Understanding HCPCS and CPT Billing Codes for Outpatient Addiction Treatment: H0015, H2036, S0201, and S9480

October 24, 2023 Ben Weiss

What are IOPs or intensive outpatient programs? When and why are they used in addiction treatment and mental health care?

Intensive outpatient programs exist in the continuum of care between residential treatment and typical outpatient programs, where a patient or client might visit with a provider on a weekly or bi-weekly basis for one-on-one or group counseling. IOPs involve the patient in a more immersive treatment plan where visits are more frequent and there are perhaps more activities and “homework” to complete than there might be in an outpatient setting. The time commitment with an IOP is going to be more significant than the time commitment a client makes in a typical outpatient program, but less significant than the time commitment they make in a residential treatment program.

IOPs are a great choice for patients who need flexibility, want to stay in their community, have personal obligations like work or caregiving responsibilities, or who are adverse to the idea of temporarily relocating to a residential program. While some patients may thrive with the minimal interventions provided in a typical outpatient program, other patients need a higher level of care to make progress on their treatment goals. IOPs are a good fit for patients like these, regardless of whether their primary diagnosis is substance use disorder or another mental health condition, like depression or anxiety.

What’s the difference between an addiction treatment IOP and a PHP?

IOPs are essentially the part-time version of a PHP. Where IOPs require around three days a week of engagement, PHPs generally require five. The time commitment with an IOP allows a patient to retain many of their usual day-to-day duties at home or at work, while the increased demands of a full-time PHP will typically not allow patients to pursue most of their day-to-day duties outside of PHP activities. Both programs will have patients physically “residing” (i.e. sleeping, eating and bathing) elsewhere - either at home or in another environment, like a sober living home or community housing situation. Neither PHP nor IOP are residential programs in this sense.

What billing codes are used for addiction treatment IOP or intensive outpatient programs?

There are a mix of codes used for this category of behavioral health treatment. Some of them are exclusive to mental health treatment while others are exclusive to drug and alcohol treatment. Some codes used with IOP are only used with private sector payers and are typically not accepted by public payers.

The two most important codes to understand for IOP are H0015, alcohol and drug services IOP program, and S9480, Intensive outpatient psychiatric services, per diem.

What rules govern some of the most common IOP or intensive outpatient addiction treatment billing codes?

H0015 - Alcohol and Drug services IOP program

This HCPCS code defines an intensive outpatient program (IOP) that runs for a minimum of three hours a day at least three times a week. In order to use this code, programs cannot be “cookie cutter” treatment modalities. Instead, programs must create individualized treatment plans that include assessment, one-on-one and/or group counseling, crisis response and intervention as well as therapeutic activities and/or educational components. Three hours represents one unit of service with this code, so if you’re billing for 6 hours of IOP, you’d submit H0015 twice.

H2036 - Alcohol and drug treatment program, per diem.

You’ll often see this code used when payers demand a more granular break-down of services provided at an addiction treatment IOP program. While some payers will accept H0015 for every 3 hours of service at an IOP program, some have more specific claims requirements. For payers like these, you’ll need to use H2036 to document each day - “per diem” - of service at your IOP. For granular claims like these, you’ll also sometimes see H2019 (therapeutic behavioral services, per 15 minutes), H2020 (therapeutic behavioral service, per diem), H2035 (alcohol and other substance abuse treatment programs per hour), H2036 (alcohol and other substance dependence treatment program, per diem).

S0201 - Partial hospitalization services, or PHP, less than 24 hours, per diem.

This S-Code is used for intensive mental health services designed to bridge inpatient psychiatric hospitalization with community-based care. Sometimes partial hospitalization is used instead of inpatient admission when it’s deemed more appropriate or feasible given the patient’s situation. You’ll often see S0201 used instead of H0035, which describes mental health partial hospitalization and treatment with a duration of less than 24 hours.

S9480 - Intensive outpatient psychiatric services, per diem.

This S-Code refers especially to mental health treatment for disorders like depression, anxiety, OCD, etc. When psychiatric services occur within the context of an IOP program - as they often do in mental health treatment settings - then S9480 is paired with 0905 to become S9480/0905. Because S9480 is an S-Code, it is always billed to private sector payers. Medicare and Medicaid do not accept S-Codes.

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