CurrentUnitedHealthcarePolicy N/A

Alabama Prior Authorization Requirements for UnitedHealthcare Exchange Plans

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

Policy Summary

PayerUnitedHealthcare

PolicyAlabama Prior Authorization Requirements for UnitedHealthcare Exchange Plans

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJan 1, 2024

Next Review DateN/A

Key ActionSubmit prior authorization requests online using the Prior Authorization and Notification tool on UHCProvider.com and reference the member-specific benefit plan.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

~70+procedure and revenue codes listed requiring prior authorization

Alabamastate-specific applicability

2024-01-01effective date

Coverage Criteria

Prior authorization is not required for emergency or urgent care for UnitedHealthcare Exchange plan members in Alabama.

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Procedure and Revenue Codes Requiring Prior Authorization

Inpatient Mental Health - Revenue CodesmixedCovered

Rev 114	Inpatient Mental Health (revenue)
Rev 124	Inpatient Mental Health (revenue)
Rev 134	Inpatient Mental Health (revenue)
Rev 144	Inpatient Mental Health (revenue)
Rev 154	Inpatient Mental Health (revenue)
Rev 204	Inpatient Mental Health (revenue)

Inpatient Mental Health - Revenue Codes (alternate grouping) - raw sourcemixed

No codes listed

Inpatient Substance Use Detoxification - Revenue CodesmixedCovered

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)
Rev 156	Inpatient Substance Use Detoxification (hospital based)

Inpatient Substance Use Detoxification - Revenue Codes (alternate grouping) - raw sourcemixed

No codes listed

Substance Use Rehabilitation - Revenue CodesmixedCovered

Rev 118	Substance Use Rehabilitation (hospital based)
Rev 128	Substance Use Rehabilitation (hospital based)
Rev 138	Substance Use Rehabilitation (hospital based)
Rev 148	Substance Use Rehabilitation (hospital based)
Rev 158	Substance Use Rehabilitation (hospital based)

Substance Use Rehabilitation - Revenue Codes (alternate grouping) - raw sourcemixed

No codes listed

Psychiatric Clinic - Revenue CodemixedCovered

Rev 513

Psychiatric Clinic

Psychiatric Clinic - Revenue Code (alternate grouping) - raw sourcemixed

No codes listed

Treatment Room - Revenue CodemixedCovered

Rev 761

Treatment Room

Treatment Room - Revenue Code (alternate grouping) - raw sourcemixed

No codes listed

Outpatient Behavioral Health - Revenue CodesmixedCovered

Rev 900	Evaluation/Initial-BH Treatments/Services
Rev 905	MH Intensive Outpatient
Rev 906	SUD Intensive Outpatient
Rev 912	MH/SUD Partial Hospitalization
Rev 913	MH/SUD Partial Hospitalization
Rev 918	OP Services- Behavioral Health Testing
Rev 919	OP Services- Other Behavioral Health Treatment/Services

Outpatient Behavioral Health - Revenue Codes (alternate grouping) - raw sourcemixed

No codes listed

Rehabilitation - Revenue CodesmixedCovered

Rev 944	Drug Rehabilitation
Rev 945	Alcohol Rehabilitation
Rev 953	Combined drug and alcohol rehabilitation

Rehabilitation - Revenue Codes (alternate grouping) - raw sourcemixed

No codes listed

Psychiatric - Revenue CodemixedCovered

Rev 961

Psychiatric

Psychiatric - Revenue Code (alternate grouping) - raw sourcemixed

No codes listed

Residential Treatment - Revenue CodesmixedCovered

Rev 1001	Residential Treatment- Psychiatric
Rev 1002	Residential Treatment- Chem Dep

Residential Treatment - Revenue Codes (alternate grouping) - raw sourcemixed

No codes listed

Psychiatric Procedure CPT CodesCPTCovered

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

Psychiatric Procedure CPT Codes (alternate grouping) - raw sourceCPT

No codes listed

Psychological Testing CPT CodesCPTCovered

96130	Psychological testing evaluation
96131	Psychological testing evaluation
96136	Psychological or neuropsychological test admin & scoring by physician or QHP, two or more tests, first 30 minutes (Auth required only if submitted with 96130 & 96131)
96137	Psychological or neuropsychological test admin & scoring by physician or QHP, two or more tests, each additional 30 minutes (Auth required only if submitted with testing eval codes)
96138	Psychological or neuropsychological test admin & scoring by technician, two or more tests, first 30 minutes
96139	Psychological or neuropsychological test admin & scoring by technician, each additional 30 minutes
96146	Computer Based Psychological/Neuropsychological Testing

Psychological Testing CPT Codes (alternate grouping) - raw sourceCPT

No codes listed

Behavioral Therapy and Assessment CodesCPTCovered

97151	Behavior ID Assessment by PHYS/QHP EA 15 min
97152	BEHAVIOR ID SUPPORT ASSMT BY 1 TECH EA 15 MIN
97153	ADAPTIVE BEHAVIOR TX BY PROTOCOL TECH EA 15 MIN
97154	GROUP ADAPTIVE BHV TX BY PROTOCOL TECH EA 15 MIN
97155	ADAPT BHV TX PRTCL MODIFICAJ PHYS/QHP EA 15 MIN
97156	FAMILY ADAPT BHV TX GDN PHYS/QHP EA 15 MIN
97157	MULTIPLE FAM GROUP BHV TX GDN PHYS/QHP EA 15 MIN
97158	GRP ADAPT BHV PRTCL MODIFCAJ PHYS/QHP EA 15 MIN
0362T	BEHAVIOR ID SUPPORT ASSMT EA 15 MIN TECH TIME
0373T	ADAPT BHV TX PRTCL MODIFICAJ EA 15 MIN TECH TIME

Behavioral Therapy and Assessment Codes (alternate grouping) - raw sourceCPT

No codes listed

Digital Assessment and Unlisted E/M CodesCPTCovered

98966	Qualified nonphysician health care professional online digital assessment and management, established patient, 5-10 minutes
98967	Qualified nonphysician health care professional online digital assessment and management, established patient, 11-20 minutes
98968	Qualified nonphysician health care professional online digital assessment and management, established patient, 21+ minutes
99499	Unlisted evaluation and management service

Digital Assessment and Unlisted E/M Codes (alternate grouping) - raw sourceCPT

No codes listed

Provider Actions and Requirements

Prior Authorization

Prior Authorization Required

Prior authorization is required for the inpatient and outpatient behavioral health services and procedure codes listed below. Prior authorization is not required for emergency or urgent care. Failure to obtain required prior authorization may result in claim denials.

Inpatient and outpatient behavioral health services (see procedure/Rev and CPT codes listed)
Prior authorization not required for emergency or urgent care
Members may have no non-emergent out-of-network coverage or coverage outside the service area — verify member plan

Note

Provider Responsibilities

When submitting a request, providers must reference the member-specific benefit plan — coverage varies by state and by plan. Providers are responsible for confirming benefits and any network or service-area restrictions prior to authorization.

Reference the member-specific benefit plan document when requesting authorization
Confirm network and service-area coverage before submitting

Note

How to Submit and Reference Benefits

Submit prior authorization requests online using the Prior Authorization and Notification tool accessed via Sign In on UHCProvider.com. Include the applicable procedure/CPT or revenue codes and supporting clinical documentation.

Online: Prior Authorization and Notification tool via Sign In on UHCProvider.com
Include all relevant procedure codes (see code list) and clinical documentation when submitting

Denial Risk

Denial Risk for Missing Prior Authorization

Failure to obtain prior authorization for the listed services may result in denial of payment. Verify authorization is approved before providing non-emergent services.

Denials may occur if prior authorization is missing
Confirm authorization approval prior to delivering non-emergent care

Level of Care Criteria

Inpatient/Outpatient (various listed services)

Prior authorization is required for the following inpatient and outpatient levels of care and associated revenue/procedure codes for UnitedHealthcare Exchange plan members in Alabama.

Services listed below require prior authorization when billed for UnitedHealthcare Exchange plan members in Alabama.

Level of care or setting

Inpatient Mental Health — Rev 114, Rev 124, Rev 134, Rev 144, Rev 154, Rev 204.
Inpatient Substance Use Detoxification (hospital based) — Rev 116, Rev 126, Rev 136, Rev 146, Rev 156.
Substance Use Rehabilitation (hospital based) — Rev 118, Rev 128, Rev 138, Rev 148, Rev 158.
Psychiatric Clinic — Rev 513.
Treatment Room — Rev 761.
Outpatient behavioral health services including Evaluation/Initial BH Treatments/Services — Rev 900; MH Intensive Outpatient — Rev 905; SUD Intensive Outpatient — Rev 906; MH/SUD Partial Hospitalization — Rev 912, Rev 913; OP Services - Behavioral Health Testing — Rev 918; OP Services - Other Behavioral Health Treatment/Services — Rev 919.
Rehabilitation services — Drug Rehabilitation Rev 944; Alcohol Rehabilitation Rev 945; Combined drug and alcohol rehabilitation Rev 953.
Psychiatric — Rev 961.
Residential Treatment — Rev 1001 (Psychiatric), Rev 1002 (Chem Dep).

OpenPayer

Alabama Prior Authorization Requirements for UnitedHealthcare Exchange Plans

Coverage Criteria

Procedure and Revenue Codes Requiring Prior Authorization

Provider Actions and Requirements

Level of Care Criteria

Specific Treatment Modalities

Background

Revision History