CurrentOptumPolicy N/A

Missouri Healthnet Medicaid and CHIP Behavioral Health — Prior Authorization Requirements

Governs which behavioral health services for UnitedHealthcare Community Plan of Missouri Healthnet Medicaid and CHIP require prior authorization; applies to participating and non-participating providers serving Missouri Healthnet Medicaid and CHIP members.

Policy Summary

PayerOptum

PolicyBehavioral health prior authorization requirements for Missouri Healthnet Medicaid and CHIP

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateMar 1, 2025

Next Review DateN/A

Key ActionProviders must check the listed services and obtain prior authorization before providing behavioral health care; emergency services are exempt but admissions require notification.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Multipleservice codes requiring prior authorization

Appliesapplies to out-of-network providers

Exemptemergency services

Services Requiring Prior Authorization

Prior authorization code lists

Services and associated revenue/procedure codes that require prior authorization:

Prior authorization is required for the behavioral health services and associated revenue/procedure codes listed below; out-of-network providers must obtain prior authorization before providing services. Prior authorization is not required for emergency services (emergency admissions require notification).

Revenue codes 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.

Policy Summary

PayerOptum

PolicyBehavioral health prior authorization requirements for Missouri Healthnet Medicaid and CHIP

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateMar 1, 2025

Next Review DateN/A

Key ActionProviders must check the listed services and obtain prior authorization before providing behavioral health care; emergency services are exempt but admissions require notification.

SourceLink

On This Page

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Revenue and Procedure Code Lists

Revenue codes requiring prior authorization — CoveredRevenueCovered

114	Mental health inpatient
124	Mental health inpatient
134	Mental health inpatient
144	Mental health inpatient
146	Mental health inpatient
154	Mental health inpatient
204	Mental health inpatient
116	Substance use disorder (SUD) - Detoxification
126	Substance use disorder (SUD) - Detoxification
136	Substance use disorder (SUD) - Detoxification

1–10 of 21

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Procedure codes requiring prior authorization — CoveredmixedCovered

H2013	PRTF for children - Private facility
H0035	Partial hospitalization - Intensive / less intensive
S9480	Intensive outpatient services - Psychiatric
H0015	Intensive outpatient services - Chemical dependency
90867	Transcranial magnetic stimulation
90868	Transcranial magnetic stimulation
90869	Transcranial magnetic stimulation
H0018	Alcohol and/or drug services
H2001	Rehabilitation program per half day

Prior Authorization Process and Provider Instructions

Prior Authorization

Prior authorization overview and instructions

Providers must check the listed services before providing services to UnitedHealthcare Community Plan members. Additional prior authorization information is available in the Optum Behavioral Health National Network Manual (pages 38-43) and the UnitedHealthcare Community Plan Care Provider Manual (Chapter 7). All out-of-network (non-participating) providers must obtain prior authorization approval before providing behavioral health services. Prior authorization is not required for emergency services; emergency admissions require notification.

Check the listed services in this document before providing care to UnitedHealthcare Community Plan members.
Refer to Optum Behavioral Health National Network Manual (pages 38-43) and UnitedHealthcare Community Plan Care Provider Manual (Chapter 7) for additional prior authorization guidance.
Out-of-network providers must obtain prior authorization prior to providing behavioral health services.
Emergency services do not require prior authorization; emergency admissions require notification.

Prior Authorization

Code-level prior authorization requirement

Specific revenue and procedure codes listed in this document require prior authorization. See the coding sections for the full lists of revenue codes (e.g., 114, 124, 134, 144, 146, 154, 204, 116, 126, 136, 156, 912, 913, 905, 906, 918, 911, 944, 945, 919, 1001) and procedure codes (e.g., H2013, H0035, S9480, H0015, 90867–90869, H0018, H2001) that require authorization.

Revenue codes requiring prior authorization include mental health inpatient (114, 124, 134, 144, 146, 154, 204), SUD detox (116, 126, 136, 156), partial hospitalization (912, 913), intensive outpatient (905, 906), behavioral health testing (918), rehabilitation services (911, 944, 945), other behavioral health treatments (919), and PRTF public facility (1001).
Procedure codes requiring prior authorization include H2013, H0035, S9480, H0015, 90867, 90868, 90869, H0018, and H2001.

Key Terms

Prior authorization — definition/term entry

TermPrior authorization

DefinitionA requirement that providers obtain approval before delivering specified behavioral health services to UnitedHealthcare Community Plan of Missouri Healthnet Medicaid and CHIP members.

ApplicabilityApplies to all participating and out-of-network (non‑participating) providers; out‑of‑network providers must obtain prior authorization before providing behavioral health services.

Emergency servicesPrior authorization is not required for emergency services; emergency admissions require notification.

Provider guidanceProviders must check the listed services and associated code lists before providing care; see the Optum Behavioral Health National Network Manual (pages 38–43) and the UnitedHealthcare Community Plan Care Provider Manual (Chapter 7) for additional information.