Behavioral health prior authorization requirements — UnitedHealthcare Community Plan (District of Columbia)
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Lists behavioral health services and specific procedure/revenue codes that require prior authorization for UnitedHealthcare Community Plan members in the District of Columbia Medicaid Managed Care contract; applies to participating and non‑participating providers delivering behavioral health services to plan members.
No material clinical or coverage changes in this revision.
Prior authorization required — behavioral health services
Required prior authorization — behavioral health services
Prior authorization is required for the following categories and listed codes:
ALL of the following
Inpatient psychiatric/detox/rehabilitation (various room types)
- Revenue codes 114, 116, 118, 124, 126, 128, 134, 136, 138, 154, 156, 158 (inpatient psychiatric, detoxification, and rehabilitation across private, semi-private, 3-4 bed and ward rooms)
- Inpatient intensive care - Psychiatric: Revenue code 204
- Behavioral health treatments/services: Revenue code 900 (requires an accompanying HCPCS or CPT code for prior authorization)
- Intensive outpatient services - Psychiatric: Revenue code 905
- Intensive outpatient services - Chemical dependency: Revenue code 906
- Rehabilitation and partial hospitalization services: Revenue codes 911-913
Behavioral health testing and psychological testing
- Behavioral health testing: Revenue code 918
Authorization requirement for admin/scoring codes differs by pairing: 96136/96137 require authorization only when submitted with psychological testing evaluation codes 96130 or 96131; no authorization required when submitted with neuropsychological testing codes 96132 or 96133.
- Drug/alcohol rehabilitation and combined programs: Revenue codes 944, 945, 953
- Ambulatory substance use disorder treatment/detox per diem: Procedure code S9475 (including Opioid Treatment Program modifier HG where applicable)
Behavioral health procedure and CPT/HCPCS codes
| 114 | Inpatient psychiatric, private room |
| 116 | Inpatient detoxification, private room |
| 118 | Rehabilitation, private room |
| 124 | Inpatient psychiatric, semi-private room |
| 126 | Inpatient detoxification, semi-private room |
| 128 | Rehabilitation, semi-private room |
| 134 | Inpatient psychiatric, 3-4 beds in room |
| 136 | Inpatient detoxification, 3-4 beds in room |
| 138 | Rehabilitation, 3-4 beds in room |
| 154 | Inpatient psychiatric, ward room |
What providers must do / authorization highlights
Reference and contact
Prior authorization is required for many behavioral health services listed below. Out-of-network (non-participating) providers must obtain prior authorization before providing behavioral health services. Prior authorization is not required for emergency services. For questions, call the Customer Service number on the back of the member's ID card or refer to the Optum Behavioral Health National Network Manual (pages 38-43) and the UnitedHealthcare Community Plan District of Columbia Dual Choice Care Provider Manual (chapter 6).
- Contact Customer Service using the number on the member's ID card for prior authorization inquiries and assistance.
- Out-of-network providers must obtain prior authorization prior to delivering non-emergency behavioral health services.
Codes requiring prior authorization (summary)
The following codes (grouped by descriptor) continue to require prior authorization. This is a summary — specific revenue, CPT/HCPCS/procedure codes and modifiers are shown where available. Some entries note that additional HCPCS/CPT codes are required (e.g., revenue code 900 requires an associated HCPC/CPT).
- Inpatient psychiatric and detoxification private, semi-private, ward and multiple-bed room revenue codes (examples: Revenue 114, 116, 118, 124, 126, 128, 134, 136, 138, 154, 156, 158).
- Inpatient intensive care - Psychiatric (Revenue 204).
- Behavioral health treatments - Services (Revenue 900) — revenue code 900 requires an associated HCPCS or CPT code for prior authorization determination.
- Intensive outpatient services - Psychiatric (Revenue 905) and related intensive outpatient programs.
- Environmental manipulation (CPT 90882).
- Psychological testing evaluation services (CPT 96130, 96131) and test administration/scoring (CPT 96136) — administration/scoring codes require authorization only when submitted with evaluation codes 96130 and 96131 (no auth required if submitted with neuropsychological testing).
- Short Term Medically Monitored Inpatient Withdrawal Management (H0010, modifier U1).
- Alcohol and/or drug intensive outpatient services (H0015).
- Behavioral health short-term and long-term residential services (H0018, H0019).
- Residential treatment and therapeutic behavioral health services for youth (H2020) — includes per diem codes; common modifiers HE, HI, HK.
- Ambulatory substance use disorder treatment or detoxification services; per diem (S9475) — includes opioid treatment program variant (modifier HG).
Definitions and special billing notes
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