Partial Hospitalization Program (PHP)
Partial hospitalization programs (PHPs) for mental health and substance use disorder are a limited benefit. Services may include day, evening, night and weekend treatment programs which employ an integrated, comprehensive and complementary schedule of recognized treatment approaches. Partial hospitalization is a time-limited, ambulatory, active treatment program that offers therapeutically intensive, coordinated, and structured clinical services within a stable therapeutic environment. Partial hospitalization is an appropriate setting for crisis stabilization, treatment of partially stabilized mental disorders, to include substance disorders, and a transition from an inpatient program when medically necessary. Office-based PHP is not a covered benefit.
Services provided in a PHP setting may not be rendered via telemedicine; however, half-day PHP services are reimbursable as an IOP when authorized and billed as such. Individual provider services such as psychotherapy and medication management that are not provided in conjunction with an PHP may be considered for telemedicine coverage. These services are subject to daily limits per TRICARE policy.
An approval from Health Net Federal Services, LLC (HNFS) is required for all beneficiaries. A request should be submitted to HNFS by the beneficiary’s primary care manager/provider or the mental health care specialty provider.
Note: Providers can refer to our PHP Claims Tips page for claims submission guidelines to ensure accurate and timely reimbursement.