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CMS-1403-FC
mental health services paid on a per diem basis under the
OPPS. A CMHC receives a per diem payment for each PHP day,
which consists of a minimum of three PHP services. The
HCPCS codes that are eligible for PHP services and count
towards the number of PHP service units required to receive
the per diem payment were originally defined in the
April 7, 2000, OPPS final rule with comment period
(65 FR 18454).
The Medicare telehealth originating site facility fee
is not a PHP service and, as such, it does not count
towards the number of PHP services for purposes of
determining payment to a CMHC for partial hospitalization
services. The originating site facility fee is not bundled
into the per diem payment for partial hospitalization.
With respect to a Medicare telehealth service furnished by
a physician or practitioner to a beneficiary at a CMHC, the
originating site facility fee is separately payable under
Part B.
Consistent with existing policy, physicians and
practitioners furnishing services to beneficiaries in CMHCs
can bill Medicare Part B for telehealth services as long as
the service would be separately payable under the PFS when
furnished in a face-to-face encounter at that location.
However, as noted above, PHP services furnished via
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