Partial Hospitalization Programs

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When billing Partial Hospitalization Program (PHP) services to TRICARE For Life as the primary payer, revenue codes 0913 or 0912 should be filed with the correct Healthcare Common Procedure Coding System (HCPC) code to allow the system to calculate the appropriate allowed amounts to ensure proper payment.

Note: Revenue codes must be billed separately for each date of service.

Partial Hospitalization Program (PHP) and Intensive Outpatient Program (IOP) claims are to be submitted per policy as listed below:

Non-OPPS payable providers

Revenue code 0912 can be billed with HCPC H0035 or by itself for half-day service
Revenue code 0913 can be billed with HCPC H0037 or by itself for full-day service
Revenue code 0905 or 0906 can be billed with H0015 or S9480

OPPS payable providers

Revenue codes 0914 and 0915 are OPPS payable codes only. Please reference figure 13.2.1 on listing of OPPS payable codes on referenced TRICARE Manual provided below.
Revenue code 0905 or 0906 can be billed with H0015 or S9480
All claims must be billed with condition code 41 on CMS 1450 UB-04 Claim Form

Reference:

Clarification on Partial Hospitalization Programs (PHP) claims and codes

TRICARE Manuals - Display Chap 13 Sect 2 (Change 64, Aug 3, 2022) (health.mil)

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