Behavioral HealthHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingNovember 22, 2023

Claims analysis of codes billed concurrently with Intensive Outpatient Treatment

Anthem Blue Cross and Blue Shield embraces opportunities to foster collaboration efforts with providers to ensure proper coding and payment of claims. To this end, we regularly review the Indiana Health Coverage Programs Provider Reference Modules to ensure we are processing claims that are consistent with state guidance.

This letter is sent as a reminder that per the Indiana Health Coverage Programs Provider References Module for Behavioral Health Services, page 15 and in accordance with 405 IAC 5-20-8 (14):

  • Intensive Outpatient Treatment (IOT) includes the following components: individual/family therapy, group therapy, skills training, medication training and support, peer recovery services, and care coordination.
  • Peer recovery services may not be billed by the same provider when performed on the same date of service as IOT.

Reimbursement is not allowed for any of the above-listed services when administered concurrently with IOT services provided by the same facility as the provider. Billing these codes in addition to IOT services (procedure codes H0015 and S9480 and revenue codes 905 and 906) through the same provider for concurrent dates of service will result in denial of the associated claim.

We are grateful for your care of our members and look forward to continued collaboration.

Anthem Blue Cross and Blue Shield is the trade name of Anthem Insurance Companies, Inc. Independent licensee of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

Providers who are contracted with Anthem Blue Cross and Blue Shield to serve Hoosier Healthwise, Healthy Indiana Plan, and Hoosier Care Connect through an accountable care organization (ACO), participating medical group (PMG) or Independent Physician Association (IPA) are to follow guidelines and practices of the group. This includes but is not limited to authorization, covered benefits and services, and claims submittal. If you have questions, please contact your group administrator or your Anthem network representative.

INBCBS-CD-026289-23-SRS26289