Behavioral Health Urgent Care (BHUC) coverage criteria
Customize your policy alerts
Sign up for all partners_health_management policy alerts
Know when partners_health_management releases new policies or updates existing guidance.
Monitor payer policy activity
Defines Partners Health Management's Behavioral Health Urgent Care (BHUC) service model as an alternative to hospital EDs for urgent behavioral health needs for ages 4 and older, including triage, brief assessment, stabilization, and disposition; covers utilization management parameters and staffing/training requirements.
Coverage Criteria
Initial Eligibility and Service Inclusion
Covered when ALL of the following are met:
Covered Interventions
Covered interventions include, as clinically indicated:
Disposition & Discharge Planning
Disposition and discharge planning required to link to least restrictive care:
Behavioral Health Urgent Care (BHUC) is described in this policy as a designated intervention/treatment location intended as an alternative to a community hospital Emergency Department for individuals with urgent behavioral health needs. The service is structured to receive and triage consumers presenting with emergent or urgent behavioral health crises and to provide referral, brief assessment, medical screening, and the ability to initiate involuntary commitment first-evaluations when clinically indicated. BHUC is therefore positioned as a diversion pathway from ED/hospital care when appropriate.
The policy allows up to 6 BHUC events per member per year without prior authorization. Events in excess of that annual threshold are not automatically covered and may require prior authorization or additional review.
The prior-authorization-free pass-through applies only within the stated admission limits. Specifically, there is no prior authorization required only for up to 3 admissions per month with a maximum of 6 admissions per year; services beyond these pass-through limits are not covered under the prior-authorization-free pass-through and will require further authorization or review.
Coding and Unit Definitions
| T2016 U5 | Behavioral Health Urgent Care (BHUC) group code / In Lieu of Service (ILOS) |
Provider Actions and Requirements
Pass-through prior authorization — up to 3/month (max 6/yr)
No prior authorization is required for a pass-through amount of up to 3 admissions per month, with a maximum of 6 admissions per member per year. Service units are defined as 1 unit = 1 event = 1 admission.
- Pass-through admissions: up to 3 per month without prior authorization
- Annual cap for pass-through admissions: up to 6 per member per year
- Unit definition: 1 unit = 1 event = 1 admission
Prior authorization required for visits beyond 6 events/year
Members may receive up to 6 BHUC events per year without prior authorization; BHUC events beyond that annual allowance may require prior authorization or review.
- Up to 6 BHUC events/admissions per year allowed without prior authorization
- Events beyond 6 per year are not automatically covered and may require prior authorization
Use BHUC as ED/hospital diversion when clinically appropriate
BHUC is defined as a designated alternative to a community hospital Emergency Department and should be used as a diversion pathway for individuals presenting with urgent behavioral health crises when appropriate.
- Intended to provide triage, brief assessment, stabilization, medical screening, and first-level involuntary commitment evaluations as an ED alternative
Step therapy — none specified
No step therapy requirements are specified for BHUC services in this policy section.
- Policy does not list any prior-required steps or step-therapy sequencing for BHUC access
Required documentation and SAR notifications (72-hour SAR)
For managed (concurrent) admissions BHUC must document an assessment and a discharge/disposition plan; Notification Service-Associated Requests (SARs) must be submitted within 72 hours of admission and written discharge instructions and standardized notifications to primary/next behavioral health provider are required.
- For managed (concurrent) admissions: complete assessment and discharge/disposition plan
- Submit SAR within 72 hours of admission for pass-through events
- Provide written discharge instructions and standardized notification to primary/next behavioral health provider detailing services rendered and follow-up
Required documentation elements and staff training evidence
BHUC staff must document use of collateral information, triage, crisis and safety/risk assessments, direct observation, and evidence of completed required trainings and competencies.
- Document collateral information, triage and crisis assessments, and safety/risk assessments
- Document direct observation and clinical findings
- Maintain evidence of completed BHUC training and required competencies
Exceeding pass-through caps may remove prior‑authorization exemption
If the pass-through caps are exceeded (more than 3 admissions in a month or more than 6 admissions in a year), the prior-authorization-free status may be removed and those additional admissions could require prior authorization, review, or alternative billing.
- Exceeding monthly or annual pass-through limits may trigger requirement for prior authorization or denial risk
- Additional admissions beyond caps may be subject to full authorization/review or different billing
Prior authorization threshold — >6 events/year
More than 6 BHUC events per member per year are not automatically covered without prior authorization and may require prior authorization.
- Annual threshold without prior authorization: up to 6 events
- Events above 6 per year may require prior authorization
Definitions and Background
Behavioral Health Urgent Care (BHUC) provides rapid triage and referral for persons ages 4 and older presenting with urgent or emergent behavioral health needs. The service model emphasizes a brief assessment and stabilization approach that includes crisis de-escalation, medical screening, initiation of involuntary commitment first-evaluations when required, medication management, case management and referral coordination, and disposition planning to the least restrictive appropriate care setting.
Level-of-Care Criteria
BHUC / Urgent Care — Level of care criteria group (staffing & supervision)
Treatment Modalities
Crisis intervention / brief behavioral health treatment
Visit Limits and Utilization
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.