Prior authorization requirements for behavioral health services — UnitedHealthcare Community Plan of Kentucky
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This document governs reinstated prior authorization requirements for specified behavioral health services for UnitedHealthcare Community Plan of Kentucky members and explains how providers must request authorizations; it affects in‑network and out‑of‑network providers delivering those services in Kentucky.
Prior authorization requirements that had been paused during the COVID-19 pandemic were reinstated and apply beginning June 25, 2025 (with some services effective July 1, 2025).
Coverage criteria for behavioral health services
Coverage criteria for listed behavioral health services
Prior authorization is required for the listed behavioral health services for UnitedHealthcare Community Plan of Kentucky members except for emergency and urgent care; providers must follow the submission instructions specific to each service type and verify member eligibility.
Service categories requiring prior authorization (examples)
- Inpatient & residential behavioral health services (all inpatient mental health/substance abuse services and inpatient/residential services).
- Behavioral Health Long‑Term Residential (per diem) — T2048 (HE or HK).
- Assertive Community Treatment — H0040 (submit via Kentucky Services Request Form for ACT/Community‑Based Services).
- Targeted Case Management — T2023.
- Community‑Based Services and related community supports (see services table).
Psychological vs neuropsychological testing (authorization rule)
- Psychological testing requires prior authorization.
- Neuropsychological testing does not require prior authorization.
- Billing must report both the CPT code(s) for the professional psychological test evaluation (e.g., 96130, 96131) and the CPT code(s) for administration/scoring (96136‑96139, 96146) as applicable; because 96136‑96139 can be used with either psychological or neuropsychological testing, authorization is determined by which set of Test Evaluation CPT codes is used.
Service categories and codes that require authorization
| H0040 | Assertive Community Treatment |
| T2023 | Targeted Case Management |
| H2034 | SUD Residential |
| H0011 | SUD Residential |
| H2036 | SUD Residential |
| T2048 | Behavioral Health Long-Term Residential (per diem) |
| 1001 | PRTF (Level I & II) |
| 1002 | PRTF (Level I & II) |
| H0035 | Partial Hospitalization |
| S9480 | Intensive Outpatient |
What providers must do (submissions, portals, verifications)
General prior authorization requirement and exemptions
Prior authorization is required before delivering the behavioral health services listed in this policy except when providing emergency or urgent care. Out-of-network (non-participating) providers and facilities must obtain prior authorization approval before providing behavioral health services. Submitting a request does not guarantee authorization — do not deliver services until a determination has been made.
- Prior authorization not required for emergency or urgent care
- Out-of-network providers must obtain prior authorization before providing behavioral health services
Submission for Inpatient/Residential and Outpatient
How to submit requests for inpatient, residential and outpatient behavioral health services: use the Prior Authorization and Notification tool in the UnitedHealthcare Provider Portal. See the quick start guide or interactive guide for step‑by‑step instructions. Note that submitting a request does not guarantee authorization.
- Use the Prior Authorization and Notification tool in the UnitedHealthcare Provider Portal
- Access quick start guide or interactive guide for instructions
Submission for Psychological and Neuropsychological Testing
Psychological testing requires prior authorization. To request authorization for psychological and neuropsychological testing, complete and submit the Optum Psych Testing Form. When billing, report both the CPT code(s) for the Test Evaluation (professional evaluation) time and the CPT code(s) for the Test Administration/Scoring time (96136–96139). Note: neuropsychological testing itself does not require prior authorization, but test administration/scoring codes may be used with either testing type — the authorization requirement is determined by which Test Evaluation codes are used.
- Complete and submit the Optum Psych Testing Form for psychological testing authorization requests
- Report both Evaluation CPTs and Administration/Scoring CPTs on claims (e.g., 96130–96131 and 96136–96139)
- Neuropsychological testing does not require prior authorization; psychological testing does
Submission for ABA
Applied Behavior Analysis (ABA) submission instructions: network (in‑network) ABA providers must submit ABA assessment and treatment authorization requests via the Provider Express secure portal using a One Healthcare ID and password. Out‑of‑network ABA providers must obtain prior authorization before providing services — follow the Provider Express portal instructions or contact customer service if you need assistance setting up access.
- Network ABA providers: submit requests via Provider Express secure portal (One Healthcare ID required)
- Out‑of‑network ABA providers: obtain prior authorization before providing services
Definitions and scope notes
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