Billing and Coding: Psychiatric Partial Hospitalization Programs

Medicare covers psychiatric partial hospitalization when the patient requires active treatment delivered by a multidisciplinary team with an individualized written plan and a minimum of 20 therapeutic hours per week. Admission requires a physician certification that inpatient hospitalization would be required without PHP, an initial psychiatric evaluation within 48 hours, and ongoing recertification (first by day 18, then at least every 30 days) with detailed documentation (treatment plan, progress notes, diagnoses, and clinician signatures). Billing rules separate physician/advanced-practice/clinical psychologist professional services (billed to Part B) from hospital-bundled nonphysician services, and claims must include valid ICD-10 coding and required referring/ordering NPI where applicable.

"Patient requires active psychiatric partial hospitalization (PHP) with an individualized written plan of care developed by a physician in consultation with appropriate staff and a multidisciplinary..."