Missouri Healthnet Medicaid and CHIP Behavioral Health - Prior Authorization Requirements
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 behavioral health services that require prior authorization for UnitedHealthcare Community Plan members under Missouri Healthnet Medicaid and CHIP; applies to in-network and out-of-network providers delivering behavioral health services to Missouri Medicaid and CHIP members.
No material clinical or coverage changes in this revision.
Prior Authorization Coverage Criteria
Prior authorization criteria
Prior authorization is required for the listed behavioral health services and revenue/procedure codes; emergency services are exempt. All out-of-network (non-participating) providers must obtain prior authorization before providing behavioral health services.
Services requiring prior authorization
- Mental health inpatient — Revenue Codes: 114, 124, 134, 144, 146, 154, 204.
- Substance use disorder (SUD) - Detoxification — Revenue Codes: 116, 126, 136, 156.
- Partial hospitalization — Less intensive (Revenue Code 912) and Intensive (Revenue Code 913); Partial hospitalization (Revenue Code H0035).
- Behavioral health testing — Revenue Code 918 (authorization follows the prior authorization rule of the specific CPT code attached to the revenue code).
- Rehabilitation services — Revenue Codes 911, 944, 945 (authorization follows the prior authorization rule of the specific CPT code attached to the revenue code).
- Other behavioral health treatments — Revenue Code 919 (authorization follows the prior authorization rule of the specific CPT code attached to the revenue code).
- Psychiatric residential treatment facility (PRTF) for children — Public facility Revenue Code 1001; Private facility Revenue Code H2013.
- Alcohol and/or drug services — Revenue Code H0018.
- Rehabilitation program per half day — Revenue Code H2001.
Operational notes
- Providers must check this list prior to providing services to UnitedHealthcare Community Plan members and follow prior authorization submission instructions in the referenced manuals and resources.
- 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.
Revenue and Procedure Codes Requiring Prior Authorization
| 114 | Mental health inpatient revenue code |
| 124 | Mental health inpatient revenue code |
| 134 | Mental health inpatient revenue code |
| 144 | Mental health inpatient revenue code |
| 146 | Mental health inpatient revenue code |
| 154 | Mental health inpatient revenue code |
| 204 | Mental health inpatient revenue code |
| 116 | SUD detoxification revenue code |
| 126 | SUD detoxification revenue code |
| 136 | SUD detoxification revenue code |
| 156 | SUD detoxification revenue code |
| 912 | Partial hospitalization less intensive revenue code |
| 913 | Partial hospitalization intensive revenue code |
| 905 | Intensive outpatient psychiatric revenue code |
| S9480 | Intensive outpatient psychiatric procedure code (HCPCS) |
| 906 | Intensive outpatient chemical dependency revenue code |
| H0015 | Intensive outpatient chemical dependency procedure code (HCPCS) |
| 918 | Behavioral health testing revenue code — auth follows CPT code attached to revenue code |
| 911 | Rehabilitation services revenue code — auth follows CPT code attached to revenue code |
| 944 | Rehabilitation services revenue code — auth follows CPT code attached to revenue code |
| 945 | Rehabilitation services revenue code — auth follows CPT code attached to revenue code |
| 919 | Other behavioral health treatments revenue code — auth follows CPT code attached to revenue code |
| 1001 | PRTF for children - public facility revenue code |
Provider Responsibilities and Authorization Notices
Prior authorization overview
Check the listed behavioral health services before providing care and obtain prior authorization when required. 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. For questions, refer to the listed submission resources or call the Customer Service number on the member's ID card.
Services and codes requiring prior authorization
The specific revenue and procedure codes in the table require prior authorization as indicated; authorization requirements for behavioral health testing, rehabilitation services, and other behavioral health treatments follow the prior authorization rule of the specific CPT code attached to the revenue code.
- Mental health inpatient revenue codes: 114, 124, 134, 144, 146, 154, 204
- SUD detoxification revenue codes: 116, 126, 136, 156
- Partial hospitalization: 912 (less intensive), 913 (intensive), H0035
- Intensive outpatient services: 905 (psychiatric), 906 (chemical dependency), S9480, H0015
- PRTF for children: 1001 (public), H2013 (private)
- Behavioral health testing: 918 (auth follows CPT-level rule)
- Rehabilitation services: 911, 944, 945 (auth follows CPT-level rule)
- Other behavioral health treatments: 919 (auth follows CPT-level rule)
- Transcranial magnetic stimulation codes: 90867, 90868, 90869
- Additional codes: H0018 (alcohol/drug services), H2001 (rehabilitation per half day)
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.