CurrentOptumPolicy N/A

Prior authorization for behavioral health services

This document lists behavioral health services and procedure codes that require prior authorization for UnitedHealthcare Community Plan members in the Washington Integrated Medicaid Managed Care contract, and applies to participating and non-participating providers delivering these services in Washington state.

Policy Summary

PayerOptum

PolicyPrior authorization for behavioral health services

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateJan 1, 2026

Next Review DateN/A

Key ActionProviders must check the listed services before providing care; out-of-network providers must obtain prior authorization; emergency services do not require prior authorization.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

~40procedure codes listed requiring prior authorization

Washingtonapplicable state

All out-of-network providersrequire prior authorization before providing behavioral health services (except emergencies)

Prior Authorization Coverage Criteria

Prior authorization coverage stance

Prior authorization required for the listed behavioral health service codes. See Care Provider Manual Chapter 7 for further authorization process and criteria.

Prior authorization is required for the behavioral health service procedure codes listed below before services are provided (except emergency services).

All out-of-network (non-participating) providers must obtain prior authorization approval before providing behavioral health services.

Providers should consult the UnitedHealthcare Community Plan of Washington Medicaid Managed Care Care Provider Manual (Chapter 7) for additional prior authorization process and criteria and call Customer Service with questions.

Procedure codes requiring prior authorization

114 — Inpatient psychiatric / private room

Policy Summary

PayerOptum

PolicyPrior authorization for behavioral health services

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateJan 1, 2026

Next Review DateN/A

Key ActionProviders must check the listed services before providing care; out-of-network providers must obtain prior authorization; emergency services do not require prior authorization.

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.

116 — Inpatient detoxification / private room

124 — Inpatient psychiatric / semiprivate room

126 — Inpatient detoxification / semiprivate room

134 — Inpatient psychiatric / 3-4 beds room

144 — Inpatient psychiatric / private deluxe room

154 — Inpatient psychiatric / ward room

169 — Administratively necessary day services

191 — Administratively necessary day services

204 — Inpatient hospital intensive care - Psychiatric

907 — Community behavioral health program, day treatment

912 — Partial hospital care

1001 — Residential treatment - Psychiatric

1002 — Residential treatment - Chemical dependency

90867 — Transcranial magnetic stimulation (TMS)

90868 — Therapeutic repetitive TMS treatment; subsequent delivery and management, per session

90869 — Therapeutic repetitive TMS treatment; subsequent motor threshold re-determination with delivery and management

97153 — Adaptive behavioral treatment by protocol technician; 15 minutes

97154 — Group adaptive behavioral treatment by protocol technician; 15 minutes

H0010 — Alcohol and/or drug sub-acute detoxification: residential addiction program inpatient

H0011 — Alcohol and/or drug acute detoxification: residential addiction program inpatient

H0017 — Behavioral health; residential (hospital residential treatment program), without room and board, per diem

H0018 — Short term residential nonhospital residential program, without room and board

H0019 — Behavioral health long-term residential

H0035 — Mental health partial hospitalization, treatment; less than 24 hours

H2012 — Behavioral health day treatment; per hour

H2020 — Therapeutic behavioral services; per diem

H2022 — Community-based wrap-around services, per diem

S5126 — Attendant care services

T2048 — Behavioral health: long-term care residential (non-acute care in a residential treatment program where stay is typically longer than 30 days)

Behavioral Health Procedure Codes

Behavioral health procedure codesmixedCovered

114	Inpatient psychiatric / private room
116	Inpatient detoxification / private room
124	Inpatient psychiatric / semiprivate room
126	Inpatient detoxification / semiprivate room
134	Inpatient psychiatric / 3-4 beds room
144	Inpatient psychiatric / private deluxe room
154	Inpatient psychiatric / ward room
169	Administratively necessary day services
191	Administratively necessary day services
204	Inpatient hospital intensive care - Psychiatric

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Provider Requirements and Action Items

Prior Authorization

Prior authorization requirement overview

Providers must check the listed behavioral health services before providing care to UnitedHealthcare Community Plan 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. For additional authorization details, see the UnitedHealthcare Community Plan of Washington Care Provider Manual (Chapter 7) or call the Customer Service number on the member's ID card.

Check the listed services prior to providing care.
Out-of-network providers: obtain prior authorization before providing behavioral health services.
Emergency services: prior authorization not required.

Prior Authorization

Procedure codes requiring prior authorization

The following procedure codes require prior authorization under this contract. Providers must obtain authorization for these services before delivery (except in emergencies).

114, 116, 124, 126, 134, 144, 154
169, 191, 204
907, 912
1001, 1002
90867, 90868, 90869
97153, 97154
H0010, H0011, H0017, H0018, H0019
H0035, H2012, H2020, H2022
S5126, T2048

Key Definitions

inv-05: Prior authorization — definition

DefinitionPrior authorization is approval required from the plan before providing certain behavioral health services; not required for emergency services.

ScopeApplies to behavioral health services listed in the UnitedHealthcare Community Plan of Washington Integrated Medicaid Managed Care contract and referenced code lists.

ReferenceSee Care Provider Manual (Chapter 7) for additional prior authorization process details.

inv-06: Out-of-network provider requirement

RequirementAll out-of-network (non-participating) providers must obtain prior authorization approval before providing behavioral health services.

ExceptionPrior authorization is not required when rendering emergency services.

Action for providersCheck the listed services and obtain authorization prior to providing care to UnitedHealthcare Community Plan members.