News
Behavioral Health (BH) Type of Bill (TOB) Scenarios:
Date: 08/07/26
*Note: The revenue and procedure codes listed are provided as examples only and is not an all-inclusive listing. Providers should refer to applicable billing guidance, contractual requirements, and payer-specific policies to confirm appropriate revenue code and procedure code use.
Inpatient TOB and Revenue Code Scenarios
Type of Bill (TOB) | TOB Description | Additional Description | Examples of appropriate INPATIENT revenue codes |
|---|---|---|---|
11X | Inpatient Hospital | Used for acute care hospitals, inpatient admissions | 1001, 1002, 114, 116, 124, 126, 134, 136, 144, 146 |
Residential Treatment Center (RTC) TOB and Revenue Code Scenarios
Type of Bill (TOB) | Description | Additional Description | Examples of Appropriate INPATIENT Revenue Codes |
86X | Residential Treatment Center (RTC) | Used for mental health residential treatment and substance use treatment & detox | 1001, 1002, 114, 116, 124, 126, 134, 136, 144, 146 |
Outpatient TOB and Revenue Code and Procedure Code Scenarios
Type of Bill (TOB) | Description | Additional Description | Examples of appropriate OUTPATIENT revenue codes to be billed WITH corresponding HCPCS/CPT Codes |
13X | Outpatient Hospital | Used for hospital-based outpatient clinics. Utilized for hospital-based PHP/IOP programs | 905, 906, 912, 913, 907 H0015, H0035, S9480, 90834 |
76X | Community Mental Health Center (CMHC) | Used for specialized clinics; commonly used for clinic-based PHP/IOP programs | 905, 906, 912, 913, 907, H0015, H0035, S9480, 90834 |