Updated: April 2026
Purpose
ND Medicaid covers partial hospitalization psychiatric services provided to a member with an impairment resulting from a psychiatric, emotional, or behavioral disorder.
Applicability
Eligible Providers
To receive payment from ND Medicaid, the eligible servicing and billing providers must be enrolled with ND Medicaid on the date of service, and their National Provider Identifiers (NPIs) must be active in their Medicaid enrollment records. Servicing providers acting as a locum tenens provider must be enrolled with ND Medicaid, and services they provide must be billed with their NPI. Please refer to provider enrollment for additional details on enrollment eligibility and supporting documentation requirements.
Eligible Members
Providers are responsible for verifying a member’s eligibility before providing services. Eligibility can be verified using the ND Medicaid MMIS Portal or through the Automated Voice Response System by dialing 1.877.328.7098.
Services are provided by a multidisciplinary team of health care professionals, designed to stabilize the health of the member with the intent to avert inpatient hospitalization or to reduce the length of a hospital stay.
Refer to the Member Eligibility Manual for additional information regarding eligibility including information regarding limited coverage categories.
Covered Services and Limits
General Provider Policies
The General Provider Policies details basic coverage requirements for all services. Basic coverage requirements include:
- The provider must be enrolled in ND Medicaid;
- Services must be medically necessary;
- The member must be eligible on the date of service; and
- If applicable, the service has an approved service authorization.
The Procedure Code Look-up Tool can be used to identify if a procedure code is covered by ND Medicaid along with code specific details such as ORP requirements, Service Authorization requirements, and current rates.
Partial hospitalization psychiatric services must be hospital-based and under the supervision of a licensed physician.
Level A is an intense level of services by a multidisciplinary team for at least four hours and no more than eleven hours per day for at least three days per week.
Level B is an intermediate level of services by a multidisciplinary team for three hours per day for at least two days per week.
Service Authorization Requirements
No service authorization required.
Noncovered Services
General Noncovered Services
The Noncovered Services Policy contains a general list of services that are not covered by North Dakota Medicaid.
ND Medicaid does not cover intensive outpatient programs for mental health as a bundled service.
Documentation Requirements
General Requirements
Providers must keep legible medical and financial records that fully justify and disclose the extent of services provided and billed to ND Medicaid. Records must be retained for at least 7 years after the last date the claim was paid or denied. Providers must follow the documentation requirements in the Provider Requirements Policy.
Reimbursement Methodology and Claim Instructions
Timely Filing
ND Medicaid must receive an original Medicaid primary claim within one hundred eighty (180) days from the date of service. The time limit may be waived or extended by ND Medicaid in certain circumstances. The Timely Filing Policy contains additional information.
Third-Party Liability
Medicaid members may have one or more additional source of coverage for health services. ND Medicaid is generally the payer of last resort. Providers must pursue the availability of third-party payment sources. The Third Party Liability Policy contains additional information.
Client Share (Recipient Liability)
Client share (recipient liability) is the monthly amount a member must pay toward the cost of medical services before the Medicaid program will pay for services received. The Client Share Policy contains additional information.
Reimbursement
A claim for services must be submitted at the provider’s usual and customary charge. Payment for services is limited to the lesser of the provider’s usual and customary charge or the ND Medicaid calculated reimbursement.
Level A
- Billing Code – H0035
- Revenue Code – 905
Level B
- Billing Code – H0040
- Revenue Code – 912
If the member misses programming hours, the reason must be documented. For outpatient levels of care, the provider may only bill for days that the member received programming.
Claim Form
PHP services must be billed using the UB 04 claim form or 837i. Detailed claim instructions are available on the ND Medicaid Provider Guidelines, Policies & Manual webpage.
Claim Requirements
The claim must be submitted with both the correct revenue and billing code as listed under the Billing Guidelines above.
References
Contact
Medical Services
600 East Boulevard Ave
Bismarck, ND 58505-0250
Phone: (701) 328-2310
Email: dhsmedicalservices@nd.gov
Policy Updates
April 2026
- Billing Guidelines
- Added paragraph on missed programming hours
- Added claim form details
- Added claim requirements
- Covered Services and Limits
- Omitted “at least three licensed healthcare professionals” and added “multidisciplinary team.”
- ADA updates made throughout the document.