CurrentUnitedHealthcarePolicy N/A

Behavioral health prior authorization requirements for Rocky Mountain Health Plans (RMHP) RAE/PRIME Medicaid

Lists behavioral health services that require prior authorization for Rocky Mountain Health Plans (RMHP) RAE/PRIME Medicaid members and explains how providers should request prior authorization; applies to participating and non-participating health care professionals using RMHP as the primary payer.

Policy Summary

PayerUnitedHealthcare

PolicyBehavioral health prior authorization requirements for Rocky Mountain Health Plans (RMHP) RAE/PRIME Medicaid

Policy CodePolicy N/A

Change TypeNo material change

Effective DateMar 1, 2026

Next Review Date

Key ActionParticipating and non-participating providers must fax requests and documentation to 888-240-2689 or email rmhpbhvm@uhc.com to request prior authorization; call 800-421-6204 for behavioral health questions or admission notification.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

2026-03-01policy effective date

Multipleservice categories

Phone & faxcontact methods

Yesexample codes listed

Behavioral Health Prior Authorization Criteria

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Behavioral health prior authorization criteria

The following behavioral health service categories require prior authorization or notification as specified below. Emergency and urgent care are excluded from prior authorization requirements; out-of-network providers must request authorization for non-emergent services.

All admissions to freestanding inpatient psychiatric facilities or hospital psychiatric facilities require prior authorization.

Psychiatric residential treatment (acute treatment unit) — requires prior authorization.

Psychiatric residential treatment facility (PRTF) — requires prior authorization.

Qualified residential treatment program (QRTP) and related services (H0019) — requires prior authorization.

Partial hospitalization program (PHP) — requires prior authorization (codes: H0035, H0016).

Intensive outpatient programming (IOP) — requires pre-service notification; prior authorization required for services greater than 15 sessions (code: S9480, rev code 905).

Multisystemic therapy (MST) and enhanced MST — notification required at admission; prior authorization required after 90 days (codes: H2033, T2022).

Functional family therapy (FFT) and enhanced FFT — notification required at admission; prior authorization required after 90 days (codes: H0036, T2022).

Electroconvulsive therapy (ECT) — requires prior authorization (code: 90870).

Neuropsychological and psychological testing (includes 96132–96139, 96146, 96130–96131) — requires prior authorization.

Neurobehavioral status exam (96116, 96121) — requires prior authorization.

ASAM level 3.7 medically monitored inpatient withdrawal management — requires prior authorization (code: H0011).

ASAM level 3.7 medically monitored intensive inpatient services — requires prior authorization (H2036 with Modifier U7; Modifier HD for Special Connections cases).

ASAM level 3.5 clinically managed high‑intensity residential services — requires prior authorization (H2036 with Modifier U5; 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; Modifier HD for Special Connections cases).

ASAM level 3.1 clinically managed low‑intensity residential services — requires prior authorization (H2036 with Modifier U1; Modifier HD for Special Connections cases).

ASAM level 2.1 SUD IOP — notification required at admission; prior authorization required after 15 sessions (codes: G0137, H0015, rev code 906).

ASAM level 2.5 partial hospitalization program (PHP) — requires prior authorization (code: H0016).

If the patient is an RMHP DSNP member, first refer to the Medicare prior authorization list; if not covered under Medicare, refer to the Medicaid prior authorization list above.

Relevant Codes and Coding Rules

Residential/PRTF/QRTPHCPCSCovered

H0017	Psychiatric residential treatment (acute treatment unit)
Rev code 0911	Psychiatric residential treatment facility (PRTF)
H0019	Qualified residential treatment program (QRTP) and associated services

PHP, IOP, ECT, testingCPT | HCPCSCovered

H0035	Behavioral health partial hospitalization program (PHP)
S9480	Behavioral health IOP
90870	Electroconvulsive therapy (ECT)
96132-96139,96146,96130-96131	Neuropsychological and psychological testing codes
96116,96121	Neurobehavioral status exam

ASAM levels and SUD servicesHCPCS | CPT | RevenueCovered

H0011	ASAM level 3.7 medically monitored inpatient withdrawal management
H2036+U7	ASAM level 3.7 intensive inpatient services (Modifier U7)
H2036+U5	ASAM level 3.5 clinically managed high-intensity residential services (Modifier U5)
H2036+U3	ASAM level 3.3 clinically managed population-specific high-intensity residential services (Modifier U3)
H2036+U1	ASAM level 3.1 clinically managed low-intensity residential services (Modifier U1)
G0137,H0015,rev code 906	ASAM level 2.1 SUD IOP
H0016	ASAM level 2.5 partial hospitalization program (PHP)

Session-based prior authorization thresholds (inv-05)

IOP session thresholdIntensive outpatient programming (IOP) requires pre-service notification; prior authorization is required for services greater than 15 sessions.

SUD IOP thresholdASAM level 2.1 SUD IOP requires notification at admission; prior authorization is required after 15 sessions.

MST/FFT time-based thresholdMultisystemic therapy (MST) and Functional Family Therapy (FFT) require notification at admission; prior authorization is required after 90 days.

IOP codes referencedS9480, revenue code 905 (IOP) are the referenced codes for IOP services subject to the session threshold.

Documentation notePre-service notification is required for IOP and admission notification is required for MST/FFT and SUD IOP; prior authorization timing follows the thresholds above.

How Providers Request Prior Authorization

Prior Authorization

How to request prior authorization and contact information

Participating and non-participating health care professionals may fax requests and documentation to 888-240-2689 or email rmhpbhvm@uhc.com. For behavioral health service questions or admitting facility notification call 800-421-6204. 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.

Fax: 888-240-2689
Email: rmhpbhvm@uhc.com
Behavioral health questions / admitting facility notification: 800-421-6204

Note

Prior authorization and admission notification requirements by service

Specific behavioral health service categories require either pre-service notification at admission or prior authorization; some services require prior authorization only after a set number of sessions (for example, IOP >15 sessions; MST/FFT after 90 days; SUD IOP after 15 sessions). Emergency and urgent care are excluded from prior authorization requirements.

Inpatient behavioral health hospitalization: Requires prior authorization for all admissions to freestanding inpatient psychiatric facilities or hospital psychiatric facilities. (chunk 1)
Psychiatric residential treatment (H0017), PRTF (Rev code 0911), QRTP (H0019): Require prior authorization. (chunk 1)
Partial hospitalization (H0035, H0016) and ECT (90870): Require prior authorization. (chunks 2,4)
IOP (S9480, rev code 905): Pre-service notification required; prior authorization required for services >15 sessions. (chunk 2)
MST (H2033, T2022) and FFT (H0036, T2022): Notification required at admission; prior authorization required after 90 days. (chunk 2)
SUD IOP (G0137, H0015, rev code 906): Notification required at admission; prior authorization required after 15 sessions. (chunk 4)
Neuropsychological/psychological testing (96132–96139, 96146, 96130–96131) and neurobehavioral status exam (96116, 96121): Require prior authorization. (chunk 2)
ASAM levels 3.7, 3.5, 3.3, 3.1 residential/intensive services (H0011, H2036 + modifiers U7/U5/U3/U1): Require prior authorization. (chunk 3)

Key Definitions

Prior authorization — definition/brief explanation (inv-08)

DefinitionPrior authorization: A requirement that providers obtain approval from the plan before providing certain non-emergent services; emergency and urgent care are excluded.

Who must requestParticipating and non-participating providers must request prior authorization; out-of-network providers must obtain authorization for non-emergent services.

How to requestProviders may fax requests and documentation to 888-240-2689 or email rmhpbhvm@uhc.com; questions and admitting facility notification by phone to 800-421-6204.

ASAM levels — definition and referenced levels for SUD care (inv-09)

ASAM level 3.7Medically monitored inpatient withdrawal management and intensive inpatient services (codes: H0011; H2036 with Modifier U7; Modifier HD for Special Connections cases).

ASAM level 3.5Clinically managed high-intensity residential services (code: H2036 with Modifier U5; Modifier HD for Special Connections cases).

ASAM level 3.3Clinically managed population-specific high-intensity residential services (code: H2036 with Modifier U3; Modifier HD for Special Connections cases).

ASAM level 3.1Clinically managed low-intensity residential services (code: H2036 with Modifier U1; Modifier HD for Special Connections cases).

ASAM level 2.5Partial hospitalization program (PHP) for SUD (code: H0016).

ASAM level 2.1Substance use disorder intensive outpatient programming (SUD IOP) — notification at admission; prior authorization required after 15 sessions (codes: G0137, H0015, Rev code 906).