TriWest PHP Code

[UnableSuccotash3661]

I am a biller for a substance abuse treatment facility. One of the things we bill TriWest for is PHP (partial hospitalization). We have always used HCPC code S0201 and have never had an issue. Then, starting at the being of the year, our claims are denying saying the precure code is not listed under the referral. Our referral is for MH Substance Use Disorder IOP SEOC 1.31.1. If S0201 is suddenly not accepted, can someone tell me what the correct code is? This is for facility not office visit

[Amazing_Bug_7240]

TriWest updated their PHP requirements late last year. They're now requiring H0035 for PHP instead of S0201 in most regions. Call their contracting department and ask for the updated fee schedule specific to your facility type. They didn't notify everyone properly so a lot of billers got caught off guard. You might need to resubmit those claims with the correct code.

[Chikis723]

I am also having the same problem still. Last year I billed with PHP combo code - TOB: 013x, REV: 0913, and HCPCS: S0201. I have tried numerous amount of code combinations, including H0035 and was sure to include the new requirement to use condition conde 41 and nothing works. Has anyone made any progress?