Changes to Billing for Substance Use Disorder Intensive Outpatient Program Treatment (revised IB 22-36 on 12.8.22)

Date: 12/12/22

Louisiana Healthcare Connections is sharing with providers a recent change on December 8, 2022, regarding billing for substance use disorder intensive outpatient program treatment.

The revision summary reflects the below changes: (Claims)

• For dates of service on or after August 8, 2022, MCEs shall recycle any claims that were not paid in accordance with these changes within 15 days of implementing the system changes.
• In the event that August 8, 2022, was not the date on which the MCE lifted the bypass of the edit that would prevent payment of a claim for H0015 for more than one unit of service, claims do not have to be recycled/recouped by the MCE or resubmitted by the provider for adjudication. Only claims that were impacted by the elimination of the bypass, resulting in either a denial or a downward adjustment in payment for only one unit at the previous rate of $12.00 for Masters and Bachelors level or $8.00 for less than Bachelors, should be readjudicated based on the current per diem logic. The intent of this correspondence is to ensure that providers experience no lapse in appropriate payment of H0015 at a rate that equates to three hours of group SUD IOP service.

Providers with questions can contact your provider network specialist or provider services at 1-866-595-8133.