CurrentColorado Rocky Mountain Health PlansPolicy N/A

Virginia - effective Jan. 1, 2024

Lists behavioral health services and procedure/revenue/CPT codes that require prior authorization for participating behavioral health providers for UnitedHealthcare Exchange Plans members in Virginia effective January 1, 2024. Applies to inpatient and outpatient behavioral health services; emergency/urgent care excluded.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyVirginia - effective Jan. 1, 2024

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJan 1, 2024

Next Review DateN/A

Key ActionProviders must submit prior authorization requests for the listed services using the Prior Authorization and Notification tool accessed via Sign In on UHCProvider.com.

SourceLink

POLICY UPDATE CHANGES

No material clinical/coverage changes — policy remains current with prior authorization requirements unchanged.

~50Listed procedure/revenue/CPT codes requiring PA

2024-01-01Effective date

Policy summary

This policy requires prior authorization for the listed behavioral health services and associated procedure/revenue/CPT codes for participating providers delivering care to UnitedHealthcare Exchange Plans members in Virginia, effective 2024-01-01. Prior authorization applies to both inpatient and outpatient behavioral health services. Prior authorization is not required for emergency or urgent care. Providers must submit requests via the Prior Authorization and Notification tool on UHCProvider.com (Sign In required).

Key facts

Effective date2024-01-01

Listed procedure/revenue/CPT codes requiring PA~50 codes (multiple revenue codes Rev 114–204, Rev 513–1002 and CPTs such as 90899, 96130–96139, 96146, 97151–97158, 0362T, 0373T, 98966–98968, 99499)

StatusCURRENT (covered)

SubjectVirginia Prior Authorization Requirements for UnitedHealthcare Exchange Plans (Behavioral Health)

Prior authorization submissionSubmit via the Prior Authorization and Notification tool on UHCProvider.com (Sign In required)

Emergency/Urgent carePrior authorization not required for emergency or urgent care

Codes requiring prior authorization

CPT / HCPCS codes requiring authorization (behavioral health services, testing, assessments, and related services)CPTCovered

90899	Unlisted psychiatric service or procedure
96130	Psychological testing evaluation
96131	Psychological testing evaluation
96136	Psychological or neuropsychological test admin & scoring by physician/QHP, two or more tests, first 30 minutes (Auth required only if submitted with 96130 & 96131)
96137	Psychological or neuropsychological test admin & scoring by physician/QHP, two or more tests, each additional 30 minutes (Auth required only if submitted with 96130 & 96131)
96138	Psychological or neuropsychological test admin & scoring by technician, two or more tests, first 30 minutes (Auth required only if submitted with 96130 & 96131)
96139	Psychological or neuropsychological test admin & scoring by technician, two or more tests, each additional 30 minutes (Auth required only if submitted with 96130 & 96131)
96146	Psychological or neuropsychological test admin, single automated standardized instrument via electronic platform, with automated result only
97151	Behavior ID Assessment by PHYS/QHP EA 15 min
97152	Behavior ID Support Assessment by 1 Tech EA 15 min

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What providers must do

Prior Authorization

Submit prior authorization via online tool

Providers must submit prior authorization requests for the listed behavioral health services using the Prior Authorization and Notification tool accessed via Sign In on UHCProvider.com.

Documentation Required

Reference member specific benefit plan

When determining coverage, providers must reference the member-specific benefit plan document because plan terms vary by state.

Denial Risk

No non-emergent out-of-network coverage

For these Exchange Plans in Virginia, members have no non-emergent out-of-network coverage (and no coverage outside the service area); claims for out-of-network non-emergent services are at risk of denial.

Additional notes

Submission: Providers must submit prior authorization requests using the Prior Authorization and Notification tool accessed via the Sign In function on UHCProvider.com. Emergency/urgent care: prior authorization is not required for emergency or urgent care. Scope/applicability: this list covers specified inpatient and outpatient behavioral health services and associated procedure/revenue/CPT codes; when deciding coverage, reference the member-specific benefit plan because plan terms vary by state.