Maryland Prior Authorization Requirements for UnitedHealthcare Exchange Plans (Behavioral Health)
Lists behavioral health services and procedure codes requiring prior authorization for UnitedHealthcare Exchange plan members in Maryland; applies to participating behavioral health providers serving these members.
No material clinical or coverage changes in this revision.
Services Requiring Prior Authorization
Services Requiring Prior Authorization
The following inpatient, outpatient, testing, behavioral treatment, and related procedure codes require prior authorization for Maryland Exchange plan members:
ALL of the following
Inpatient and facility services
- Inpatient Mental Health — Rev 114, 124, 134, 144, 154, 204
- Inpatient Substance Use Detoxification (hospital based) — Rev 116, 126, 136, 146, 156
- Substance Use Rehabilitation (hospital based) — Rev 118, 128, 138, 148, 158
- Psychiatric Clinic — Rev 513
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