CurrentOptumPolicy N/A

Mississippi CAN behavioral health prior authorization list

Defines behavioral health services that require prior authorization for the Mississippi Coordinated Access Network (CAN) Medicaid contract and instructs providers how to request authorizations; applies to UnitedHealthcare Community Plan members and participating/non-participating providers serving Mississippi members.

Policy Summary

PayerOptum

PolicyMississippi CAN behavioral health prior authorization list

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateOct 1, 2023

Next Review DateN/A

Key ActionObtain prior authorization via the MS Community Mental Health Services portal on Provider Express before providing covered behavioral health services (all inpatient stays and out-of-network services require authorization).

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Multipleservice categories listed for prior authorization

Requiredinpatient authorization rule

MYPACMYPAC under-22 reference

Provider Expresssubmission portal

Services Requiring Prior Authorization

Prior authorization criteria and notes

Services listed below require prior authorization for Mississippi CAN members. Specific notes and coverage limitations are included per service line.

All inpatient behavioral health stays require prior authorization

See inpatient categories below for MYPAC coverage notes.

Inpatient service categories

Inpatient Mental Health (Revenue Code 114)
Coverage for MYPAC members under 22 only.
Inpatient Detox (Revenue Code 116)
Coverage for MYPAC members under 22 only.
Inpatient Mental Health (Revenue Code 124)

Policy Summary

PayerOptum

PolicyMississippi CAN behavioral health prior authorization list

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateOct 1, 2023

Next Review DateN/A

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Coverage for MYPAC members under 22 only.

Inpatient Substance Abuse (Revenue Code 126)

Coverage for MYPAC members under 22 only.

Psychiatric Residential Treatment Facility (PRTF) services (Revenue Code 1001) and associated leave/therapeutic leave days (Revenue Codes 183, 185) require prior authorization

Follow standard PRTF authorization process.

Partial Hospitalization (H0035) requires prior authorization

Code listed as Partial Hospitalization Mental Health.

Outpatient electroconvulsive therapy (ECT) requires prior authorization

Revenue Code referenced as 90870.

Behavioral health community and case management programs (e.g., Community Psychiatric Supportive Treatment, Assertive Community Treatment H0039, Targeted Case Management T2023, I-CORT S9480) require prior authorization

Targeted Case Management (wraparound) submission via Provider Express MS Community Mental Health Services portal.

Medication Assisted Treatment (MAT) weekly bundles (G2067-G2074, G2070-G2072, G2073) require prior authorization

Includes buprenorphine implant insertion/removal and naltrexone weekly bundles as listed.

Psychological testing evaluation services (96130, 96131) require prior authorization when performed

Psychological testing evaluation codes listed as 96130 and 96131.

Psychological & neuropsychological testing administration/scoring (97158) authorization rule

Auth required when admin & scoring codes (e.g., 96136, 96137, 96138) are submitted with Psychological Testing Evaluation codes 96130 & 96131
Auth Required - Only if the Admin & Scoring codes are submitted with Psychological Testing Eval Codes 96130 & 96131.
No auth required when admin & scoring codes are submitted with Neuropsychological Testing Evaluation codes 96132 & 96133
No Auth Required - If the Admin & Scoring codes are submitted with Neuropsychological Testing Eval Codes 96132 & 96133.

Out-of-network behavioral health providers must obtain prior authorization before providing services

General prior authorization rule: all out-of-network providers must obtain prior authorization before providing behavioral health services; emergency services are exempt.

How to submit prior authorization requests

Submit via the MS Community Mental Health Services portal on Provider Express (Provider Express > Our Network > State-Specific Provider Information > Mississippi > MS Medicaid Prior Authorization Information and Resources > MS Community Mental Health Services Request Form).

Service Codes and Coding Rules

Select service codes with auth notesmixedCovered

H0035	Partial Hospitalization Mental Health
H0018	Short-term residential (nonhospital residential treatment program), per diem
H0037	Community Psychiatric Supportive Treatment Program
G2067	Medication assisted treatment, methadone weekly bundle
G2068	Medication assisted treatment, buprenorphine (oral) weekly bundle
G2069	Medication assisted treatment, buprenorphine (injectable) weekly bundle
G2070	Buprenorphine implant insertion weekly bundle
G2071	Buprenorphine implant removal weekly bundle
G2072	Buprenorphine implant insertion and removal weekly bundle
G2073	Medication assisted treatment, naltrexone weekly bundle

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Psych testing admin/scoring auth rule

Triggering codesAdministration/scoring codes (96136, 96137, 96138) when submitted in combination with psychological testing evaluation codes 96130 and 96131 require prior authorization

When auth is NOT requiredAdministration/scoring codes submitted with neuropsychological testing evaluation codes 96132 and 96133 do not require prior authorization

ScopeApplies to psychological & neuropsychological testing administration and scoring service lines as listed in the prior authorization table

Authorization Rules and Submission Instructions

Prior Authorization

General prior authorization rules

All out-of-network (non-participating) providers must obtain prior authorization approval before providing behavioral health services. All inpatient stays require an authorization. Prior authorization is not required when rendering emergency services.

Documentation Required

How to submit prior authorization

Submit prior authorization requests using the MS Community Mental Health Services portal on Provider Express via: Provider Express > Our Network > State-Specific Provider Information > Mississippi > MS Medicaid Prior Authorization Information and Resources > MS Community Mental Health Services Request Form.

Key Terms

Prior authorization

DefinitionPrior authorization: approval that must be obtained before providing specified behavioral health services under the Mississippi CAN Medicaid contract

Who must obtain itAll out-of-network (non-participating) providers must obtain prior authorization before providing behavioral health services

Inpatient ruleAll inpatient stays require an authorization

MYPAC (Mississippi Youth Program Around the Clock)

Program nameMississippi Youth Program Around the Clock (MYPAC)

Age-based coverage noteInpatient behavioral health and inpatient detox services are covered for MYPAC members under 22 only

ApplicationSeveral inpatient and service coverage entries reference MYPAC-specific coverage limitations; follow MYPAC rules when member is identified as MYPAC