Health Information Management

Q/A: Payment for partial hospitalization services

APCs Insider, July 8, 2011

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Q: Is CMS proposing any changes to the APCs for partial hospitalization programs (PHPs)?

A: The 2012 OPPS proposed rule, released July 1, would continue CMS’ methodology for creating separate APCs for partial hospitalization when provided in a hospital setting or a freestanding community mental health center (CMHC).

CMS would update the four existing CMHC PHP APC payment rates—two for freestanding CMHC PHPs, and two for hospital-based PHPs. Pursuant to its proposal, CMS would pay:

  • $97.78 for APC 0172 (level 1 partial hospitalization for CMHC)
  • $113.62 for APC 0173 (level II partial hospitalization CMHC)
  • $162.34 for APC 0175 (level 1 partial hospitalization for hospital-based PHPs)
  • $189.87 for APC 0176 (level II Partial Hospitalization for hospital-based PHPs)



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