Technically, partial hospitalization is outpatient treatment, as clients attend recovery sessions while living at home. However, insurers place it in a separate category from other types of outpatient care, resulting in different deductibles, copays, and visit limits. Learn more about how this affects the care you receive.

Key Takeaways

To most, partial hospitalization seems like outpatient care, as it allows clients to live at home while receiving treatment. However, insurance companies view it as a special type of outpatient service, requiring prior authorization and specific cost-sharing rules.
It provides mental health services to individuals with substance abuse and emotional disorders, offering treatment on a more full-time basis.
In New Hampshire, it is a popular treatment solution, offering an alternative to harder-to-access inpatient care, and various laws and departments are in place to ensure people get the treatment they need.

Table of Content

What is a Partial Hospitalization Program?
How Do Insurance Providers Classify PHP?
What Does This Mean For Me?
What Do I Need to Know About PHP in New Hampshire?
Get the Care You Need at Capital Recovery
FAQs

Introduction

Partial hospitalization provides outpatient psychiatric services. Clients attend therapy sessions for several hours a day over several weeks while living at home. The ‘living at home’ aspect distinguishes it from inpatient treatment.

However, it behaves like inpatient care in terms of intensity, which puts it in a gray area, especially regarding insurance. It has its own codes that impact deductibles, copays, and visit limits. Find out how that might affect your treatment experience.

What is a Partial Hospitalization Program?

PHP acts as a bridge between traditional weekly therapy and 24/7 inpatient hospitalization. It can also be a primary form of care after detox. Clients attend for several hours a day, several days a week, for a more full-time approach to treatment. They return home after each session.

The programs consist of support groups, individual therapy, and various treatment modalities like cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), psychoeducation, and healthy activities, teaching clients coping skills to manage mental health and alcohol and substance use disorders. They are recommended for individuals who require a structured program but can adhere to treatment without 24/7 oversight.

A PubMed study reports that clients in PHP programs experience improvements in symptom severity and cognitive function.

How Does PHP Differ From Other Outpatient Treatments?

While PHP falls under the outpatient treatment umbrella, the approach is much more structured and clinical than other outpatient treatments, like intensive outpatient programs and traditional outpatient programs. For example:

Intensive Outpatient Programs (IOPs): Require shorter treatment sessions, typically around 3 hours a day, 3-5 days a week, offering structure for those who don’t require daily oversight. They are often a follow-up to PHP, but can also be a form of primary care.
Traditional Outpatient: Clients attend shorter sessions, typically about 30-45 minutes, once or twice a week, typically for ongoing support following a higher level of care.

How Do Insurance Providers Classify PHP?

Like clinicians and clients, insurance providers classify PHP as outpatient care, but there are specific rules, codes, and authorization requirements that don’t come with lower levels of treatment. For example, specific codes are used in documentation, as follows:

HCPCS code H0035 (mental health PHP, per diem)
HCPCS code H2036 (substance use PHP)
Revenue code 0912/0913 (used on facility claims)
CPT codes for individual therapy sessions delivered within PHP

As a result, it goes through different pipelines, which affects how authorization, coverage limits, and cost sharing are applied.

What Does This Mean For Me?

As a client, you should note that the different classifications used for PHP mean that prior authorization is required and cost-sharing may be affected.

Prior Authorizations

Due to the clinical nature of PHP, a prior authorization is typically required before coverage is approved. Generally, the provider will want to know if the treatment is medically necessary, with the following requirements.

A clinical assessment showing the client needs more than weekly outpatient care
Documented symptoms and risk factors justifying a need for intense treatment
A treatment plan with measurable goals
Diagnoses that align with an accepted criteria set- typically ASAM criteria

Authorizations are typically made in 5-10 day blocks with concurrent reviews.

Cost Sharing

Here’s how cost-sharing typically works with a commercial plan:

PHP days count toward the outpatient benefit, not the inpatient benefit
Cost-sharing is typically applied per day or per visit, not per admission (so a 10-day PHP stay generates 10 instances of cost-sharing, not one)
Some plans have a separate “intermediate care” or “alternate level of care” benefit category that includes PHP
Out-of-pocket maximums still apply, which is often the patient’s real protection against cost

Questions to Ask

Ask the following questions when enrolling in a treatment program to avoid unwanted surprises.

Is PHP a covered benefit, and what’s the prior authorization process?
What are my per-day or per-visit cost-sharing amounts?
Does PHP apply toward my outpatient deductible, inpatient deductible, or a separate category?
Is there a day or visit limit per benefit year?
Which PHP providers are in-network in New Hampshire?
What criteria set does the plan use to determine medical necessity?

What Do I Need to Know About PHP in New Hampshire?

The PHP landscape in New Hampshire is shaped by regulatory framework, treatment gaps, and access realities. Here are some things you should know before you start treatment.

The Regulatory Framework

The Mental Health Parity and Addiction Equity Act (MHPEA) ensures individuals who require care for substance use and psychiatric disorders get the help they need, just as they would for any medical condition. In New Hampshire, this is enforced by the NH Insurance Department, which handles appeals for people with addiction who were denied care, and the NH Bureau of Drug and Alcohol Services, which ensures treatment centers meet certain standards.

The Treatment Gap

New Hampshire was heavily impacted by the opioid crisis, with 287 confirmed overdose deaths in 2024. As a result, there are typically long wait times for inpatient hospitalization. Clients who can’t access care are typically referred to PHP, making it a popular treatment for individuals who need treatment for substance abuse and related mood disorders.

Geographic and Access Realities

While PHP programs exist, they are typically located in more populated areas of New Hampshire, such as the Concord/Manchester corridor, the Seacoast, and the Upper Valley, leaving the North Country with limited options. While telehealth is available, it’s not right for every person. These geographic issues further contribute to the treatment gap.

Get the Care You Need at Capital Recovery

At Capital Recovery, we understand the need and importance of PHP care in New Hampshire. Our clinic meets the demand with evidence-based therapies and a team of trained therapists and psychiatrists. We offer PHP alongside a full range of outpatient services, providing supportive care that guides you through your recovery journey.

FAQs

Is PHP the same as inpatient rehab?

No, despite the word ‘hospital’ in the name, PHP is not the same as inpatient treatment. While both offered structured care, residential treatment requires clients to stay at the facility 24/7. With PHP, clients can live at home while receiving care.

What is a typical PHP schedule?

PHP programs generally run Monday through Friday during typical business hours. At least 20 hours of therapeutic services are recommended weekly. However, this can vary based on the client’s mental health needs.

Will my insurance cover PHP?

Yes, insurance is available for PHP, although plans and coverage vary. Talk to your insurance provider and treatment center to find out more about what you’ll pay. You should also ask about cost-sharing and authorizations to learn what’s required.

How long does PHP last?

PHP length varies based on clinical needs, but most programs run two to four weeks. Some patients stay longer if they’re stepping down from inpatient or need additional stabilization. Insurance authorizations are typically granted in blocks of 5–10 days, with the treatment team submitting concurrent reviews to extend coverage as needed.

Who is PHP for?

A PHP is for people who require structured care but don’t need 24/7 oversight and have a supportive home environment. Patients must have the stability to return home after PHP sessions.

Sources

American Society of Addiction Medicine. “The ASAM Criteria.” https://www.asam.org/asam-criteria
Substance Abuse and Mental Health Services Administration. “Substance Use Disorder Treatment: Levels of Care.” https://www.samhsa.gov/substance-use/treatment
Centers for Medicare & Medicaid Services. “Medicare Benefit Policy Manual, Chapter 6 – Hospital Services Covered Under Part B (Partial Hospitalization Services).” https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c06.pdf
McCarthy et al. “Outcomes of Acute Partial Hospital Treatment: Comparison of Two Programs and a Waiting List Control.” Journal of Nervous and Mental Disease, 2018. https://pubmed.ncbi.nlm.nih.gov/29303947/
National Library of Medicine (PMC). “Alcohol Treatment Outcomes Following Discharge from a Partial Hospital Program.” 2019. https://pmc.ncbi.nlm.nih.gov/articles/PMC6419972/
Thompson et al. “Systematic Review: Patient Outcomes in Transdiagnostic Adolescent Partial Hospitalization Programs.” Journal of the American Academy of Child and Adolescent Psychiatry, 2023. https://pubmed.ncbi.nlm.nih.gov/37271333/
New Hampshire Fiscal Policy Institute. “New Study: Sharp Decline in Drug-Related Fatalities Follows Increase in Investment in Prevention, Treatment, and Recovery.” September 30, 2025. https://nhfpi.org/press-releases/new-study-sharp-decline-in-drug-related-fatalities-follows-increase-in-investment-in-prevention-treatment-and-recovery/
New Hampshire Department of Health and Human Services. “Substance Misuse.” https://www.dhhs.nh.gov/programs-services/health-care/substance-misuse
New Hampshire Department of Health and Human Services. “NH Drug Monitoring Initiative (DMI) – May 2025 Report.” https://www.dhhs.nh.gov/sites/g/files/ehbemt476/files/documents2/dmi-may2025.pdf
New Hampshire Insurance Department. “Mental Health Parity.” https://www.nh.gov/insurance/consumers/mental-health-parity.htm
U.S. Department of Labor. “Mental Health and Substance Use Disorder Parity.” https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/mental-health-and-substance-use-disorder-parity
The Doorway NH. https://www.thedoorway.nh.gov/
U.S. Department of Labor. “FMLA: Frequently Asked Questions.” https://www.dol.gov/agencies/whd/fmla/faq

Is partial hospitalization considered outpatient? How insurers and providers classify PHP