Behavioral Health Prior Authorization Code List — TennCare and CoverKids
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Lists behavioral health services and billing codes that require prior authorization for Tennessee TennCare and CoverKids members served by UnitedHealthcare Community Plan; applies to inpatient stays, out-of-network providers, TMS, ABA, residential, and related services.
No material clinical or coverage changes in this revision.
Coverage Criteria Summary
This list outlines behavioral health services that require prior authorization for Tennessee TennCare and CoverKids members served by UnitedHealthcare Community Plan. All inpatient stays require prior authorization, and out-of-network (non‑participating) providers require authorization. Prior authorization is not required when rendering emergency services. Providers should consult the plan manual (Chapter 9) or call the Customer Service number on the member's ID card for additional authorization guidance.
Billing Codes Requiring Prior Authorization
| 114 | Psychiatric, room and board - private room |
| 116 | Detoxification, room and board - private room |
| 118 | Rehabilitation, room and board - private room |
| 120 | Room and board - semi-private room |
| 124 | Psychiatric, room and board - semi-private room, two beds |
| 126 | Detoxification, room and board - semi-private room, two beds |
| 128 | Rehabilitation, room and board - semi-private room, two beds |
| 134 | Psychiatric, room and board - three and four beds |
| 136 | Detoxification, room and board - semi-private room, three and four beds |
| 138 | Rehabilitation, room and board - semi-private room, three and four beds |
| 190 | Subacute care - General |
| 191 | Subacute care - Level 1 |
| 192 | Subacute care - Level 2 |
| 193 | Subacute care - Level 3 |
| 194 | Subacute care - Level 4 |
| 199 | Other subacute care |
| 203 | Intensive care-Pediatric |
| 204 | Intensive care-Psychiatric |
| 1001 | Behavioral health accommodations - Residential treatment, Psychiatric |
| 1002 | Behavioral health accommodations - Residential treatment, Chemical dependency |
| 1003 | Behavioral health accommodations - Supervised living |
| 1004 | Halfway house |
| 1005 | Group home |
| 97151 | ABA - Behavior identification assessment (physician or qualified professional), per 15 minutes |
| 97152 | ABA - Behavior identification supporting assessment (technician), per 15 minutes |
| 97153 | ABA - Adaptive behavior treatment by protocol (technician), per 15 minutes |
| 97154 | ABA - Group adaptive behavior treatment by protocol, per 15 minutes |
| 97155 | ABA - Adaptive behavior treatment with protocol modification (physician or qualified professional), per 15 minutes |
| 97156 | ABA - Family adaptive behavior treatment guidance, per 15 minutes |
| 97157 | ABA - Multiple-family group adaptive behavior treatment guidance, per 15 minutes |
| 97158 | ABA - Group adaptive behavior treatment with protocol modification |
| 0362T | ABA - Behavior identification supporting assessment (technicians), per 15 minutes |
| 0373T | ABA - Adaptive behavior treatment with protocol modification (technicians), per 15 minutes |
| G9002 | Coordinated care fee, maintenance rate |
| H0018 | Behavioral health; short-term residential (nonhospital residential treatment program), without room and board, per diem |
| H0025 | Alcohol and/or drug prevention |
| H0036 | Community psychiatric supportive treatment, face-to-face, per 15 min |
| H0037 | Community psychiatric supportive treatment program, per diem |
| H0043 | Supported housing, per diem |
| H2015 | Comprehensive community support services, per 15 minutes |
| T2048 | Behavioral health; long-term care community based psychiatric residential treatment facility (non-acute care) in a residential program, per diem |
What Providers Must Do
Prior Authorization Required for Listed Codes
The table below outlines the behavioral health services that require prior authorization for the Tennessee TennCare (Medicaid) and CoverKids contracts. Please check this list before you provide services to UnitedHealthcare Community Plan members. Additional information about prior authorization for behavioral health services can be found in the UnitedHealthcare Community Plan of Tennessee Care Provider Manual (Chapter 9). If you have additional questions, please call the Customer Service number on the back of the member's ID card. Note: Prior authorization is not required for emergency services.
- All out-of-network (non-participating) providers require prior authorization.
- All inpatient stays require prior authorization.
- Prior authorization is not required when rendering emergency services.
- Prior authorization is not required for IDD/ICF Bill Type 66x for certain room-and-board semi-private room services (see code list).
Prior authorization is required for the codes below
Prior authorization is required for the behavioral health codes listed in the policy code list (includes, but is not limited to: room and board psychiatric/detoxification/rehabilitation codes; supervised living, halfway house, group home; TMS codes 90867–90869; extensive Applied Behavior Analysis (ABA) codes 97151–97158, 0362T, 0373T; coordinated care fee G9002; short-term residential H0018; H0036/H0037/H0043/H2015/T2048; and others). Prior authorization is required for all inpatient stays and for services provided by out-of-network providers. Failure to obtain prior authorization for these services may result in claim denial or nonpayment.
Provider resources
Providers should refer to the UnitedHealthcare Community Plan of Tennessee Care Provider Manual (Chapter 9) for detailed prior authorization procedures, submission instructions, and any service-specific documentation requirements. If you have questions about coverage or the authorization process, contact the plan's Customer Service number found on the member's ID card.
- Check the UnitedHealthcare Community Plan of Tennessee Care Provider Manual (Chapter 9) for authorization procedures.
- Call Customer Service on the member's ID card for questions.
Prior authorization required — Denial Risk
Failure to obtain prior authorization for the listed behavioral health services — including all inpatient stays and services provided by out-of-network providers — may result in denial of the claim or nonpayment. Always verify authorization requirements before rendering non-emergency services.
- Denial risk applies to inpatient stays and out-of-network provider services without prior authorization.
- Confirm prior authorization and document authorization numbers on claims to reduce denial risk.
Background and Scope
This document is an administrative prior authorization list for behavioral health services under Tennessee TennCare and CoverKids. It enumerates the billing codes and service types that require prior authorization for UnitedHealthcare Community Plan members in Tennessee and directs providers to the UnitedHealthcare Community Plan of Tennessee Care Provider Manual (Chapter 9) or Customer Service for further authorization details. Note that emergency services are exempt from prior authorization requirements.
Definitions
Level of Care Mapping
ABA Prior Authorization Criteria
Treatment Modalities
Visit Limits and Quantity Rules
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