CurrentUnitedHealthcarePolicy N/A

Georgia Prior Authorization Requirements for UnitedHealthcare Exchange Plans

Lists behavioral health inpatient and outpatient services and specific procedure/revenue/CPT codes that require prior authorization for UnitedHealthcare Exchange plan members in Georgia. Applies to participating behavioral health providers serving those members.

Policy Summary

PayerUnitedHealthcare

PolicyGeorgia Prior Authorization Requirements for UnitedHealthcare Exchange Plans

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateJan 1, 2025

Next Review DateN/A

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

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

>=60procedure/revenue/CPT codes listed for authorization

Georgiastate-specific prior authorization list

Exchangeplan type covered by this list

Coverage criteria and scope

Authorization requirement for listed services

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.

Procedure, revenue, and CPT codes requiring authorization

Inpatient Mental Health Revenue CodesRevenueCovered

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

Inpatient SUD Detox Revenue CodesRevenueCovered

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)

SUD Rehabilitation Revenue CodesRevenueCovered

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)

Psychiatric Clinic Revenue CodeRevenueCovered

Rev 513

Psychiatric Clinic

Evaluation/Initial Behavioral Health Revenue CodeRevenueCovered

Rev 900

Evaluation/Initial-BH Treatments/Services

Outpatient Behavioral Health Revenue CodesRevenueCovered

Rev 905	MH Intensive Outpatient
Rev 906	SUD Intensive Outpatient
Rev 907	Community Behavioral Health
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

Rehabilitation Revenue CodesRevenueCovered

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

Residential/Other Revenue CodesRevenueCovered

Rev 961	Psychiatric
Rev 1000	Behavioral Health Accommodations
Rev 1001	Residential Treatment- Psychiatric
Rev 1002	Residential Treatment- Chem Dep
Rev 1003	Supervised Living

TMS 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; subsequent motor threshold re-determination with delivery and management

Unlisted PsychiatricCPTCovered

90899

Unlisted psychiatric service or procedure

Psychological Testing CPT CodesCPTCovered

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

Behavioral/ABA-related CPT CodesCPTCovered

97151	Behavior ID Assessment by PHYS/QHP EA 15 min
97152	Behavior ID Support Assessment by 1 Tech EA 15 min
97153	Adaptive Behavior Treatment by Protocol Tech EA 15 min
97154	Group Adaptive Behavior Treatment by Protocol Tech EA 15 min
97155	Adaptive Behavior Treatment by Protocol Modification PHYS/QHP EA 15 MIN
97156	Family Adaptive Behavior Treatment Guidance PHYS/QHP EA 15 MIN
97157	Multiple Family Group Behavior Treatment Guidance PHYS/QHP EA 15 MIN
97158	Group Adaptive Behavior Protocol Modification PHYS/QHP EA 15 MIN
0362T	Behavior ID Support Assessment EA 15 MIN TECH TIME
0373T	Adaptive Behavior Treatment Protocol Modification EA 15 MIN TECH TIME

Unlisted E/MCPTCovered

99499

Unlisted evaluation and management service

Provider responsibilities and prior authorization process

Prior Authorization

Prior Authorization Required

Prior Authorization Required. Prior authorization is required for the inpatient and outpatient behavioral health services and procedure/revenue/cpt codes listed in this policy for Exchange Plans members in Georgia. Failure to obtain prior authorization may result in denial of payment. Prior authorization is not required for emergency or urgent care.

Inpatient mental health and substance use services (see listed Rev codes)
Outpatient behavioral health services, testing, evaluations, and TMS (see listed CPT/HCPCS/revenue codes)
Psychological and neuropsychological testing and administration/scoring codes (96130–96139, 96146)
TMS codes 90867–90869 and unlisted psychiatric code 90899
Behavioral treatment and adaptive behavior codes (97151–97158, 0362T, 0373T)

Note

PROVIDER ACTIONS

Provider Actions — submit prior authorization requests online using the Prior Authorization and Notification tool accessible via the Sign In function on UHCProvider.com. When requesting authorization, reference the member’s specific benefit plan document as plan terms vary by state and some plans have no non‑emergent out‑of‑network or out‑of‑service‑area coverage.

Note

Submission Method

Submission Method. To request prior authorization for the listed services, submit requests online using the Prior Authorization and Notification tool on UHCProvider.com (Sign In required).

Online: Prior Authorization and Notification tool via UHCProvider.com

Denial Risk

Denial Risk & Consequences

Denial Risk. Failure to obtain required prior authorization for non‑emergent inpatient or outpatient behavioral health services may result in claim denial and lack of coverage for services provided. Prior authorization is not required for emergency or urgent care; document emergencies accordingly.

Levels of care covered by the authorization list

Inpatient, Residential, Partial Hospitalization, Intensive Outpatient, Outpatient — level of care grouping

Prior authorization is required for the following levels of care when the listed procedure/revenue/CPT codes are billed for Exchange Plan members in Georgia.

Levels of care: Inpatient, Residential, Partial Hospitalization, Intensive Outpatient, Outpatient services require prior authorization when billed with the listed procedure/revenue/CPT codes

See coding tables for specific revenue and CPT codes (Rev 114–204, Rev 900–1003, Rev 905–919, Rev 944–953, Rev 961, Rev 1000–1003, CPT 90867–90869, 90899, 96130–96139, 96146, 97151–97158, 0362T, 0373T, 99499)

Specific treatment modalities requiring authorization

TMS — treatment modality criteria

Therapeutic Repetitive Transcranial Magnetic Stimulation (TMS) CPT codes require prior authorization for Exchange Plan members in Georgia.

TMS auth: Therapeutic Repetitive Transcranial Magnetic Stimulation CPT codes 90867, 90868, 90869 require prior authorization for Exchange Plan members in Georgia

Prior authorization requests must be submitted online via the Prior Authorization and Notification tool

Key definitions

Prior authorization definition — the online Prior Authorization and Notification tool process

DefinitionPrior authorization: the process by which providers must request approval before delivering certain non-emergent services for Exchange Plan members via the online Prior Authorization and Notification tool.

How to submitSubmit prior authorization requests online using the Prior Authorization and Notification tool accessed via Sign In on UHCProvider.com.

Applies toParticipating behavioral health providers for UnitedHealthcare Exchange Plan members in Georgia

ExclusionDoes not apply to emergency or urgent care services (no prior auth required)

Policy background and scope

This document is an administrative list of prior authorization requirements for behavioral health services under UnitedHealthcare Exchange plans in Georgia. It identifies inpatient and outpatient services and specific procedure/revenue and CPT codes that require prior authorization. To request authorization, providers must submit prior authorization requests online using the Prior Authorization and Notification tool accessed via Sign In on UHCProvider.com. When determining coverage, providers must reference the member-specific benefit plan because plan terms vary by state.