Kansas Long Term Care — Behavioral health prior authorization requirements for Kansas LTC
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Defines behavioral health services and specific revenue/procedure codes that require prior authorization for UnitedHealthcare Community Plan of Kansas Medicaid Long Term Care (LTC) members; applies to participating and non‑participating providers serving Kansas LTC members.
No material clinical or coverage changes in this revision.
Prior Authorization Coverage Criteria
Prior authorization requirements
Behavioral health services listed by revenue and procedure code require prior authorization for UnitedHealthcare Community Plan of Kansas Medicaid Long Term Care (LTC) members. Out‑of‑network providers must obtain prior authorization before providing services; emergency services do not require prior authorization but emergency admissions require notification.
Services requiring prior authorization
- Mental health inpatient services (Revenue Codes: 0114, 0124, 0134, 0144).
- Hospital-based inpatient detoxification (Revenue Codes: 0116, 0126, 0136, 0146, 0156).
- Intensive outpatient (IOP) services for eating disorders (Revenue Code: 905; Procedure Code: S9480).
- Rehab services/Facility therapy (Revenue Codes: 911, 915).
- Partial hospitalization programs (PHP) for eating disorders (Revenue Codes: 912, 913; Procedure Code: H0035).
- Psychiatric residential treatment facility (PRTF) (Procedure Code: T2048).
- Behavior identification and adaptive behavior treatment series (Procedure Codes: 97151–97156, 97158).
Providers should check the listed services and referenced manuals (prior authorization submission instructions, Optum Behavioral Health National Network Manual, and UnitedHealthcare Community Plan of Kansas Care Provider Manual) for submission details and program‑specific coverage.
Codes Requiring Prior Authorization
| 0114 | Mental health inpatient services |
| 0124 | Mental health inpatient services |
| 0134 | Mental health inpatient services |
| 0144 | Mental health inpatient services |
| 0116 | Hospital-based inpatient detoxification |
| 0126 | Hospital-based inpatient detoxification |
| 0136 | Hospital-based inpatient detoxification |
| 0146 | Hospital-based inpatient detoxification |
| 0156 | Hospital-based inpatient detoxification |
| 905 | Intensive outpatient (IOP) services for eating disorders |
| H0015 | SUD intensive outpatient - Adult |
| H0018 | Substance use disorder (SUD) - Residential |
| H0019 | Residential - Reintegration SUD |
| H0035 | Partial hospital |
| H0037 | Community psychiatric supportive treatment program |
| H2016 | Comprehensive community support services |
| S9480 | Intensive outpatient - Eating disorder |
| T2048 | Psychiatric residential treatment facility (PRTF) |
| 96130 | Psychological testing evaluation |
| 96131 | Psychological testing evaluation |
Provider Responsibilities and Callouts
Prior authorization overview and provider responsibilities
Please check the listed services before providing care to UnitedHealthcare Community Plan of Kansas LTC members. All out-of-network (non-participating) providers must obtain prior authorization approval before providing behavioral health services. Prior authorization is not required when rendering emergency services; however, emergency admissions require notification to the plan.
Prior authorization code list (revenue & procedure codes)
The following revenue and procedure codes listed in this policy require prior authorization for Kansas LTC members. Use this list as a quick reference when determining authorization needs before providing services.
- Revenue codes: 0114, 0124, 0134, 0144; 0116, 0126, 0136, 0146, 0156; 905; 911; 915; 912; 913
- Procedure codes: H0015, H0018, H0019, H0035, H0037, H2016, S9480, T2048
- Testing and admin/scoring: 96130, 96131, 96136, 96137, 96138, 96139
- Behavior/ABA series: 97151, 97152, 97153, 97154, 97155, 97156, 97158
- HCBS/waiver and related: H2021, S5110, S5150, S9482, T1005, T1019, T1027, T2038
Key Definitions
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