Anthem New Partial Hospitalization Program and Intensive Outpatient Program Services Facility Reimbursement Policy

April 2019 ~

Beginning with dates of service on or after July 1, Anthem Blue Cross Blue Shield (Anthem) will implement their new facility reimbursement policy, Partial Hospitalization Program and Intensive Outpatient Program Services. According to the insurer, the new policy, C-19002, will enforce a daily unit limit.

Effective July 1, the Health Plan allows reimbursement for one (1) unit per date of service for Partial Hospitalization Program and Intensive Outpatient Program services for facilities under Per Diem, Per Unit, Per Visit, or Percentage Rate methodologies.

All other units billed will be denied.

In addition, the Health Plan allows reimbursement per date of service for only Partial Hospitalization Program or Intensive Outpatient Program services, not both.

NOTE: Facilities should report the appropriate PHP or IOP specific revenue code and HCPCS code for reimbursement. Standard correct coding applies.

For more information, refer to Anthem’s Administrative, Billing and Reimbursement Policies.

Source(s): Anthem Provider News;