UnitedHealthcare behavioral health Prior Auth Policy Update | OpenPayer
CurrentUnitedHealthcarePolicy N/A
Behavioral health prior authorization requirements for Rocky Mountain Health CHP+ plans
Specifies prior authorization requirements and contact methods for behavioral health services (mental health and substance use) for Rocky Mountain Health Plans CHP+ members; applies to participating and non-participating providers and admitting facilities when RMHP CHP+ is the primary payer.
Policy Summary
PayerUnitedHealthcare
PolicyBehavioral health prior authorization requirements for Rocky Mountain Health CHP+ plans
Policy CodePolicy N/A
Change TypeNo material changes
Effective DateDec 1, 2024
Next Review DateN/A
Key ActionFor behavioral health prior authorization requests call 877-668-5947 or fax documentation to 888-240-2689.
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Prior Authorization Criteria
Prior authorization criteria for behavioral health services
Services that require prior authorization or notification:
Behavioral health inpatient hospitalization: Requires prior authorization for all admissions to freestanding inpatient psychiatric facilities or hospital psychiatric facilities (see facility billing codes).
Long-term residential treatment (excluding QRTP and PRTF): Requires prior authorization for HB modifier only.
Psychiatric residential treatment: Requires prior authorization except for Community Mental Health Center (CMHC) services (POS 53).
Behavioral health partial hospitalization program (PHP): Requires prior authorization.
Behavioral health intensive outpatient programming (IOP): Requires prior authorization; example code S9480; ASAM level 2.1 IOP corresponds to H0015.
ASAM level 3.7 medically monitored inpatient withdrawal management: Requires prior authorization for 5 or more days; the initial days do not require prior authorization but notification of admission is required (H0011).
ASAM residential levels (3.7, 3.5, 3.3, 3.1): Require prior authorization; use H2036 with population/modifier codes (UZ, U5, U3, U1) and Modifier HD for Special Connections cases as specified.
ASAM level 2.5 partial hospitalization program (PHP): Requires prior authorization.
Unlisted service code (99499): Requires prior authorization.
Codes and Clinical Thresholds Requiring Authorization
Behavioral health CPT codes requiring authorization or single-case agreementCPT
90832
Psychotherapy, 30 minutes with patient
90833
Psychotherapy, 30 minutes with patient when performed with an evaluation and management service
90834
Psychotherapy, 45 minutes with patient
90836
Psychotherapy, 45 minutes with patient when performed with an evaluation and management service
90837
Psychotherapy, 60 minutes with patient
90838
Psychotherapy, 60 minutes with patient when performed with an evaluation and management service
90839
Psychotherapy for crisis; first 60 minutes
90840
Psychotherapy for crisis; each additional 30 minutes
90846
Family psychotherapy (without the patient present)
90847
Family psychotherapy (conjoint psychotherapy) (with patient present)
1–10 of 12
1/2
ASAM 3.7 inpatient withdrawal authorization threshold — prior authorization required for 5 or more days; admission notification requirement
ASAM 3.7 prior auth thresholdPrior authorization required for >= 5 days; admission notification required for shorter stays
How to Request Authorization and Provider Requirements
Note
How to Request Prior Authorization
To request prior authorization for behavioral health services: call 877-668-5947 for questions or to notify admissions. Participating and non‑participating providers may fax requests and documentation to 888-240-2689 or email rmhpbhvmeuhccom. Admitting facilities may give notification by calling 877-668-5947. Prior authorization is not required for emergency or urgent care. Out-of-network physicians, facilities and other health care professionals must request prior authorization for all procedures and services, excluding emergent or urgent care.
Prior Authorization
Services and Codes Requiring Prior Authorization or Single‑Case Agreement
The following services and codes require prior authorization or a single‑case agreement. Providers must obtain authorization or a single‑case agreement as noted before rendering services unless otherwise specified (emergency/urgent care excluded).
Behavioral health inpatient hospitalization: All admissions to freestanding inpatient psychiatric facilities or hospital psychiatric facilities require prior authorization
Key Definitions
Services not covered under the Evidence of Coverage that require prior authorization
DefinitionServices not covered under the Evidence of Coverage that require prior authorization as identified on this list.
ScopeApplies when Rocky Mountain Health Plans (RMHP) CHP+ is the primary payer; the list is subject to periodic updates announced in UnitedHealthcare Network News.
Action requiredPrior authorization must be obtained for services on this list before providing care unless the service is emergency or urgent care.
Where to confirm updatesSee the Advance Notification and Clinical Submission Requirements and UnitedHealthcare Network News for the most current information.
Authorization mechanism required for certain services provided by out-of-network providers
Definition
Long‑term residential treatment (excluding QRTP and PRTF): Requires prior authorization (HB modifier only for certain cases)
Psychiatric residential treatment: Requires prior authorization except for Community Mental Health Centers (POS 53)
Behavioral health partial hospitalization program (PHP): CPT/HCPCS codes require prior authorization
Behavioral health intensive outpatient program (IOP): Requires prior authorization (example code S9480)
ASAM level 3.7 medically monitored inpatient withdrawal management: Requires prior authorization for stays of 5 or more days; initial days require notification of admission (H0011)
ASAM level 3.7 medically monitored intensive inpatient services: Requires prior authorization (H2036 with modifier UZ; use modifier HD for Special Connections cases)
ASAM level 3.5 clinically managed high‑intensity residential services (including Special Connections): Requires prior authorization (H2036 with modifier U5; use modifier HD for Special Connections cases)
ASAM level 3.3 clinically managed population‑specific high‑intensity residential services: Requires prior authorization (H2036 with modifier U3; use modifier HD for Special Connections cases)
ASAM level 3.1 clinically managed low‑intensity residential services: Requires prior authorization (H2036 with modifier U1; use modifier HD for Special Connections cases)
ASAM level 2.5 partial hospitalization program (PHP): Requires prior authorization
Unlisted service codes: 99499 requires prior authorization
Single-case agreement is an authorization mechanism required for certain services provided by out-of-network providers; listed CPT codes do not require standard prior authorization for out-of-network providers but do require a single-case agreement.