CMS suspends proposed billing edits for partial hospitalization program services

The Centers for Medicare & Medicaid Services today suspended changes to its billing process for Partial Hospitalization Program services that were scheduled to begin July 1. The changes to the agency’s Integrated Outpatient Code Editor would have enforced the program’s minimum 20 hours per week of therapeutic services by requiring weekly billing and denying claims that did not meet the 20 hours in a given week. AHA and others had urged CMS to drop the proposed edits, which are inconsistent with CMS guidance and regulation and would require substantial administrative and clinical changes by program providers.