ATTENTION: Behavioral Health Partial Hospitalization Program and Intensive Outpatient Program Billing Code Update

Date: 09/11/25

The Texas Health and Human Services Commission (HHSC) has required Managed Care Organizations (MCOs) to report on the utilization of In-Lieu-of Services (ILOS) for Partial Hospitalization Program (PHP), and Intensive Outpatient Program (IOP) using Healthcare Common Procedure Coding System (HCPCS) procedural codes, to align with Medicaid fee for service requirements.

Effective immediately, PHP and IOP claim billing for Medicaid members (STAR, STAR Health, and STAR+PLUS) adult members over 20 years of age must include the applicable HCPCS procedural code, together with the applicable revenue code when billing appropriately authorized PHP and IOP services. Providers may also bill only the applicable HCPCS code for authorized services on claims, if desired.

Please Note: For Medicaid members under 21 years of age, PHP and IOP services may also be available as a Texas Health Steps Early Periodic Screening and Treatment (EPSDT) Medicaid benefit as an option to inpatient psychiatric hospitalization.      

Below is required billing codes for PHP and IOP:

Service	Revenue Code Optional	HCPC Code Required	Service Description
Partial Hospitalization Program (PHP)	912	H0035	Behavioral health treatment services, partial hospitalization, less intensive
	913	S0201	Behavioral health treatment services, partial hospitalization, intensive
Intensive Outpatient Program (IOP)	905	S9480	Behavioral health treatment services, intensive outpatient psychiatric
	906	H0015	Behavioral health treatment services, intensive outpatient chemical dependency

Previously Superior HealthPlan accepted the revenue codes for these services when specified in the provider’s contract or single case agreement. As of July 1, 2025, the appropriate HCPCS code must also be provided for claims payment. Claims billed without the applicable HCPCS procedural code will be denied and will require a corrected claim.

For questions, please contact your Behavioral Health Provider Representative at AM.BH@SuperiorHealthPlan.com.

Please note: This article is an update from the previously posted article: Medicaid Partial Hospitalization Program and Intensive Outpatient Program Mental Health and Substance Use Disorder (SUD) Services Available.