Virginia Prior Authorization Requirements for UnitedHealthcare Exchange Plans
List of behavioral health services that require prior authorization for UnitedHealthcare Exchange plan members in Virginia; applies to participating behavioral health providers requesting inpatient and outpatient behavioral health services.
No material clinical or coverage changes in this revision.
Coverage Criteria
This policy lists behavioral health services for which prior authorization is required for participating providers when treating UnitedHealthcare Exchange plan members in Virginia. It applies to the inpatient and outpatient service categories and the revenue and CPT/HCPCS codes identified in this document. When determining coverage, reference the member-specific benefit plan document because plan terms vary by state. Prior authorization is not required for emergency or urgent care, and these benefit plans do not provide non-emergent out-of-network coverage or coverage outside the service area.
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