Prior authorization for behavioral health services
Customize your policy alerts
Sign up for all Optum policy alerts
Know when Optum releases new policies or updates existing guidance.
Monitor payer policy activity
Defines which behavioral health services and specific procedure/revenue codes require prior authorization for UnitedHealthcare Community Plan members under Kansas Medicaid; applies to participating and non-participating providers serving Kansas Medicaid members.
No material clinical or coverage changes in this revision.
Prior Authorization and Coverage Criteria
Prior authorization criteria and exceptions
Services and codes requiring prior authorization are enumerated below; providers should reference submission instructions and the listed manuals for full requirements.
Code lists (examples)
- Inpatient mental health revenue codes: 0114, 0124.
- Hospital-based inpatient detoxification revenue codes: 0116, 0126, 0136, 0146, 0156.
- Intensive outpatient (IOP) for eating disorders revenue code: 905.
- Rehab services / facility therapy revenue codes: 911, 915 (authorization may follow the CPT/HCPCS code billed with these revenue codes).
- Partial hospitalization program (PHP) for eating disorders revenue codes: 912, 913.
- Substance use disorder (SUD) intensive outpatient – adult: H0015.
- Substance use disorder (SUD) – residential: H0018.
- Residential – reintegration SUD: H0019.
- Partial hospitalization procedure: H0035.
- Community psychiatric supportive treatment program: H0037.
Additional procedure codes that require prior authorization
Procedure, Revenue and Testing Codes
| 0114 | Mental health inpatient services (revenue code) |
| 0124 | Mental health inpatient services (revenue code) |
| 0116 | Hospital-based inpatient detoxification (revenue code) |
| 0126 | Hospital-based inpatient detoxification (revenue code) |
| 0136 | Hospital-based inpatient detoxification (revenue code) |
| 0146 | Hospital-based inpatient detoxification (revenue code) |
| 0156 | Hospital-based inpatient detoxification (revenue code) |
| 905 | Intensive outpatient (IOP) services for eating disorders (revenue code) |
| 911 | Rehab services/Facility therapy (revenue code) |
| 915 | Rehab services/Facility therapy (revenue code) |
| H2016 | Comprehensive community support services (procedure code) |
| S9480 | Intensive outpatient - Eating disorder (procedure code) |
| T1019/HK | Attendant care (procedure code) |
| T2048 | Psychiatric residential treatment facility (PRTF) (procedure code) |
| 97151-97158 | Behavior identification and adaptive behavior treatment codes (procedure codes) |
| 96130-96139 | Psychological and neuropsychological testing evaluation and administration/scoring (procedure codes) |
Provider Responsibilities and Authorization Workflow
Prior authorization requirements, out-of-network rules, and emergency notification
Check the listed behavioral health services and code lists for prior authorization requirements before providing services to UnitedHealthcare Community Plan of Kansas members. All out-of-network (non-participating) providers must obtain prior authorization approval prior to providing behavioral health services. Prior authorization is not required for emergency services; however, emergency admissions require notification. For submission instructions and additional details, refer to the Prior authorization submission instructions, the Optum Behavioral Health National Network Manual, and the UnitedHealthcare Community Plan of Kansas Care Provider Manual, or call the Customer Service number on the member's ID card.
- Verify whether the service and billed code appear on the prior authorization lists before delivering care.
- Out-of-network providers: obtain prior authorization approval before providing behavioral health services.
- Emergency services: prior authorization not required; emergency admissions require notification.
Codes that require prior authorization (selected revenue & procedure codes)
Submit a prior authorization request when billing any of the listed revenue or procedure codes for behavioral health services, including the inpatient mental health and detoxification revenue codes, specified SUD and partial hospitalization procedure codes, comprehensive community and adaptive behavior treatment codes, and psychological testing codes as detailed below.
- Revenue codes: 0114, 0124 (mental health inpatient); 0116, 0126, 0136, 0146, 0156 (hospital-based inpatient detoxification); 905 (IOP eating disorders); 911, 915 (rehab/facility therapy; authorization follows CPT/HCPCS billed with these codes); 912, 913 (PHP eating disorders).
- Procedure codes (examples): H0015, H0018, H0019, H0035, H0037, H2016, S9480, T1019/HK, T2048.
- CPT/HCPCS examples: 97151–97158 (behavior identification/adaptive behavior treatment); 96130–96139 (psychological/neuropsychological testing — see testing auth rules below).
- Testing auth rule: Auth required if 96136/96137 are submitted with psychological testing eval codes 96130/96131; no auth required if 96138/96139 are submitted with neuropsychological testing eval codes 96132/96133.
Key Definitions
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.