New Changes to Behavioral Health Intensive Outpatient Program Coverage in Medicare

August 9, 2024

New Changes to Behavioral Health Intensive Outpatient Program Coverage in Medicare

The Center for Health Care Strategies published a policy cheat sheet highlighting the Centers for Medicare & Medicaid Services’ coverage of intensive outpatient program (IOP) services.

As of January 1, 2024, Medicare now covers IOP services. IOPs are structured treatment programs that take place on an outpatient basis. IOPs are designed for individuals with mental health or substance use disorder (SUD) conditions, who have treatment plans demonstrating a need for 9-19 hours a week of therapeutic services.

The cheat sheet highlights:

  • The latest policy changes in IOP covered services
  • How changes impact dually eligible individuals
  • Medicaid-only enrollees
  • New billing requirements and guidance for crossover claims

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