2025 Commercial Outpatient Behavioral Health Prior Authorization Codes
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Defines outpatient behavioral health service categories and CPT/HCPCS codes for which prior authorization may be required for Blue Cross and Blue Shield of Oklahoma commercial members, and describes utilization management processes and service definitions; affects in-network providers and facilities managing BCBSOK members.
No material clinical or coverage changes in this revision.
Prior Authorization and Service Management
General Prior Authorization and Service Management
Prior authorization may be required for listed outpatient behavioral health services; authorization decisions confirm medical necessity per the member's benefit plan and are not guarantees of payment.
Service-specific notes
- Psychological/Neuropsychological testing requires prior authorization in some cases; BCBSOK will notify the provider when authorization is required.
- rTMS, ECT, PHP, IOP, and ABA services are defined with typical treatment schedules and may appear on the prior authorization/code list; refer to the code file for specific CPT/HCPCS entries and service definitions.
CPT / HCPCS Codes and Code-Specific Notes
| 97151 | Behavior identification assessment by physician/qualified health professional |
| 97152 | Behavior identification support assessment by a technician |
| 97153 | Adaptive behavior therapy by technician |
| 90870 | Electroconvulsive therapy |
| 90867 | rTMS treatment planning |
| 90868 | rTMS delivery |
| 96130 | Psychological testing evaluation by physician/qualified health professional |
| 90869 | rTMS - Redetermine / Tcran Magn Stim (listed for rTMS related services) |
What Providers Must Do
Prior authorization required; provider usually requests
Prior authorization is required for some members/services/drugs before services are rendered to confirm medical necessity as defined by the member's health benefit plan. A prior authorization is not a guarantee of benefits or payment; the provider is usually responsible for requesting prior authorization for in-network services.
- Check member eligibility and benefits prior to requesting authorization via Availity or preferred portal.
- Authorization decisions confirm medical necessity but do not guarantee payment; member plan terms control benefits.
Authorizations may be managed by Carelon — confirm contact
Some prior authorization decisions and utilization management functions are managed by Carelon Medical Benefits Management under contract with BCBSOK; check the member's ID card or Availity/portal for the correct authorization contact number.
- If unclear, call the authorization number on the member's ID card.
- Always verify whether BCBSOK or Carelon manages the authorization for the specific service/member.
Psychological/Neuropsychological testing may require prior authorization
Psychological/Neuropsychological testing only requires prior authorization in some cases; BCBSOK will notify the provider if prior authorization is required for these testing services.
- Do not assume authorization is required for all psychological testing—await BCBSOK notification when authorization is necessary.
Service Definitions and Program Descriptions
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