CurrentBlue Cross Blue Shield - OklahomaPolicy N/A

2024 Commercial Outpatient Behavioral Health Prior Authorization Codes

A searchable list of CPT/HCPCS codes for outpatient behavioral health services for which prior authorization may be required by Blue Cross and Blue Shield of Oklahoma for specified commercial networks, effective 1/1/2024. Includes service descriptions for PHP, IOP, ABA, ECT, rTMS, and psychological/neuropsychological testing and instructions about prior authorization process.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

Policy2024 Commercial Outpatient Behavioral Health Prior Authorization Codes

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJan 1, 2024

Next Review Date

Key ActionObtain prior authorization for listed behavioral health codes when required by the member's plan and verify eligibility/benefits before rendering services.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes — list of codes and requirements published without substantive policy changes.

~40Listed CPT/HCPCS codes (approximate)

2024Effective date (YYYY)

5Primary service categories described

Policy summary and scope

Policy: Blue Cross and Blue Shield of Oklahoma — 2024 Commercial Outpatient Behavioral Health Prior Authorization Codes (effective 1/1/2024). Scope: A searchable list of CPT/HCPCS codes for outpatient behavioral health services for which prior authorization may be required for specified commercial networks (Blue Choice Preferred PPO SM, Blue Choice PPO SM, and Blue Traditional SM). This includes service descriptions and operational constraints for PHP, IOP, ABA, ECT, rTMS, and psychological/neuropsychological testing and instructions about the prior authorization process.

Background: This document is a Claim Administrator/BCBSOK-maintained list of CPT and HCPCS codes and related service descriptions used to identify services that may require prior authorization. It summarizes program-level requirements (e.g., PHP licensing/accreditation, PHP staffing and psychiatrist contact, IOP minimum hours/days, ABA diagnosis scope, ECT frequency differences inpatient vs outpatient, and rTMS typical treatment course and constraints).

High-level note: Presence on this list does not imply coverage; member benefits and eligibility determine coverage and payment. Prior authorization, when required, is intended to confirm medical necessity per the member's health benefit plan and is not a guarantee of payment.

Policy summary

Effective date2024-01-01

StatusCURRENT

SubjectCommercial Outpatient Behavioral Health Prior Authorization Codes

Policy numberN/A

Key actionPrior authorization may be required for listed CPT/HCPCS codes for specified commercial networks; presence on list does not guarantee coverage; verify member eligibility/benefits before service

Prior authorization requirement & criteria

Prior Authorization

Obtain prior authorization for listed behavioral health codes as required

Provider must request prior authorization for services listed when required by the member's plan; prior authorization is not a guarantee of payment and eligibility/benefits must be verified prior to rendering services.

Verify member eligibility and benefits before rendering services
Call the prior authorization number on the member's ID card with questions

Service-level operational constraints & provider rules

Billing Rule

Do not bill rTMS same day as PHP, IOP, ECT, or ABA

rTMS therapy cannot be administered on the same day as a PHP, IOP, ECT, or ABA care-level service; providers must not bill these services on the same date of service.

Documentation Required

Ensure program licensing/accreditation for PHP and credentialing compliance

Partial Hospitalization programs must be licensed in the state or accredited by a national organization recognized by the Claim Administrator and meet credentialing requirements.

Documentation Required

Check payer/vendor routing for prior authorization

Some prior authorization requests are handled by BCBSOK and some by Carelon Medical Benefits Management; providers must follow the appropriate vendor/process and call the prior authorization number on the member's ID card for questions.

CPT / HCPCS codes requiring prior authorization (listed)

rTMS and related CPT/HCPCS codes requiring prior authorization (listed)CPT

97151	Bhv Id Assmt By Phys/Qhp
97152	Bhv Id Suprt Assmt By 1 Tech
97153	Adaptive Behavior Tx By Tech
97154	Grp Adapt Bhv Tx By Tech
97155	Adapt Behavior Tx Phys/Qhp
97156	Fam Adapt Bhv Tx Gdn Phy/Qhp
97157	Mult Fam Adapt Bhv Tx Gdn
97158	Grp Adapt Bhv Tx By Phy/Qhp
0362T	Bhv Id Suprt Assmt Ea 15 Min
0373T	Adapt Bhv Tx Ea 15 Min

1–10 of 31

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Key terms & service definitions

Definitions

Partial Hospitalization Treatment Program (PHP)Planned hospital or SUD facility program typically 5–8 hours/day, 5 days/week (≥20 hours/week), medically supervised with psychiatrist face-to-face at least weekly; participants are not 24‑hour residents; program must be licensed or nationally accredited per Claim Administrator

Intensive Outpatient Program (IOP)Freestanding or hospital-based program providing ≥3 hours/day, ≥2 days/week for mental illness or SUD; may treat co‑occurring conditions with integrated planning

Applied Behavior Analysis (ABA)Therapy to improve/change specific behaviors for members with diagnoses within pervasive and specific developmental disorders (ICD‑10)

Outpatient Electroconvulsive Therapy (ECT)Brief electrical brain stimulation under anesthesia billed by facility/clinic; frequency varies (2–3x/week inpatient; once every 3–4 weeks outpatient)

rTMS treatment courseTypically 1 session/day, 5 days/week up to 6 weeks followed by a 3‑week taper (3,2,1) for a total of 36 sessions; may be repeated after a 6‑month cessation; cannot be given same day as PHP, IOP, ECT, or ABA

Operational thresholds

rTMS treatment course total sessions36 sessions (typical: 1/day, 5 days/week up to 6 weeks, then 3‑week taper: 3+2+1)

rTMS repeat intervalMay be repeated after a 6‑month cessation period

Partial Hospitalization weekly hoursNot less than 20 hours of treatment services per week

Partial Hospitalization psychiatrist contactPsychiatrist sees patient face‑to‑face at least once a week