CurrentColorado Rocky Mountain Health PlansPolicy N/A

Behavioral health prior authorization requirements for Rocky Mountain Health Plans CHP+

Lists behavioral health services for which Rocky Mountain Health Plans (RMHP) CHP+ requires prior authorization or notification, and describes how providers should request authorization. Applies to participating and non-participating providers for RMHP CHP+ members.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyBehavioral health prior authorization requirements for Rocky Mountain Health Plans CHP+

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateApr 1, 2026

Next Review DateN/A

Key ActionParticipating and non-participating providers must fax requests and documentation to 888-240-2689 or email rmhpbhvm@uhc.com for prior authorization; call 877-668-5947 for questions or advance notification.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

multipleservice categories listed

fax/email/phonerequest methods

exemptemergency/urgent

specific codescodes listed

Prior Authorization and Notification Requirements

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Prior authorization and notification requirements

The following behavioral health services require prior authorization or notification as specified:

ALL of the following

Behavioral health inpatient hospitalization: All admissions to freestanding inpatient psychiatric facilities or hospital psychiatric facilities require prior authorization.
Psychiatric residential treatment (acute treatment unit): Requires prior authorization (H0017).
Psychiatric residential treatment facility (PRTF): Requires prior authorization (Rev code 0911).
Qualified residential treatment program (QRTP) and all services associated with H0019: Requires prior authorization (H0019).
Behavioral health partial hospitalization program (PHP): Requires prior authorization (H0035; ASAM level 2.5 PHP uses H0016).
ALL of the following
- Behavioral health intensive outpatient programming (IOP): Notification required at admission; prior authorization required after 15 sessions (S9480, rev code 905).
- ASAM level 2.1 substance use disorder intensive outpatient programming (SUD IOP): Notification required at admission; prior authorization required after 15 sessions (G0137, H0015, rev code 906).
ALL of the following
- Multisystemic therapy (MST), enhanced MST: Notification required at admission; prior authorization required after 90 days (H2033, T2022).
- Functional family therapy (FFT), enhanced FFT: Notification required at admission; prior authorization required after 90 days (H0036, H0037, T2022).
Electroconvulsive therapy (ECT): Requires prior authorization (90870).
Neuropsychological and psychological testing (and related codes): Requires prior authorization (96132, 96133, 96136, 96137, 96138, 96139, 96146, 96130, 96131).
Neurobehavioral status exam: Requires prior authorization (96116, 96121).
ALL of the following
- ASAM level 3.7 medically monitored inpatient withdrawal management: Requires prior authorization (H0011).
- ASAM level 3.7 medically monitored intensive inpatient services: Requires prior authorization (H2036 with Modifier U7; Modifier HD for Special Connections cases).
- ASAM level 3.5 clinically managed high-intensity residential services, including Special Connections programs: Requires prior authorization (H2036 with Modifier U5; Modifier HD for Special Connections cases).
- ASAM level 3.3 clinically managed population-specific high-intensity residential: Requires prior authorization (H2036 with Modifier U3; Modifier HD for Special Connections cases).
- ASAM level 3.1 clinically managed low-intensity residential services: Requires prior authorization (H2036 with Modifier U1; Modifier HD for Special Connections cases).
Unlisted service code: Requires prior authorization (99499).
Prior authorization is not required for emergency or urgent care. Participating and non‑participating providers may fax requests and documentation to 888-240-2689 or email rmhpbhvm@uhc.com. For behavioral health questions or advance notification call 877-668-5947. Out-of-network providers must request prior authorization for all procedures and services except emergent or urgent care.

Procedure and Service Codes; Authorization Thresholds

Covered behavioral health procedure/service codesmixedCovered

H0017	Psychiatric residential treatment (acute treatment unit)
Rev code 0911	Psychiatric residential treatment facility (PRTF)
H0019	Qualified residential treatment program (QRTP) and associated services
H0035	Behavioral health partial hospitalization program (PHP)
S9480	Behavioral health intensive outpatient programming (IOP)
rev code 905	Behavioral health intensive outpatient programming (IOP)
90870	Electroconvulsive therapy (ECT)
96132	Neuropsychological testing - analysis
96133	Neuropsychological testing - interpretation
96136	Psychological or neuropsychological test administration and scoring

1–10 of 25

1/3

Authorization triggers by session/day thresholds — IOP, SUD IOP, MST, FFT

IOP (Behavioral health intensive outpatient programming)Notification required at admission; prior authorization required after 15 sessions.

SUD IOP (ASAM level 2.1 substance use disorder IOP)Notification required at admission; prior authorization required after 15 sessions.

MST (Multisystemic therapy, enhanced)Notification required at admission; prior authorization required after 90 days.

FFT (Functional family therapy, enhanced)Notification required at admission; prior authorization required after 90 days.

How to Request Authorization and Notification Rules

Prior Authorization

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. For questions about behavioral health services (including mental health and substance use disorders), call 877-668-5947. The admitting facility may give advance notification by calling 877-668-5947.

Fax/email for prior authorization: 888-240-2689; rmhpbhvm@uhc.com
Behavioral health questions / admissions notification: 877-668-5947

Documentation Required

Notification and timing rules

Notification is required at admission for Intensive Outpatient Programming (IOP), Multisystemic Therapy (MST), and Functional Family Therapy (FFT). Prior authorization is required for IOP after 15 sessions and for MST and FFT after 90 days. Many inpatient and residential behavioral health services also require prior authorization — including inpatient hospitalization, psychiatric residential treatment (PRTF), psychiatric residential treatment (acute treatment unit), qualified residential treatment program (QRTP), partial hospitalization (PHP), electroconvulsive therapy (ECT), neuropsychological/psychological testing, and neurobehavioral status exams. Out-of-network physicians, facilities and other health care professionals must request prior authorization for all procedures and services (excluding emergent or urgent care).

IOP: notification at admission; prior authorization required after 15 sessions (S9480, rev code 905)
MST / enhanced MST: notification at admission; prior authorization required after 90 days (H2033, T2022)
FFT / enhanced FFT: notification at admission; prior authorization required after 90 days (H0036, H0037, T2022)
PHP: requires prior authorization (H0035)
Inpatient psychiatric admissions and PRTF/acute units/QRTP: require prior authorization (H0017, Rev code 0911, H0019)
ECT: requires prior authorization (90870)
Neuropsychological/psychological testing: requires prior authorization (96130–96139, 96146, 96132, 96133, 96136, 96137)
Neurobehavioral status exam: requires prior authorization (96116, 96121)

Note

Emergency/urgent care exemption

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 except emergent or urgent care.

Emergency/urgent care: no prior authorization required
Out-of-network providers: must request prior authorization for non-emergent services

OpenPayer

Behavioral health prior authorization requirements for Rocky Mountain Health Plans CHP+

Prior Authorization and Notification Requirements

Procedure and Service Codes; Authorization Thresholds

How to Request Authorization and Notification Rules

Key Definitions