CurrentUnitedHealthcarePolicy N/A

Prior authorization requirements for UnitedHealthcare Exchange behavioral health services

This document lists behavioral health services and procedure codes that require prior authorization for UnitedHealthcare Exchange Plan members in Washington and describes how providers should submit authorization requests.

Policy Summary

PayerUnitedHealthcare

PolicyPrior authorization requirements for UnitedHealthcare Exchange behavioral health services

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJan 1, 2023

Next Review Date

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.

~70procedure and billing codes listed

Washingtonexplicitly governed state

Onlineprior authorization submission method

Emergency/Urgentno prior authorization required

Coverage Summary

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

Inpatient Mental Health revenue codesmixedCovered

Rev 113	Inpatient Mental Health
Rev 114	Inpatient Mental Health
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 Substance Use Detox 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)

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)

Outpatient and clinic revenue codesmixedCovered

Rev 513	Psychiatric Clinic
Rev 761	Treatment Room
Rev 900	Evaluation/Initial-BH Treatments/Services
Rev 901	ECT- Electroshock Treatment
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

Rehabilitation, anesthesia, residential codesmixedCovered

Rev 944	Drug Rehabilitation
Rev 945	Alcohol Rehabilitation
Rev 953	Combined drug and alcohol rehabilitation
Rev 961	Psychiatric
00104	Anesthesia for ECT
Rev 1001	Residential Treatment- Psychiatric
Rev 1002	Residential Treatment- Chem Dep

TMS, ECT, unlisted psychiatric 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
90870	ECT
90899	Unlisted psychiatric service or procedure

Psychological testing CPT codesCPTCovered

96130	Psychological testing evaluation
96131	Psychological testing evaluation
96136	Psychological or neuropsychological test admin and scoring by physician or other qualified health care professional, two or more tests, any method, first 30 minutes (Auth required only if submitted with 96130 & 96131)
96137	Psychological/neuropsych test admin & scoring, each additional 30 minutes (Auth required with 96130 & 96131)
96138	Test admin and scoring by technician, first 30 minutes (Auth required with 96130 & 96131)
96139	Test admin and scoring by technician, each additional 30 minutes (Auth required with 96130 & 96131)
96146	Computer Based Psychological/Neuropsychological Testing

Behavioral therapy and adaptive behavior 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

Revenue codes — mapping to facility billing categories

DefinitionRevenue codes correspond to facility billing categories used to bill hospital and facility services (examples in this policy: Rev 113, Rev 513, Rev 944, Rev 1001).

Examples by categoryInpatient Mental Health: Rev 113, Rev 114, Rev 124, Rev 134, Rev 144, Rev 154, Rev 204; Psychiatric Clinic: Rev 513; Drug Rehabilitation: Rev 944; Residential Treatment – Psychiatric: Rev 1001.

Use for prior authorizationListed revenue codes must be included on prior authorization requests for the corresponding inpatient and outpatient behavioral health services for Exchange Plan members.

Anesthesia & procedure linkageSome facility or procedure-specific services are billed with non‑standard numeric codes (e.g., anesthesia for ECT = 00104) that are treated alongside revenue codes in authorization requirements.

Scope of mappingRevenue codes in this policy cover inpatient, detoxification, rehabilitation, outpatient clinic, partial hospitalization/intensive outpatient, residential, and specialized services (e.g., Rev 761 treatment room; Rev 918 behavioral health testing).

Prior Authorization & Submission Requirements

Prior Authorization

Prior Authorization Required

Prior authorization is required for the services and revenue/CPT codes listed below for UnitedHealthcare Exchange Plans (Washington) — submit requests online via the Prior Authorization and Notification tool on UHCProvider.com (Sign In required). Prior authorization is not required for emergency or urgent care. When deciding coverage, reference the member-specific benefit plan document. Members on these plans have no non-emergent out-of-network coverage and no coverage outside the service area.

Online submission: Prior Authorization and Notification tool via Sign In on UHCProvider.com
Reference the member-specific benefit plan for coverage details
Emergency or urgent care does not require prior authorization

Documentation Required

Submission and documentation

Providers must submit documentation with authorization requests sufficient to support medical necessity for the requested service (clinical notes, test results, treatment plans, admission summaries, and relevant diagnostic information). Use the online tool for clinical transactions and attach supporting documents. Incomplete documentation may delay review or result in denial.

Attach clinical notes, test results, treatment plans, admission summaries, and diagnostic information
Submit documentation via the Prior Authorization and Notification tool on UHCProvider.com

Denial Risk

Risk of denial if not authorized

Failure to obtain prior authorization for the services listed may result in denial of coverage and financial responsibility for the member and/or provider. Confirm authorization before scheduling non-emergent services.

No coverage outside service area and no non-emergent out-of-network coverage for these plans
Denial risk if prior authorization not obtained

Billing Rule

Services and Codes Requiring Prior Authorization

The following procedure/revenue/CPT codes require prior authorization for inpatient and outpatient behavioral health services (list consolidates all code entries from source): Inpatient Mental Health (Rev 113, 114, 124, 134, 144, 154); Inpatient SUD Detoxification (Rev 116, 126, 136, 146, 156); Substance Use Rehabilitation (Rev 118, 128, 138, 148, 158); Psychiatric Clinic (Rev 513); Treatment Room (Rev 761); Evaluation/Initial BH Treatments/Services (Rev 900); ECT - Electroshock Treatment (Rev 901, CPT 90870 for outpatient ECT); MH Intensive Outpatient (Rev 905); SUD Intensive Outpatient (Rev 906); MH/SUD Partial Hospitalization (Rev 912, 913); Outpatient Behavioral Health Testing (Rev 918); Other Outpatient Behavioral Health Treatment/Services (Rev 919); Drug Rehabilitation (Rev 944); Alcohol Rehabilitation (Rev 945); Combined Drug and Alcohol Rehabilitation (Rev 953); Psychiatric (Rev 961); Anesthesia for ECT (00104); Residential Treatment - Psychiatric (Rev 1001); Residential Treatment - Chemical Dependency (Rev 1002); TMS treatments (90867, 90868, 90869); Unlisted psychiatric service (90899); Psychological testing evaluation (96130, 96131); Test administration/scoring and related codes (96136, 96137, 96138, 96139) — auth required only if submitted with 96130/96131; Computer-based testing (96146); Behavior identification and adaptive behavior treatment codes (97151–97158, plus 0362T, 0373T).

Inpatient Mental Health: Rev 113,114,124,134,144,154
Inpatient SUD Detoxification: Rev 116,126,136,146,156
Substance Use Rehabilitation (hospital): Rev 118,128,138,148,158
Psychiatric Clinic: Rev 513

Care Setting Criteria (Inpatient, Residential, PHP, IOP, Outpatient)

Inpatient, Residential, PHP, IOP, Outpatient — level-of-care criteria

Covered when services correspond to the listed facility or clinic revenue codes and are submitted for prior authorization as required.

Services requiring prior authorization for UnitedHealthcare Exchange members correspond to the inpatient, residential, partial hospitalization, intensive outpatient and outpatient revenue codes listed below.

ALL of the following

Inpatient and residential revenue codes
- Rev 113, Rev 114, Rev 124, Rev 134, Rev 144, Rev 154, Rev 204 (Inpatient Mental Health)
- Rev 116, Rev 126, Rev 136, Rev 146, Rev 156 (Inpatient Substance Use Detoxification - hospital based)
- Rev 118, Rev 128, Rev 138, Rev 148, Rev 158 (Substance Use Rehabilitation - hospital based)
- Rev 1001 (Residential Treatment - Psychiatric)
- Rev 1002 (Residential Treatment - Chemical Dependency)
Partial hospital/IOP/clinic revenue codes
- Rev 905 (MH Intensive Outpatient)
- Rev 906 (SUD Intensive Outpatient)
- Rev 912, Rev 913 (MH/SUD Partial Hospitalization)
- Rev 513 (Psychiatric Clinic)
- Rev 761 (Treatment Room)
- Rev 900 (Evaluation/Initial - Behavioral Health Treatments/Services)
Outpatient behavioral health services and other facility codes
- Rev 918 (OP Services - Behavioral Health Testing)
- Rev 919 (OP Services - Other Behavioral Health Treatment/Services)
- Rev 944, Rev 945, Rev 953 (Drug/Alcohol/Combined Rehabilitation)
- Rev 961 (Psychiatric)
- 00104 (Anesthesia for ECT)
- Rev 901 (ECT - Electroshock Treatment)

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OpenPayer

Prior authorization requirements for UnitedHealthcare Exchange behavioral health services

Coverage Summary

Procedure, Revenue and CPT Codes

Prior Authorization & Submission Requirements

Care Setting Criteria (Inpatient, Residential, PHP, IOP, Outpatient)

Specific Treatment Modalities (ECT, TMS, Testing, Therapy)