Same-Day Overlapping Services: Psychotherapy or Crisis Intervention Same Day as Intensive Outpatient Program (IOP)

Thank you for your continued partnership in serving WellCare of Kentucky members. We have an important reminder to share with you related to overlapping services billed for the same date of service. 

Individual, Family, or Group Psychotherapy (90832, 90833, 90834, 90836, 90837, 90838, 90839, 90840, 90845, 90846, 90847, 90849, 90853, 90870, 90875, 90876, H0004), Crisis Intervention H2011 and Intensive Outpatient Program (IOP) H0015 Same Day:

DMS regulations 907 KAR 15:010, 907 KAR 15:020, and 907 KAR 15:022 establish that individual psychotherapy, family psychotherapy, group psychotherapy, and crisis intervention services are components of IOP and shall not be separately reimbursable on a date of service where IOP was rendered to the member.

Effective February 1, 2025 WellCare will not reimburse for individual psychotherapy, family psychotherapy, group psychotherapy, or crisis intervention services billed regarding a member with the same date of service as an IOP claim billed regarding the member.

Please Note: The codes listed above are not an all-inclusive list. If the Department for Medicaid Services recognizes at any point more codes related to psychotherapy, crisis intervention, or IOP, the policy will also apply to any such additional codes. 

Recovery Scenario
If you receive payment for individual psychotherapy, family psychotherapy, group psychotherapy, or crisis intervention services billed on the same date as IOP for a member, WellCare intends to recover any such overpayment in accordance with KRS 304.17A-714.

Applicable Regulations
The applicable regulations:

• 907 KAR 15:010 coverage provisions and requirements regarding behavioral health services provided by individual behavioral health practitioners, behavioral health provider groups, and behavioral health multi-specialty groups.
• 907 KAR 15:020 coverage provisions and requirements regarding behavioral health services organizations for mental health treatment.
• 907 KAR 15:022 coverage provisions and requirements regarding behavioral health services organizations for substance use disorder treatment and co-occurring disorders.
• 907 KAR 15:080, coverage provisions and requirements regarding chemical dependency treatment services.
• 907 KAR 1:044, coverage provisions and requirements regarding community mental health center behavioral health services.

Again, we thank you for your continued partnership in delivering quality healthcare to our members. If you have any question regarding this notice, please contact your Provider Relations Representative.

Sincerely,
WellCare of Kentucky