid per diem, carries its own code set and revenue codes, and draws the closest medical necessity review of any outpatient level.
| PHP billing element | What applies |
|---|---|
| Common HCPCS | S0201 (partial hospitalization, per diem); H0035 (mental health partial hospitalization) per payer |
| Revenue codes (UB-04) | 0912 (less intensive), 0913 (intensive) |
| Hours | Medicare: at least 20 hours a week; commercial and Medicaid rules vary |
| Medical necessity | Patient would otherwise require inpatient care; daily structured treatment |
| Documentation | Individualized treatment plan, physician certification, daily attendance and services, progress toward goals |
| Claim form | Usually UB-04 for facility programs |
What we get right on every PHP claim: daily attendance and hours support each billed day, PHP revenue codes never appear on IOP days, and authorization covers every date billed.
Medicare has covered PHP for years and added an IOP benefit on January 1, 2024. Both are billed only by the provider types Medicare lists, so a freestanding program that isn't one of them has no Medicare route.
| Medicare element | IOP | PHP |
|---|---|---|
| Eligible settings | Hospital outpatient departments, community mental health centers (CMHCs), FQHCs, RHCs, and OTPs for opioid use disorder | Hospital outpatient departments and CMHCs |
| Weekly minimum in plan of care | 9 hours | 20 hours |
| Condition code | 92 | 41 |
| Physician certification | Required; recertified at least every 60 days | Required, with periodic recertification |
| Payment | Per diem by setting, split by days with 3 services vs 4 or more | Per diem by setting, split by days with 3 services vs 4 or more |
| Billing method (hospital, CMHC) | Each covered service on its own line with revenue code, HCPCS, and date | Each covered service on its own line with revenue code, HCPCS, and date |
S9480, S0201, and H-codes are not payable by Medicare. Physician, NP, PA, and psychologist services are billed separately to Part B, while counselor and social worker services are included in the facility claim.
Most IOP and PHP revenue is lost at transitions, when a patient moves to a new level before it's approved or the dates of two levels overlap.
ASAM 3.1–3.7
per diem, UB-04
ASAM 2.5 · 20+ hrs/wk
S0201/H0035 · 0912/0913
ASAM 2.1 · 9+ hrs/wk
S9480/H0015 · 0905/0906
ASAM 1
per session, CMS-1500
Losing days at step-down? Get a Free IOP and PHP Billing Audit and we'll match every program day to an approved level of care.
HIPAA and 42 CFR Part 2 compliant · No obligation
We manage the full revenue cycle for intensive outpatient and partial hospitalization programs, from the first benefits call to the final payment.
We confirm IOP and PHP benefits separately, including day limits, behavioral health carve-out vendors, network status, deductibles, and authorization rules, so admissions know what's covered before day one. Eligibility Verification
We request approval with the assessment, level-of-care criteria (ASAM, LOCUS, MCG, or InterQual), and treatment plan, then schedule concurrent reviews before approved days run out. We prepare your clinicians for peer-to-peer reviews. Prior Authorization
For every payer, we confirm the code pair, revenue code, claim form, unit definition, and hour rules for each program you run, and document them in a billing crosswalk.
We check each program day's attendance and hours against the payer's minimum before billing it as a per diem, and bill individual services instead where the payer allows on short days.
We separate services included in the per diem from separately billable ones, such as psychiatric medication visits, so nothing is billed twice or left unbilled. psychiatry billing services
For eligible hospital outpatient departments, CMHCs, FQHCs, and RHCs, we bill Medicare with the right bill type, condition code, line-level services, and certification documentation.
We appeal medical necessity, authorization, hours, and overlap denials with clinical documentation, and use parity rules when payers limit behavioral health more strictly than medical care. Denial Management
We secure assignment of benefits, negotiate single case agreements, and follow up on out-of-network payments.
We post per-diem payments daily, compare them to contracted rates, and work every open program day by value and filing deadline. Payment Posting · AR Follow-Up
Opening an IOP or PHP, or adding Medicare? We handle payer enrollment, code crosswalks, authorization workflow, and documentation templates before your first admission. Credentialing
Nevada Medicaid substance use programs bill IOP and PHP under Nevada's SUD rules (Medicaid Services Manual Chapter 4100) and the Provider Type 93 enrollment that opened in July 2024. substance abuse billing services
Nevada Medicaid managed care covers members statewide through Anthem, CareSource, Health Plan of Nevada, Molina, and SilverSummit, each with its own authorization process for program levels of care.
Medicare IOP and PHP claims for Nevada go to Noridian (Jurisdiction E) for eligible settings.
Commercial plans often send IOP and PHP authorizations to behavioral health carve-out vendors, not the medical plan on the card.
Code pair and revenue code check by payer
Hours vs per-diem day audit
Authorization and step-down overlap review
HIPAA and 42 CFR Part 2 compliant · No obligation
| Denial cause | How we resolve it |
|---|---|
| Wrong code pair for the program population | Rebill with S9480 or H0015 (or the payer's PHP code) matched to the primary diagnosis |
| Revenue code doesn't match the procedure code | Correct the 0905/0906 or 0912/0913 pairing per payer and resubmit |
| Day billed without meeting minimum hours | Rebill as individual services where allowed; tighten daily hours capture |
| Days past the approved authorization | Request retro-review where allowed; schedule concurrent reviews earlier |
| PHP and IOP dates overlap | Correct transition dates and secure the IOP authorization |
| Included service billed separately on a program day | Remove the duplicate line or appeal if the payer allows it |
| Not medically necessary for the level of care | Appeal with level-of-care criteria, progress notes, and peer-to-peer review |
| Medicare claim missing condition code or certification | Add condition code 92 or 41 and the physician certification, then resubmit |
| Claim sent to the medical plan instead of the carve-out | Re-route to the behavioral health administrator within timely filing |
| Program type | What we handle for you |
|---|---|
| Mental health IOPs | S9480 per diem, psychiatric criteria, same-day psychiatry visits |
| Substance use IOPs | H0015 per diem, ASAM documentation, Nevada Medicaid SUD rules |
| Partial hospitalization programs | Per-diem facility billing, daily hours, intensive authorizations |
| Co-occurring (dual-diagnosis) programs | Primary-diagnosis code selection and bundling rules |
| Adolescent IOPs | Payer-specific hour thresholds and family involvement documentation |
| Hospital outpatient and CMHC programs | Medicare line-level billing, condition codes, certifications |
| Programs with a residential-to-outpatient continuum | Step-down authorizations and clean transition dates |
| New programs | Launch support from enrollment to first paid claim |
| Payer category | Plans |
|---|---|
| Nevada Medicaid | Fee-for-service, including SUD services under MSM Chapter 4100 |
| Nevada Medicaid managed care | Anthem Blue Cross and Blue Shield, CareSource, Health Plan of Nevada, Molina Healthcare of Nevada, SilverSummit Healthplan |
| Medicare | Noridian Healthcare Solutions (Jurisdiction E), eligible settings only |
| Medicare Advantage | Health Plan of Nevada/UnitedHealthcare, Humana, Aetna, Anthem, and other MA plans |
| Commercial | Anthem BCBS Nevada, UnitedHealthcare/Optum, Aetna, Cigna, Hometown Health, Prominence Health Plan |
| Behavioral health carve-outs | Vendors that manage IOP and PHP approvals for commercial plans |
| Military | TRICARE |
| Out-of-network | Single case agreements and OON claims with assignment of benefits |
We bill in the systems IOP and PHP programs use, including Kipu, Sunwave, BestNotes, Lightning Step, Alleva, Valant, AdvancedMD, and Tebra/Kareo. No software change needed. EHR Integration
Free IOP and PHP billing audit: We review 90 days of program-day claims, authorizations, hours documentation, and denials.
Secure setup: We sign a BAA and 42 CFR Part 2 terms, then connect to your EHR, clearinghouse, and payer portals.
Payer crosswalk: We document each payer's code pair, revenue codes, claim form, unit, and hour rules for your IOP and PHP.
Census and authorization inventory: Every current patient's level, approved days, and next review date go into tracking.
Go-live: Daily hours validation, charge entry, and submission begin.
Legacy A/R cleanup: We work old program-day claims in parallel while filing and appeal windows are open.
Monthly review: KPI report and a call with your dedicated account manager.
These are the performance standards we manage your IOP and PHP revenue cycle to, based on industry best practices.
| KPI | What it measures | Best-practice target |
|---|---|---|
| First-pass clean claim rate | Program-day claims paid without rework | 95% or higher |
| Denial rate | Claims denied on first submission | Under 5% |
| Days in A/R | Average time from program day to payment | Under 35 days for in-network claims |
| Unauthorized program days | Days billed without an active approval | Zero, with daily tracking |
| Hours compliance | Billed days that meet the payer's minimum | Every billed day |
| Claim submission | Time from program day to claim sent | Within 48 hours |
Mental health IOP days billed with H0015, or SUD days with S9480
0905 and 0906 revenue codes swapped on facility claims
Short program days billed as full per diems
PHP and IOP dates overlapping at step-down
Psychiatry visits billed separately when the payer includes them in the per diem, or missed when it doesn't
Medicare IOP claims missing condition code 92 or a current recertification
IOP and PHP billing is usually priced as a percentage of monthly collections, commonly 4–9% for behavioral health programs. Where your program falls depends on program-day volume, payer mix, and how much utilization review and out-of-network work is involved. There are no setup fees, the agreement is month-to-month with 30-day notice, and you get a fixed quote after your free audit.
HIPAA and 42 CFR Part 2 compliant · No obligation
| Factor | In-house biller | Nevada Medical Billing |
|---|---|---|
| Code pairs by payer and population | Learned from denials | Documented in a crosswalk before go-live |
| Hours validation | Rarely checked before billing | Checked on every program day |
| Concurrent reviews | Falls on clinical staff | Scheduled and tracked by our team |
| Medicare IOP and PHP | Often unbilled | Billed with condition codes and certifications |
| Absences and turnover | Billing stops | Backup team keeps working |
| Cost | Salary, benefits, software | One fee tied to collections |
"Patients mid-program will lose authorizations." Every current approval and review date is loaded before go-live.
"Our cash flow will drop." We work old claims in parallel while new ones go out.
"Our patients' privacy is at risk." We follow HIPAA and 42 CFR Part 2 with role-based access.
"We're locked in." You're not. The agreement is month-to-month with 30-day notice.
IOP and PHP billing follows HCPCS, CPT, and NUBC revenue code guidelines, the Medicare Benefit Policy Manual and claims processing rules for IOP and PHP, state Medicaid manuals, payer medical policies, mental health parity rules, HIPAA, and 42 CFR Part 2.
Both levels, one team: IOP and PHP billed with separate code sets and shared tracking.
Every program day checked: hours, authorization, and code pair validated before billing.
Clean step-downs: next-level approvals secured before transitions.
Medicare-ready: IOP and PHP billed for eligible settings with condition codes and certifications.
Nevada expertise: Medicaid SUD rules, five MCOs, Noridian, and local carve-out vendors.
No lock-in: Month-to-month agreement with 30-day notice.
Las Vegas: Mental health and substance use IOPs, PHPs, and full-continuum treatment centers. Las Vegas page
Henderson: Outpatient programs with heavy commercial and out-of-network volume. Henderson page
North Las Vegas: Community programs serving many Nevada Medicaid MCO members. North Las Vegas page
Reno: Hospital-affiliated and community IOP/PHP programs serving northern Nevada. Reno page
Carson City: Outpatient programs and rural providers billing CareSource and SilverSummit. Carson City page
We also support programs in Sparks, Pahrump, Elko, and Mesquite, including telehealth IOP tracks.
We help Nevada IOP and PHP programs bill the right code pair, prove every day's hours, keep approvals active, and step patients down without losing revenue.
Free 90-day review · No obligation · HIPAA and 42 CFR Part 2 compliant
Behavioral health billing servicesPsychiatry billing servicesSubstance abuse billing servicesPrimary care billing servicesThey manage the revenue cycle for intensive outpatient and partial hospitalization programs: verification of benefits, authorizations and concurrent reviews, per-diem and per-service coding, claim submission, payment posting, denial appeals, and A/R follow-up.
They are different levels of care with different codes. IOP (ASAM 2.1) commonly uses S9480 or H0015 with revenue codes 0905/0906; PHP (ASAM 2.5) uses S0201 or H0035 with revenue codes 0912/0913. Medicare requires at least 9 weekly hours for IOP and 20 for PHP, and marks claims with condition codes 92 and 41.
S9480 is generally used for psychiatric IOPs and H0015 for substance use IOPs. The program's primary diagnosis decides, and each payer's policy confirms it.
Usually per program day, as a per diem, for days that meet the payer's minimum hours. Some payers use hourly codes or bill individual services on short days.
Yes, for eligible settings. Medicare has covered PHP in hospital outpatient departments and community mental health centers for years, and added IOP on January 1, 2024, including FQHCs, RHCs, and OTPs for opioid use disorder. Freestanding programs outside those settings can't bill Medicare for IOP or PHP.
It depends on your licensure and each payer's contract. Facility programs usually bill on the UB-04; some payers accept IOP per diems on the CMS-1500. We confirm each payer before the first claim.
It depends on the payer. Some include all behavioral health services in the per diem; others let physician, NP, or psychologist services bill separately. We check the rule for each payer before coding the day.
We secure the IOP authorization before the transition and make sure the last PHP date and first IOP date never overlap.
Yes. We handle payer enrollment, code crosswalks, authorization workflow, and documentation templates before your first admission.
Most programs pay 4–9% of collections, depending on volume, payer mix, and utilization review workload. We give a fixed quote after a free audit.