CurrentUnitedHealthcarePolicy N/A

Louisiana Prior Authorization Requirements for UnitedHealthcare Exchange Plans

Lists inpatient and outpatient behavioral health services and procedure codes that require prior authorization for UnitedHealthcare Exchange Plan members in Louisiana; applies to participating behavioral health providers and directs online submission.

Policy Summary

PayerUnitedHealthcare

PolicyLouisiana Prior Authorization Requirements for UnitedHealthcare Exchange Plans

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJan 1, 2024

Next Review DateN/A

Key ActionTo request prior authorization, submit your request online via the Prior Authorization and Notification tool accessed through Sign In on UHCProvider.com.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

~70+procedure/revenue and CPT codes listed requiring prior authorization

Online onlyprior authorization submission method (via UHCProvider.com tool)

Emergency/urgent excludedprior authorization not required for emergency or urgent care

No out-of-networkmembers have no non-emergent out-of-network or out-of-area coverage

Services Requiring Prior Authorization

Policy Summary

PayerUnitedHealthcare

PolicyLouisiana Prior Authorization Requirements for UnitedHealthcare Exchange Plans

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJan 1, 2024

Next Review DateN/A

Key ActionTo request prior authorization, submit your request online via the Prior Authorization and Notification tool accessed through Sign In on UHCProvider.com.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Prior authorization required services

Services requiring prior authorization (providers must submit requests online). When deciding coverage, reference the member-specific benefit plan document.

Prior authorization is required for the inpatient and outpatient behavioral health services and procedure/revenue codes listed below for participating UnitedHealthcare Exchange Plan members in Louisiana.

Providers must submit prior authorization requests online via the Prior Authorization and Notification tool accessed through Sign In on UHCProvider.com.

When deciding coverage, reference the member-specific benefit plan document as plan terms vary by state.

Prior authorization is not required for emergency or urgent care services.

For these benefit plans, members have no non-emergent out-of-network coverage and no coverage outside of the service area.

Services and associated procedure/revenue codes that require prior authorization include (partial list): 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); Treatment Room (Rev 761); Evaluation/Initial-BH Treatments/Services (Rev 900); MH Intensive Outpatient (Rev 905); SUD Intensive Outpatient (Rev 906); MH/SUD Partial Hospitalization (Rev 912, 913); OP Services - Behavioral Health Testing (Rev 918); OP Services - Other Behavioral Health Treatment/Services (Rev 919); Drug Rehabilitation (Rev 944); Alcohol Rehabilitation (Rev 945); Combined Drug and Alcohol Rehabilitation (Rev 953); Psychiatric (Rev 961).

Selected Revenue, Service, and CPT Codes Requiring Prior Authorization

Selected Revenue Codes Requiring Prior AuthorizationRevenueCovered

114	Inpatient Mental Health
124	Inpatient Mental Health
134	Inpatient Mental Health
144	Inpatient Mental Health
154	Inpatient Mental Health
204	Inpatient Mental Health

Selected CPT and Other Procedure Codes Requiring Prior AuthorizationCPTCovered

90867	Therapeutic Repetitive Transcranial magnetic stimulation treatment; planning, 1 visit
90868	Therapeutic Repetitive Transcranial magnetic stimulation treatment; delivery and management, per session, 1 visit
90869	Therapeutic Repetitive Transcranial Magnetic Stimulation (TMS) treatment; subsequent motor threshold re-determination with delivery and management, 1 visit
90899	Unlisted psychiatric service or procedure
96130	Psychological testing evaluation
96131	Psychological testing evaluation
96136	Psychological or neuropsychological test admin and scoring by physician or other qualified health care professional, two or more tests, any method, first 30 minutes (Auth required only if submitted with 96130 & 96131)
96137	Psychological or neuropsychological test admin and scoring by physician or other qualified health care professional, two or more tests, any method, each additional 30 minutes (Auth required only if submitted with 96130 & 96131)
96138	Psychological or neuropsychological test admin and scoring by technician, two or more tests, any method, first 30 minutes (Auth required only if submitted with 96130 & 96131)
96139	Psychological or neuropsychological test admin and scoring by technician, two or more tests, any method, each additional 30 minutes (Auth required only if submitted with 96130 & 96131)

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What Providers Must Do

Prior Authorization

Submit prior authorization requests online via the Prior Authorization and Notification tool

To request prior authorization, submit your request online via the Prior Authorization and Notification tool accessed through the Sign In function on UHCProvider.com.

Note

No prior authorization required for emergency or urgent care

Prior authorization is not required for emergency or urgent care.

Key Definitions

Prior authorization — definition

DefinitionPrior authorization is the requirement to obtain approval before providing the listed inpatient or outpatient behavioral health services for Exchange Plan members in Louisiana.

Applies toParticipating behavioral health providers treating UnitedHealthcare Exchange Plan members in Louisiana.

ScopeInpatient and outpatient behavioral health services and specific procedure/revenue codes listed in the policy.

Reference for coverage decisionsWhen deciding coverage, reference the member-specific benefit plan document because plan terms vary by state.

Submission requirementPrior authorization requests must be submitted online via the Prior Authorization and Notification tool on UHCProvider.com.

Emergency/urgent care — exemption

DefinitionEmergency or urgent care services do not require prior authorization.

Implication for providersDo not submit prior authorization requests for emergency or urgent care services; proceed with necessary care immediately.

Member coverage noteFor these benefit plans, members have no non-emergent out-of-network coverage and no coverage outside of the service area.

Related policy instructionWhen applicable, reference the member-specific benefit plan document for coverage details that may affect non-emergent situations.