Billing and Coding: Partial Hospitalization Programs

This policy supplements Local Coverage Determination L37633 for billing and coding of Partial Hospitalization Programs and defers to that LCD for specific coverage criteria and documentation requirements. CPT codes 90875 and 90876 are explicitly non-covered and will be denied as not reasonable and necessary. Providers should follow LCD L37633 for required medical record documentation, prior authorization, and claim submission rules.

"Partial Hospitalization Program services that meet the coverage criteria of Local Coverage Determination L37633 are considered covered."

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