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IOP Coding Clarification

Date: 04/01/24

Intensive Outpatient Program (IOP) Coding Clarification

This memo is being sent to all contracted providers regarding the use of H0015 and S9480 for Intensive Outpatient Program (IOP) services. AHCCCS has become aware of a shift in the utilization of these codes and is concerned providers who are billing S9480 do not meet the requirements for this level of service.

Providers billing S9480 for intensive outpatient psychiatric services must meet the minimum requirements as described below:

  1. Treatment shall consist of a minimum of 9 hours of service per week, a minimum of 3 hours per day, conducted on at least 2 days and shall include, but is not limited to, the following:
    •  1 session with the members treating Psychiatric Provider (Behavioral Health Medical Practitioner – BHMP) per week, and
    •  1-3 individual counseling sessions with a BHP, no less than 50 minutes in duration, per week, anD
    •  2 group counseling sessions, no less than 50 minutes in duration, per week.
  2.  A BHMP shall be available on-site at least 80% of the time during IOP Program operation, and
  3. BHP Caseloads shall not exceed 16 active members, and
  4. Group sessions shall include no more than 8 members and be facilitated by a BHP, and
  5. Intensive outpatient psychiatric services focused on the treatment of substance use and co-occurring disorders shall be consistent with the American Society of Addiction Medicine (ASAM) Criteria (3rd edition) level 2.1.

Providers billing H0015 for intensive outpatient alcohol and/or drug services provide substance use disorder and co-occurring treatment, in alignment with ASAM Criteria, 3rd Edition, level 2.1, must meet the minimum requirements as described below:

  1. Services may include individual and group counseling, medication management, family therapy, educational groups, occupational and recreational therapy, and peer support.
  2.  Services are provided in amounts, frequencies, and intensities appropriate to the objectives of the treatment plan.
  3. Treatment shall consist of a minimum of 9 hours of services a week, conducted for at least 3 hours a day and at least 3 days a week.

AzCH providers and staff:

If you have questions, please contact your AzCH Provider Engagement Specialist. If you need your assigned Provider Engagement Specialist’s contact information, please email us at AzCHProviderEngagement@azcompletehealth.com.

Care1st providers and staff:

If you have questions, please call Network Management at 1-866-560-4042 (Options in order: 5, 7) or email SM_AZ_PNO@care1staz.com.