CurrentOptumPolicy N/A

Prior authorization for behavioral health services (NY Child Health Plus)

Defines which behavioral health services require prior authorization for UnitedHealthcare Community Plan members under New York Child Health Plus (CHP), and applies to participating and non-participating providers delivering behavioral health services in NY.

Policy Summary

PayerOptum

PolicyPrior authorization for behavioral health services (NY Child Health Plus)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateOct 1, 2023

Next Review DateN/A

Key ActionAll out-of-network providers must obtain prior authorization before providing behavioral health services; emergency services are exempt.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Manyprocedure & revenue codes requiring prior authorization

Ended 11/1/2023ECT (90870) authorization removed

Auth requiredout-of-network provider rule

Exemptemergency services

Services Requiring Prior Authorization

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.

Prior authorization required services

The following lists (by procedure and revenue code) denote services that continue to require prior authorization under NY Child Health Plus (CHP).

ALL of the following

Revenue codes: 100 (All-inclusive room and board plus ancillary); 0114, 0124, 0134 (Inpatient Psychiatric); 0116, 0126, 0136, 0146, 0156 (Medically Supervised Residential Inpatient Withdrawal Management ASAM 3.7W); 158 (Medically Monitored Intensive Inpatient Services, ASAM 3.7); 169 (Chemical Dependency Rehab ALOC); 0905 (Mental Health intensive outpatient - NOT State Plan); 906 (Intensive OP Services - Psychiatric); 0912/0913 (Mental Health partial hospitalization);

ALL of the following

Procedure codes: 97151–97158 and related technician/provider variants (including 97152, 97153, 97154, 97155, etc.).

ALL of the following

Procedure codes: 96136, 96137 (admin & scoring) — Auth required only when submitted with Psychological Testing Eval codes 96130 & 96131; No auth required when submitted with Neuropsychological Testing Eval codes 96132 & 96133. Also includes codes such as 96156 as specified in document.

ALL of the following

Examples: H0031, H0032, H2012, H2014, H2015, H2019, H2019, H2021, H2023; S5150, S5151, T2015, T2020 and other listed day treatment, habilitation, respite and community-based service codes.

Authorization removal

Removed authorization requirement

Electroconvulsive Therapy (ECT) — procedure code 90870 — prior authorization requirement ended on Nov. 1, 2023.

Procedure and Revenue Codes

Inpatient and residential revenue codesRevenueCovered

100	All-inclusive room and board plus ancillary
0114, 0124, 0134	Inpatient Psychiatric revenue codes
158	Medically Monitored Intensive Inpatient Services, ASAM 3.7

Outpatient, testing, ABA, and community servicesCPT | HCPCS | mixedCovered

97151-97158, 0362T, 0373T	Behavioral assessment and adaptive behavior treatment codes (multiple variants)
96130-96137, 96156, 96159	Psychological testing and related administration/scoring codes
H0031, H0032, H2012, H2014, H2015, H2019, H2021, H2023	Behavioral health HCPCS-level service codes requiring auth
S5150, S5151, T2015, T2020	Respite, prevocational, and habilitation service codes

Authorization Rules and Important Dates

Prior Authorization

Prior authorization required for out-of-network providers; emergency services exempt

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.

Requirement applies to out-of-network/non-participating providers for behavioral health services
Emergency services are exempt from prior authorization

Prior Authorization

Authorization removed for ECT (90870) effective 11/01/2023

Prior authorization requirement for electroconvulsive therapy (ECT), Procedure Code 90870, ended on November 1, 2023.

Procedure code: 90870 (ECT, single seizure and multiple seizure per day)
Authorization removal effective date: Nov. 1, 2023

Key Terms

Prior authorization (definition and emergency services exemption)

DefinitionPrior authorization is the requirement to obtain approval before providing certain behavioral health services.

Emergency services exemptionPrior authorization is not required when rendering emergency behavioral health services.

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

Reference for detailsSee the Optum Behavioral Health National Network Manual (pages 38-40) for additional prior authorization information.

Member assistanceIf providers have questions, contact the Customer Service number on the back of the member's ID card.

Policy Summary

PayerOptum

PolicyPrior authorization for behavioral health services (NY Child Health Plus)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateOct 1, 2023

Next Review DateN/A

Key ActionAll out-of-network providers must obtain prior authorization before providing behavioral health services; emergency services are exempt.

SourceLink

On This Page