CurrentColorado Rocky Mountain Health PlansPolicy N/A

Behavioral health prior authorization requirements for Rocky Mountain Health Plans Individual Exchange plans

Governs prior authorization and notification requirements for behavioral health services for Rocky Mountain Health Plans Individual Exchange members in Colorado; applies to participating and non-participating health care professionals and facilities.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyBehavioral health prior authorization requirements for RMHP Individual Exchange plans

Policy CodePolicy N/A

Change TypeNo material change

Effective DateMar 1, 2026

Next Review DateN/A

Key ActionFax requests and documentation to 888-240-2689 or email rmhpbhvm@uhc.com to request prior authorization; admitting facilities must notify at admission and obtain authorization after 2 days for inpatient behavioral health stays.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Multiplebehavioral health service types listed

Phone/Email/Faxsubmission methods provided

Excludedemergency/urgent exclusion

Notify→Authinpatient notification/auth

Behavioral Health Coverage Criteria

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyBehavioral health prior authorization requirements for RMHP Individual Exchange plans

Policy CodePolicy N/A

Change TypeNo material change

Effective DateMar 1, 2026

Next Review DateN/A

SourceLink

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Behavioral health services prior authorization criteria

The following behavioral health services require prior authorization or pre-service notification as specified. Emergency and urgent care are excluded from prior authorization requirements.

Prior authorization is not required for emergency or urgent care; out-of-network providers must request prior authorization for all procedures and services excluding emergent/urgent care.

How to request prior authorization: Participating and non-participating health care professionals may fax requests and documentation to 888-240-2689 or email rmhpbhvm@uhc.com; questions: 888-478-4760. Admitting facilities may give notification by calling 888-282-8801.

ALL of the following

Relevant revenue codes: 114, 116, 118, 124, 126, 128, 134, 136, 138, 144, 146, 148, 154, 156, 158, 204.

Services requiring prior authorization or pre-service notification

Behavioral health programs
- Partial hospitalization program (PHP) — requires prior authorization; Rev codes 912, 913.
- Intensive outpatient program (IOP) — requires pre-service notification; prior authorization required for services greater than 15 sessions; Rev code 905.
Addiction treatment (ASAM levels)
- ASAM level 3.7 medically monitored inpatient withdrawal management - adolescent — requires prior authorization; Rev codes 1000, 1001, 1002.
- ASAM level 3.7 medically monitored intensive inpatient services - adult — requires prior authorization; Rev code 1000.
- ASAM level 3.7 medically monitored intensive inpatient services - adolescent — requires prior authorization; Rev code 128.
- ASAM level 3.5 clinically managed high-intensity residential services — requires prior authorization; Rev code 1002.
- ASAM level 3.1 clinically managed low-intensity residential services — requires prior authorization; Rev code 1003.
- Level 2.7 medically managed intensive outpatient - adult — requires prior authorization; Rev codes 944, 945.
Procedures and services
- Transcranial Magnetic Stimulation (TMS) — requires prior authorization; CPT codes 90867, 90868, 90869.
- Electroconvulsive therapy (ECT) — requires prior authorization; Rev code 901.
- Psychological testing (and related codes) — requires prior authorization; CPT codes 96136, 96137, 96138, 96139, 96130, 96131.
- Psychiatric residential treatment (PRTF/QRTP and related services) — requires prior authorization; Rev code 1001.
- Unlisted service codes — requires prior authorization; CPT codes 90899, 99499.

For inpatient admissions, admitting facility notification must be provided at admission (call 888-282-8801); the plan requires authorization after two days of inpatient behavioral health hospitalization.

Relevant Codes and Thresholds

Behavioral health inpatient revenue codesRevenueCovered

114	Inpatient behavioral health
116	Inpatient behavioral health
118	Inpatient behavioral health
124	Inpatient behavioral health
126	Inpatient behavioral health
128	Inpatient behavioral health
134	Inpatient behavioral health
136	Inpatient behavioral health
138	Inpatient behavioral health
144	Inpatient behavioral health

1–10 of 16

1/2

Psychiatric residential treatment / QRTP / PRTF revenue codesRevenueCovered

1001	Psychiatric residential treatment facility / QRTP / PRTF
1000	ASAM level 3.7 inpatient (adult/adolescent)
1002	ASAM level 3.5/3.5 residential services
1003	ASAM level 3.1 clinically managed low-intensity residential

Partial hospitalization program revenue codesRevenueCovered

912	Behavioral health partial hospitalization program (PHP) / ASAM level 2.5 PHP (adolescent)
913	Behavioral health partial hospitalization program (PHP) / ASAM level 2.5 PHP (adolescent)

Intensive outpatient and SUD IOP revenue codesRevenueCovered

905	Behavioral health intensive outpatient programming (IOP)
906	ASAM level 2.1 substance use disorder intensive outpatient programming (SUD IOP)
944	Level 2.7 medically managed intensive outpatient - adult
945	Level 2.7 medically managed intensive outpatient - adult
907	ASAM level 2.5 high intensity outpatient - adult

Other behavioral health revenue codesRevenueCovered

901	Electroconvulsive therapy (ECT)
905	IOP (alternative listing)

How Providers Request Authorization and Notification Requirements

Note

How to request prior authorization and contacts — fax and email contact details for authorization requests

Participating and non-participating health care professionals may fax prior authorization requests and supporting documentation to 888-240-2689 or email rmhpbhvm@uhc.com. For questions about behavioral health services (including mental health and substance use disorders), call 888-478-4760. Admitting facilities may give notification by calling 888-282-8801. Prior authorization is not required for emergency or urgent care. Out-of-network physicians, facilities and other health care professionals must request prior authorization for all procedures and services, excluding emergent or urgent care.

Prior Authorization

Inpatient hospitalization notification/auth requirement

Behavioral health inpatient hospitalization: Notification required at admission; authorization required after 2 days. Affects revenue codes: 114, 116, 118, 124, 126, 128, 134, 136, 138, 144, 146, 148, 154, 156, 158, 204. Admitting facility may notify by calling 888-282-8801.

Prior Authorization

Service-specific prior authorization requirements — PHP, IOP, TMS, ECT, psychological testing, ASAM levels, PRTF/QRTP, unlisted codes and other services requiring prior auth or pre-service notification

The following services require prior authorization or pre-service notification as noted. Providers must obtain authorization for the listed programs, procedures, and unlisted codes prior to routine (non-emergent) delivery of services. Out-of-network providers must request prior authorization for all services except emergency/urgent care. - Partial Hospitalization Program (PHP): Requires prior authorization. Revenue codes: 912, 913. - Intensive Outpatient Program (IOP): Requires pre-service notification; prior authorization required for services greater than 15 sessions. Revenue code: 905. - Transcranial Magnetic Stimulation (TMS): Requires prior authorization. CPT codes: 90867, 90868, 90869. - Electroconvulsive Therapy (ECT): Requires prior authorization. Revenue code: 901. - Psychological testing (and related codes): Requires prior authorization. CPT codes: 96130, 96131, 96136, 96137, 96138, 96139. - Psychiatric Residential Treatment (acute treatment unit): Requires prior authorization. Revenue code: 1001. - Psychiatric Residential Treatment Facility (PRTF) and Qualified Residential Treatment Program (QRTP) and all services associated with revenue code 1001: Requires prior authorization. Revenue code: 1001. - ASAM level 3.7 medically monitored inpatient withdrawal management (adolescent): Requires prior authorization. Revenue codes: 1000, 1001, 1002. - ASAM level 3.7 medically monitored intensive inpatient services (adult): Requires prior authorization. Revenue code: 1000. - ASAM level 3.7 medically monitored intensive inpatient services (adolescent): Requires prior authorization. Revenue code: 128. - ASAM level 3.5 clinically managed high-intensity residential services: Requires prior authorization. Revenue code: 1002. - ASAM level 3.1 clinically managed low-intensity residential services: Requires prior authorization. Revenue code: 1003. - Level 2.7 medically managed intensive outpatient (adult): Requires prior authorization. Revenue codes: 944, 945. - ASAM level 2.5 partial hospitalization program (PHP) - adolescent: Requires prior authorization. Revenue codes: 912, 913. - ASAM level 2.5 high intensity outpatient (adult): Requires prior authorization. Revenue code: 907; HCPCS/H2012. - ASAM level 2.1 substance use disorder intensive outpatient programming (SUD IOP): Notification required at admission; prior authorization required after 15 sessions. Revenue code: 906. - Unlisted service codes (behavioral health): Requires prior authorization. Codes: 90899, 99499.

Key Terms

inv-09: Prior authorization

DefinitionPrior authorization

DescriptionA requirement that certain services be reviewed and approved before they are provided to members of Rocky Mountain Health Plans Individual Exchange plans

ScopeApplies to listed behavioral health services; emergency and urgent care are excluded

How to obtainRequests may be submitted per the contact and submission methods listed in the policy (see provider contacts)

inv-10: Inpatient notification/auth

RequirementNotification required at admission for behavioral health inpatient hospitalization

Authorization timingAuthorization required after 2 days of inpatient behavioral health hospitalization

Relevant rev codesRev codes 114, 116, 118, 124, 126, 128, 134, 136, 138, 144, 146, 148, 154, 156, 158, 204

How to notifyAdmitting facility may give notification by calling 888-282-8801