CurrentUnitedHealthcarePolicy N/A

Arizona Prior Authorization Requirements for UnitedHealthcare Exchange Plans

Lists behavioral health services and procedure/revenue/CPT codes that require prior authorization for UnitedHealthcare Exchange Plan members in Arizona; applies to participating behavioral health providers requesting inpatient and outpatient behavioral health services.

Policy Summary

PayerUnitedHealthcare

PolicyArizona Prior Authorization Requirements for UnitedHealthcare Exchange Plans

Policy CodePolicy N/A

Change TypeTechnical — no material change

Effective DateJan 1, 2024

Next Review DateN/A

Key ActionSubmit prior authorization requests online via the Prior Authorization and Notification tool on UHCProvider.com.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

~80+distinct procedure/revenue/CPT codes listed for authorization

Arizonastate-specific coverage

2024-01-01policy effective date

Coverage Criteria

Prior authorization is not required for emergency or urgent care. This policy applies to participating behavioral health providers for UnitedHealthcare Exchange Plans members in Arizona; when determining coverage, always reference the member-specific benefit plan document because benefit terms vary by state. Prior authorization requests for non-emergent inpatient and outpatient behavioral health services must be submitted online via the Prior Authorization and Notification tool on UHCProvider.com.

Policy Summary

PayerUnitedHealthcare

PolicyArizona Prior Authorization Requirements for UnitedHealthcare Exchange Plans

Policy CodePolicy N/A

Change TypeTechnical — no material change

Effective DateJan 1, 2024

Next Review DateN/A

Key ActionSubmit prior authorization requests online via the Prior Authorization and Notification tool 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.

Codes Requiring Prior Authorization

Covered Revenue Codes requiring prior authRevenueCovered

Rev 114	Inpatient Mental Health (revenue codes listed)
Rev 124	Inpatient Mental Health (revenue codes listed)
Rev 134	Inpatient Mental Health (revenue codes listed)
Rev 144	Inpatient Mental Health (revenue codes listed)
Rev 154	Inpatient Mental Health (revenue codes listed)
Rev 204	Inpatient Mental Health (revenue codes listed)
Rev 116	Inpatient Substance Use Detoxification (hospital based)
Rev 126	Inpatient Substance Use Detoxification (hospital based)
Rev 136	Inpatient Substance Use Detoxification (hospital based)
Rev 146	Inpatient Substance Use Detoxification (hospital based)

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Covered CPT/HCPCS codes requiring prior authCPTCovered

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 QHP, 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 QHP, 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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Time thresholds for online digital assessment and management

98966Qualified nonphysician health care professional online digital assessment and management; cumulative time during 7 days — 5–10 minutes

98967Qualified nonphysician health care professional online digital assessment and management; cumulative time during 7 days — 11–20 minutes

98968Qualified nonphysician health care professional online digital assessment and management; cumulative time during 7 days — 21+ minutes

Provider Actions and Authorization Requirements

Prior Authorization

Prior authorization required for listed services

Prior authorization is required for the listed inpatient and outpatient behavioral health services and the specific revenue and CPT codes. To request prior authorization, submit your request online using the Prior Authorization and Notification tool accessible via the Sign In function on UHCProvider.com.

Online: Use the Prior Authorization and Notification tool on UHCProvider.com
Prior authorization not required for emergency or urgent care
Members have no non-emergent out-of-network coverage and no coverage outside the service area for these plans

Note

(No additional provider action summary provided.)

Note

Submission and plan reference

When deciding coverage, the member specific benefit plan document must be referenced as terms vary by state. For these Exchange Plans members in Arizona, the list below indicates services that require prior authorization for participating behavioral health providers. Prior authorization requests should be submitted online.

Reference the member specific benefit plan for coverage details
Submit prior authorization requests via UHCProvider.com

Prior Authorization

Prior authorization required

Services listed require prior authorization for participating behavioral health providers for Exchange Plans members in Arizona. Failure to obtain prior authorization may result in denial of payment. Prior authorization is not required for emergency or urgent care.

Inpatient Mental Health — Revenue codes: 114, 124, 134, 144, 154, 204
Inpatient Substance Use Detoxification (hospital based) — Revenue codes: 116, 126, 136, 146, 156
Substance Use Rehabilitation (hospital based) — Revenue codes: 118, 128, 138, 148, 158
Psychiatric Clinic — Revenue code: 513
Treatment Room — Revenue code: 761
Evaluation/Initial-BH Treatments/Services — Revenue code: 900
MH Intensive Outpatient — Revenue code: 905
SUD Intensive Outpatient — Revenue code: 906
MH/SUD Partial Hospitalization — Revenue codes: 912, 913
OP Services- Behavioral Health Testing — Revenue code: 918
OP Services- Other Behavioral Health Treatment/Services — Revenue code: 919
Drug Rehabilitation — Revenue code: 944
Alcohol Rehabilitation — Revenue code: 945
Combined drug and alcohol rehabilitation — Revenue code: 953
Psychiatric — Revenue code: 961

Definitions

Exchange Plans — definition/notes

Exchange PlansMembers enrolled through the health insurance Exchange (Exchange Plans members)

Plan-specific termsCoverage determinations reference the member specific benefit plan document as terms vary by state

Prior authorization requirementPrior authorization is required for listed inpatient and outpatient behavioral health services for Exchange Plans members in Arizona

Emergency carePrior authorization is not required for emergency or urgent care

Level of Care Criteria

Treatment Modalities Requiring Authorization

Residential Treatment- Psychiatric — Revenue code: 1001

Residential Treatment- Chem Dep — Revenue code: 1002

TMS planning — CPT: 90867

TMS delivery and management per session — CPT: 90868

TMS subsequent motor threshold re-determination with delivery and management — CPT: 90869

Unlisted psychiatric service or procedure — CPT: 90899

Psychological testing evaluation — CPTs: 96130, 96131

Psychological/neuropsych test admin & scoring by physician/QHP, two+ tests, first 30 min — CPT: 96136 (auth required only if submitted with 96130/96131)

Psych test admin & scoring by physician/QHP, each additional 30 min — CPT: 96137 (auth required only if submitted with 96130/96131)

Psych test admin & scoring by technician, two+ tests, first 30 min — CPT: 96138 (auth required only if submitted with 96130/96131)

Psych test admin & scoring by technician, each additional 30 min — CPT: 96139 (auth required only if submitted with 96130/96131)

Computer based psychological/neuropsych testing — CPT: 96146

Behavior Identification Assessment by PHYS/QHP each 15 min — CPT: 97151

Behavior ID Support Assessment by TECH each 15 min — CPT: 97152

Adaptive Behavior Treatment by Protocol TECH each 15 min — CPT: 97153

Group Adaptive Behavior Tx by Protocol TECH each 15 min — CPT: 97154

Adaptive Behavior Tx Protocol Modification PHYS/QHP each 15 min — CPT: 97155

Family Adaptive Behavior Tx Guidance PHYS/QHP each 15 min — CPT: 97156

Multiple Family Group Behavior Tx Guidance PHYS/QHP each 15 min — CPT: 97157

Group Adaptive Behavior Protocol Modification PHYS/QHP each 15 min — CPT: 97158

Behavior ID Support Assessment each 15 min TECH time — CPT: 0362T

Adaptive Behavior Tx Protocol Modification each 15 min TECH time — CPT: 0373T

Qualified nonphysician health care professional online digital assessment and management (established patient, up to 7 days cumulative): 5-10 min — CPT: 98966; 11-20 min — CPT: 98967; 21+ min — CPT: 98968

Unlisted evaluation and management service — CPT: 99499