The inclusion of a CPT or HCPCS code on this list does not guarantee coverage. Coverage and payment are determined by the member’s health benefit contract and plan terms, which control available benefits. Providers should verify a member’s eligibility and benefits before submitting claims or scheduling services, because plan-specific limitations, exclusions, or vendor arrangements may affect coverage.

When prior authorization is required by the member’s plan, it must be obtained before services are rendered to confirm medical necessity as defined by the health benefit plan. A prior authorization decision is not a guarantee of payment. Typically the in‑network provider is responsible for requesting prior authorization, though some plans may require the member to initiate the request. Always check eligibility and benefits via Availity or the vendor portal and follow the instructions on the member’s ID card for prior authorization submission and questions.

Partial Hospitalization (PHP) and Intensive Outpatient Program (IOP) are structured outpatient levels of care for mental health and substance use disorders. PHP is a planned day‑program model that typically provides 5–8 hours per day, 5 days per week (not less than 20 hours/week), is medically supervised with psychiatric oversight, and requires weekly face‑to‑face psychiatrist contact. IOP provides structured treatment delivered at least 3 hours per day on two or more days per week and may treat mental illness, substance use disorders, or co‑occurring conditions. Repetitive transcranial magnetic stimulation (rTMS) is an outpatient procedural therapy usually given 1 session/day, 5 days/week for up to 6 weeks with a taper (typical total ~36 sessions); rTMS courses have a recommended 6‑month interval before repeat and cannot be administered on the same day as PHP or IOP. These program definitions support medical‑necessity and prior‑authorization determinations described elsewhere in this document.