Ohio Prior Authorization Requirements for UnitedHealthcare Exchange Plans
Lists behavioral health services and procedure codes that require prior authorization for UnitedHealthcare Exchange plan members in Ohio; applies to participating behavioral health providers submitting inpatient and outpatient authorization requests.
No material clinical or coverage changes in this revision.
Prior Authorization Required Services
Prior Authorization Required Services
Covered when ALL of the following are met:
Requests must be submitted online via the Prior Authorization and Notification tool (accessed via Sign In on UHCProvider.com). Prior authorization is not required for emergency or urgent care.
Prior authorization is not required for emergency or urgent care services for Exchange plan members in Ohio. Providers rendering emergency or urgent behavioral health services should proceed without prior authorization and reference the member-specific benefit plan for coverage details.
Procedure and Revenue Codes Requiring Authorization
| Rev114 | Inpatient Mental Health (revenue code listed) |
| Rev124 | Inpatient Mental Health (revenue code listed) |
| Rev134 | Inpatient Mental Health (revenue code listed) |
| Rev144 | Inpatient Mental Health (revenue code listed) |
| Rev154 | Inpatient Mental Health (revenue code listed) |
| Rev204 | Inpatient Mental Health (revenue code listed) |
| No codes listed |
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