CurrentOptumPolicy N/A

Special accommodation services for inpatient psychiatric care

Defines Optum's policy for identifying, requesting, authorizing, and billing special accommodation services (e.g., 1:1 staffing, single room, extra personnel) in inpatient psychiatric settings; applies to inpatient psychiatric facilities, EDs, and ESPs seeking payment and authorization from Optum.

Policy Summary

PayerOptum

PolicySpecial accommodation services for inpatient psychiatric care

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionRequest special accommodation prior to admission by contacting the Behavioral Health Insurance Provider Line (1-866-414-5533).

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

24/7/365BH Provider Line

2-3 daysSCA outreach

Per DiemAuthorization unit

Rev 114Single room code

Special Accommodation Coverage Criteria

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Special accommodation must be requested prior to admission; Optum will authorize requests made prior to admission without clinical review.

Includes

Requests to facilitate inpatient admission from the Emergency Department—these can be requested prior to admission and will be authorized without clinical review.
Requests from an inpatient psychiatric facility during the course of admission for extraordinary additional special accommodation services—these will be reviewed on a case‑by‑case basis.

Request must identify the specific service(s) requested and provide clinical information about the member's presentation, including symptoms, barriers or special needs that require the accommodation; requests for continued authorization will be addressed as part of concurrent clinical review for continued stay.

A Single Case Agreement (SCA) is required to ensure correct claims processing; the SCA is initiated when the provider requests and receives an authorization and the SCA team will outreach the facility within 2–3 business days to send the SCA letter that includes billing codes and applicable rates.

Each special accommodation service is authorized on a per diem basis.

Single room handling

Single room (Rev 114) may be covered under the facility's existing participation agreement; if Rev 114 is in contract, authorization will be given and the facility may bill per usual.
If Rev 114 is not in the facility's contract, an SCA will be initiated to authorize and set rates for the single room.

Codes and Billing Units

Special accommodation service codesmixedCovered

Rev 114	Single room
Rev 900 + H0046 + U6	Caregiver / Personal Care Attendant / Security
Rev 900 + H0046 + U7	Mental Health Worker / additional staffing (tech/counselor/nursing)
Rev 900 + H0046 + U8	Intensive RN and Physical Care

Authorization unit

Authorization unitPer Diem

SCA requiredSingle Case Agreement required; initiated when provider requests and receives an authorization

SCA timingSCA team will outreach facility within 2-3 business days after authorization to confirm contact and send SCA letter

Prior Authorization and Provider Steps

Prior Authorization

Prior authorization and Single Case Agreement process

Request special accommodation prior to admission by contacting the member's Behavioral Health Insurance Provider Line at 1-866-414-5533 (available 24/7/365). Optum will authorize any special accommodation services requested prior to admission without clinical review; requests during admission (beyond included 1:1 staffing) are reviewed case-by-case.

A Single Case Agreement (SCA) is required and will be initiated when the provider requests and receives an authorization.
Within 2–3 business days of authorization approval, Optum’s SCA team will contact the facility to confirm email/fax and send the SCA letter with billing codes and applicable rates.
Each special accommodation service is authorized on a Per Diem basis.

Key Definitions

Special accommodation — definition and examples

DefinitionSpecial accommodation services are services identified by an inpatient facility provider as necessary for safe and effective patient care

Examples1:1 staff/patient ratio; single room; extra personnel (Personal Care Attendant, Security)

Billing requirementRequires a Single Case Agreement to ensure claims process correctly; SCA includes billing codes and rates

Psychiatric inpatient unit — site of service definition

Site of servicePsychiatric inpatient unit where the member is being admitted

Applicable settingsInpatient psychiatric facilities, Emergency Department (requests to facilitate admission may be requested prior to admission)

Provider responsibilityFacility identifies need and requests special accommodation prior to admission