Changes to Billing for Substance Use Disorder Intensive Outpatient Program Treatment (ASAM 2.1) (IB 22-36)

Date: 11/09/22

Louisiana Healthcare Connections is sharing with providers a recent change to billing for substance use disorder intensive outpatient program treatment. 

Effective August 8, 2022, H0015 Substance Use Disorder Intensive Outpatient treatment ASAM 2.1 (SUD IOP) may not be billed for more than one unit per day. The change is being made so that the description and use of the code aligns with the Centers for Medicare and Medicaid (CMS) Healthcare Common Procedure Coding System (HCPCS) description. Once the description and billing guidance is updated, providers will bill the code correctly and National Correct Coding Initiative (NCCI) editing will not be an issue. The Specialized Behavioral Health Services (SBHS) fee schedule has been updated to reflect a per diem rate for SUD IOP group services. Additional allowable services are to be billed using appropriate Current Procedural Terminology (CPT) and HCPCS codes, located on the SBHS fee schedule which is available at Medicaid Provider Resources. Please note the following parameters for the appropriate provision and billing of SUD IOP:

1. Adult IOP group must consist of a minimum of 3 hours per day, for a minimum of 3 days per calendar week (9 contact hours) and a maximum of 5 days per calendar week.
2. Youth IOP group must consist of a minimum of 3 hours per day, for a minimum of 2 days per calendar week (6 contact hours) and a maximum of 5 days per calendar week.
3. For both youth and adults receiving SUD IOP, a minimum of 1 session of individual therapy must be provided within each 30-day service period, with a maximum of 4 sessions per 30-day service period.
4. The maximum number of SUD IOP treatment hours for adolescents and adults is 19 hours per week.

The Medicaid Behavioral Health Services Manual will be updated to reflect the above requirements for the provision of the SUD IOP service. Monitor Medicaid Provider Resources for updated versions of the SBHS fee schedule and provider manual.

Louisiana Healthcare Connections is updating our claims processing systems to properly adjudicate behavioral health claims for the applicable H0015 code, Substance Use Disorder Intensive Outpatient Treatment ASAM 2.1 and will have completed prior to December 4, 2022.

For claims processed on or after August 8, 2022, Louisiana Healthcare Connections will recycle any claims that were not paid in accordance with these changes within 15 days of implementing the system changes automatically. 

Providers with questions regarding managed care claims processing, billing guidance and prior authorization may contact Provider Network Services at 1-866-595-8133.