Prior Authorization Code List — UnitedHealthcare Exchange Plans (Colorado)
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Lists services and procedure codes requiring prior authorization for participating behavioral health providers for UnitedHealthcare Exchange Plans members in Colorado; affects providers delivering inpatient and outpatient behavioral health services to those members.
No material clinical or coverage changes in this revision.
Prior Authorization Coverage Criteria
Prior authorization coverage criteria
Services listed with the specified revenue or CPT codes require prior authorization for UnitedHealthcare Exchange Plans members in Colorado. Emergency or urgent care is excluded from prior authorization.
Revenue codes
- Inpatient Mental Health — Rev 114, 124, 134, 144, 154, 204.
- Inpatient Substance Use detoxification (hospital based) — Rev 116, 126, 136, 146, 156.
- Substance Use rehabilitation (hospital based) — Rev 118, 128, 138, 148, 158.
- Psychiatric Clinic — Rev 513.
- Electroshock treatment — Rev 901.
- Mental Health Intensive Outpatient — Rev 905.
- Substance Use Disorder Intensive Outpatient — Rev 906.
- Community Behavioral Health Program, day treatment — Rev 907.
- Mental Health/Substance Use Disorder Partial Hospitalization — Rev 912, 913.
- Drug rehabilitation — Rev 944.
- Alcohol rehabilitation — Rev 945.
- Behavioral Health Accommodations — Rev 1000.
- Residential Treatment - Psychiatric — Rev 1001.
- Residential Treatment - Chemical Dependency — Rev 1002.
- Supervised Living — Rev 1003.
CPT codes
- Therapeutic Repetitive Transcranial Magnetic Stimulation (rTMS) — 90867 (planning).
- Therapeutic Repetitive Transcranial Magnetic Stimulation (rTMS) — 90868 (delivery and management, per session).
- Therapeutic Repetitive Transcranial Magnetic Stimulation (rTMS) — 90869 (subsequent motor threshold re-determination with delivery and management).
Revenue and CPT Codes Requiring Prior Authorization
| Rev 114 | Inpatient Mental Health |
| Rev 124 | Inpatient Mental Health |
| Rev 134 | Inpatient Mental Health |
| Rev 144 | Inpatient Mental Health |
| Rev 154 | Inpatient Mental Health |
| Rev 204 | Inpatient Mental Health |
| Rev 116 | Inpatient Substance Use detoxification (hospital based) |
| Rev 126 | Inpatient Substance Use detoxification (hospital based) |
| Rev 136 | Inpatient Substance Use detoxification (hospital based) |
| Rev 146 | Inpatient Substance Use detoxification (hospital based) |
| 90867 | Therapeutic Repetitive Transcranial Magnetic Stimulation treatment; planning |
| 90868 | Therapeutic Repetitive Transcranial Magnetic stimulation treatment; delivery and management, per session |
| 90869 | Therapeutic Repetitive Transcranial Magnetic Stimulation treatment; subsequent motor threshold re-determination with delivery and management |
| 96130 | Psychological testing evaluation |
| 96131 | Psychological testing evaluation |
How to Request Prior Authorization and Provider Responsibilities
How to request prior authorization online
Submit prior authorization requests online using one of the two approved portals: sign in at UHCProvider.com and use the Prior Authorization and Notification tool, or sign in at Providerexpress.com and navigate to Auths > Auth Request to complete the request.
- Use your One Healthcare ID and password to sign in.
- Follow the interactive guide on UHCProvider.com for step‑by‑step instructions or the Prior Authorizations and Notifications page on Provider Express for additional details.
Check eligibility, network status, grace period, and financial responsibility
Verify member eligibility and benefits before providing care, including confirming network participation, whether the member is in the plan's grace period, and the member's financial responsibilities at time of service.
- Verify your network participation in the member's health plan.
- Confirm whether the member is in the plan's grace period.
- Know the member's financial responsibilities at the time of service.
Emergency and Urgent Care Exception
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