Provider Notices


Preauthorization (PA) requirements change: Medicaid Behavioral Health codes - Effective 3/15/19

2/15/2019 8:49:25 AM

Effective 3/15/19, PacificSource will not be requiring a PA with the associated codes:

 

90785

Interactive complexity 

       
 

90792

Psychiatric diagnostic interview (for prescribers / medical services)

 

90832

Individual psychotherapy, 30 minutes

     
 

90833

(when performed with an evaluation & management service)

 

90834

Individual psychotherapy, 45 minutes

     
 

90836

(when performed with an evaluation & management service)

 

90837

Individual psychotherapy, 60 minutes

     
 

90838

(when performed with an evaluation & management service)

 

90839

Patient in crisis add-on – 60 minutes

     
 

90840

Patient in crisis add-on – Each additional 30 minutes

 
 

90846

without patient present:

       
 

90847

Family psychotherapy with patient present

   
 

90849

multiple-family group psychotherapy

     
 

90853

Group psychotherapy

       
 

96112

Developmental test administration; first hour

   
 

96113

Developmental test administration; each additional 30 minutes

 

96130

IQ eval, first hour

         
 

96131

IQ eval each additional hour

       
 

96132

Neuropsych testing, first hour

     
 

96133

Neuro psych each additional hour

     
 

96136

Test admin and scoring by psychologist or neuropsychologist, first 30 minutes

 

96137

each additional 30 minute increments of test admin and scoring

 

Effective 3/15/19, PacificSource will require a PA with the associated codes:

 

97151

Behavior identification assessment per 15 minutes

PA required if exceeds 16 units

97152

Behavior identification supporting assessment per 15 minutes

 

97153

Adaptive behavior treatment by protocol per 15 minutes

   

97154

Group adaptive behavior treatment by tech per 15 minutes

   

97155

Adaptive behavior treatment with protocol modification per 15 minutes- by physician or other QHP

97156

Family adaptive behavior treatment guidance per 15 minutes by physician or QHP

97157

Multiple family adaptive behavior treatment guidance per 15 minutes by physician or QHP

97158

Group adaptive behavior treatment by physician per 15 minutes

 

0362T

Behavior identification supporting assessment per 15 minutes

 

0373T

Adaptive behavior treatment with protocol modification per 15 minutes

 

Please call PacificSource with any questions concerning these changes. 

 

 


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