Psychiatric and Substance Abuse Facilities

The information in this section pertains to members with PPO (BlueChoice, BlueMedicare PPO, and BlueOptions) and Traditional coverage.

Note: All behavioral health services for HMO members should be arranged through New Directions Behavioral Health, including submission of claims.

Intensive Outpatient Program

Intensive outpatient program is defined as treatment that lasts a minimum of three hours a day for a minimum of three days per week in a structured program.

• Indicate “131” type of bill with revenue code 0905 for psychiatric services and 0906 for substance abuse services. Do not bill revenue codes 0500 or 0914.

• For FEP members, IOP admissions must be certified.

Outpatient

Outpatient behavioral billing are for treatments that do not last longer than 80 minutes per day, and are eligible for payment based on the terms of the rendering MD, PhD, or licensed masters level clinician’s agreement. No more than one outpatient visit per day will be eligible for payment.

Partial Hospitalization (PHP)

Florida Blue defines revenue code 0912 as partial hospitalization for chemical dependency and revenue code 0913 as partial hospitalization for psychiatric services.

• Indicate “131” type of bill.

Note: For BlueCard members, you must contact the home plan to identify if the member’s benefit is identified as inpatient or outpatient and bill your claim to Florida Blue accordingly.

For BlueCard members, indicate “111” or “131” type of bill depending on the member’s benefits.

• For inpatient, indicate “111” type of bill with room and board revenue code 0169, and the applicable revenue code 0912 or 0913 on the following line. The days/units must be submitted on the line that contains revenue code 0169.

• If outpatient, indicate “131” type of bill with the applicable revenue code 0912 or 0913. Do not bill revenue code 0169.

For FEP members, indicate “131” type of bill with the applicable revenue code 0912 or 0913. Do not bill revenue code 0169.

New Directions Behavioral Health defines revenue codes 0912, 0913, and 0915 for use as partial hospitalization. The primary diagnosis will determine the per diem rate.