If you are a provider that accepts the following Rocky Mountain Health Plan types, then this blog post is for you:
- D-SNP: dual eligible special needs plan
- Child Health Plus
- Medicare Advantage
- Individual and Family plans
- Medicaid: RAE/PRIME
The following update will take affect for any DOS 7/1/25 and thereafter:
1.HCPCs – H2033, T2022- Multisystemic Therapy (MST), Enhanced MST: Requires pre-service notification, authorization necessary for services provided more than 90 days
2.H0036, T2022-Functional Family Therapy (FFT), Enhanced FFT: Requires pre-service notification, authorization necessary for services provided more than 90 days
3. G0137, H0015, Rev code 906- Substance use disorder intensive outpatient programming (SUD IOP): Requires pre-service notification, authorization necessary for services greater than 15 sessions
4. HCPCs code S9480, Rev code 905-Behavioral health intensive outpatient programming (BH IOP): Requires pre-service notification, authorization necessary for services greater than 15 sessions
5. Rev. code 0911-Psychiatric Residential Treatment Facility (PRTF): Requires prior authorization
6.H0019-Psychiatric Residential Treatment Facility (PRTF): Requires prior authorization
8. CPT codes: 6132, 96133, 96136, 96137, 96138, 96139, 96146, 96130, 96131-Neuropsychological and psychological testing (and related codes): Requires prior authorization
7. H0017- All services associated with H0017, including Acute Treatment Unit (ATU): Requires prior authorization
9. CPT codes- 96116, 96121- Neurobehavioral status exam: Requires prior authorization
To access the full list of codes, please click here: https://www.uhcprovider.com/en/prior-auth-advance-notification/adv-notification-plan-reqs.html and find the BH section
If you find this type of content useful? Subscribe to my blog where I bring you the latest payer updates including medical billing and coding.
- NYS Medicaid POC Syphilis testing coverage
- NYS Medicaid OBGYN CPT II codes reporting requirement
- NYS Medicaid: Bariatric Surgery Medical Policy Update
- NJ Medicaid: Sickle cell Disease Generally Therapy- billing and coding
- Hedis Measure: Controlling Blood Pressure Controlling Blood Pressure
KR2 Medical Billing 