Facility Billing
Behavioral Health Facility Billing For IOP, PHP And Residential Programs
UB-04 claims, per diem units, revenue codes and the separate authorization each level of care needs, set up so what you bill matches what the chart shows.
Reviewed by Ryan Berg · Updated September 26, 2026
Why It’s Different
Facility Claims Run On A Different Set Of Rules
Most outpatient billers live on the professional claim, the CMS-1500 that goes out electronically as an 837P. A program that runs intensive outpatient, partial hospitalization or residential care bills on the institutional claim instead, the UB-04 that goes out as an 837I. That one change pulls in revenue codes, bill types, per diem units and condition codes, and it’s where in-house teams that learned billing on office visits start losing money.
The level of care drives everything downstream. It decides the code you submit, the authorization you need and the rate the payer applies. PHP often goes out with revenue codes such as 0912 or 0913, and some Medicaid programs use H0035 for the program day. Commercial psychiatric IOP commonly uses S9480, and H0015 shows up for substance use IOP. Those are common conventions, not a rulebook. They change by payer and by state Medicaid program, so we confirm them against each payer’s policy before the first claim.
The per diem rule catches a lot of programs. The program day is the unit, so a day that falls short of the payer’s minimum hours generally shouldn’t be billed at all. Billed anyway, it’s a clawback waiting for the next audit.
What We Do
What We Set Up, Check And Run
Contracts And Rates
Each payer’s per diem rates, covered levels of care and billing rules loaded where your team can actually see them, so a claim isn’t the first time anyone checks the contract.
Authorizations By Level Of Care
An authorization for PHP doesn’t cover IOP, and the reverse. We track each one to its approved days and flag every step up or step down that needs a new or revised authorization before services continue.
UB-04 Claim Build
Revenue codes, HCPCS codes, bill type, units and dates configured per payer in the system you already run, then tested on real claims before volume moves through.
Clearinghouse And Remittance
837I enrollment, 835 remittance, EFT and payer portal access for the facility, so payments post to the right place and denials come back where someone works them.
Denials And A/R
Every denial worked to a documented outcome, with the pattern behind it fixed at the source. Aging A/R sorted by what’s still collectible.
Training Your Team
If you’d rather keep billing in house, we set it up and train your staff on facility claims, then hand back the checklists and the tracker they’ll run it with.
How It’s Priced
Scoped First, Priced In Writing
Facility billing doesn’t fit a per-provider package, so we don’t pretend it does. We start with your payer mix, levels of care, claim volume and the system you bill from. Then you get the work included, the boundaries, the price and the start conditions in writing before you commit to anything.
There are two ways to work together. We can set up and train your in-house team, or we can run facility billing for you. Some programs start with the first and move to the second once they see the numbers.
Questions We Get
Facility Billing Questions
Do You Bill UB-04 Claims?
Yes. Facility billing for IOP, PHP and residential programs goes out on the UB-04 institutional claim, sent electronically as an 837I, with the revenue codes, bill type and units each payer expects.
Can You Train Our In-House Billing Staff Instead Of Taking Billing Over?
Yes. We can set up the claims, authorizations and payer rules, train your team on facility billing, and hand back the checklists and tracker they’ll use. You can move billing to us later if you want to.
How Is Facility Billing Priced?
It’s scoped, not packaged. We look at your payer mix, levels of care, claim volume and billing system, then put the included work, the price and the start conditions in writing before anything starts.
Do You Track Authorizations For Residential, PHP And IOP?
Yes. Each level of care is authorized separately against its own medical necessity criteria, so we track every authorization to its approved days and flag step ups and step downs before services continue.
Which Billing Codes Do Facilities Use?
It depends on the payer and the state. PHP often uses revenue codes such as 0912 or 0913, and some Medicaid programs use H0035. Psychiatric IOP commonly uses S9480, and substance use IOP often uses H0015. We confirm the current codes and minimum hours against each payer’s policy before the first claim.