Medicare's new IOP coverage: how to bill it right
Until 2024, Medicare paid for partial hospitalization but not intensive outpatient. Now it covers both. For a lot of treatment centers, that is money you never used to be able to bill.
The coverage started January 1, 2024. Medicare pays for intensive outpatient when the patient gets at least nine hours of treatment a week.
Not everyone can bill it. Medicare covers IOP at hospital outpatient departments, community mental health centers, health centers, rural clinics, and opioid treatment centers. Where you sit decides whether you can bill Medicare at all.
Medicare does not pay like a commercial plan. It has its own codes, its own paperwork, and its own limits, and a claim built like a commercial one denies. Altair bills Medicare the way Medicare wants, so the day gets paid and holds up.
Altair is the done-for-you billing service, run by AI, backed by our expert in-house billers. You do not need a billing team of your own. You treat patients. We get you paid.
Common questions
Can we bill Medicare for IOP now?
Yes, since January 1, 2024. Whether you can bill it depends on your setting: Medicare covers IOP at hospital outpatient departments, community mental health centers, health centers, rural clinics, and opioid treatment centers.
How is Medicare different from commercial insurers?
Medicare has its own codes, its own paperwork, and its own limits, and it wants at least nine hours of treatment a week. A claim built for a commercial plan denies. We bill Medicare on its own terms.
Do you bill Medicare and commercial IOP the same way?
No, and billing them the same is how days deny. We bill each one the way it wants, so you get paid either way.
Sources: the Consolidated Appropriations Act, 2023 (Medicare intensive outpatient benefit); CMS 2024 payment policy for intensive outpatient (2024 to 2026).