CommercialCoverageMedium impact
PAP906 - Intensive Outpatient Program (IOP) Guidelines - Added clarification regarding telehealth benefit verification.
Blue Cross of Idaho·ID · Psychiatry·Medical Policy
Effective date
Mar 1, 2026
We identified it
Jun 19, 2026
Summary
Blue Cross of Idaho added clarification to PAP906 requiring billing teams to verify member benefits for telehealth coverage before providing Intensive Outpatient Program (IOP) services via telehealth. Telehealth services may not be reimbursable for all members depending on their specific contract terms.
Action Required
Immediately: Billing and authorization teams must verify telehealth benefits for all IOP services before scheduling telehealth sessions. Add telehealth benefit verification to the pre-authorization workflow for HCPCS codes H0015 and S9480. Update staff training to include checking member contracts for telehealth coverage. Claims for telehealth IOP services may be denied if member's plan does not include telehealth benefits.