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Provider Notices

Behavioral Health services – Removal of Prior Authorization requirements and related submission changes

5/14/2021 6:29:05 AM

Effective as indicated, we have removed the requirement for prior authorizations for the following codes related to behavioral health services:

Outpatient CPT codes and effective dates:

  • H0004 – effective 3/23/19

  • H0005 – effective 5/20/19

  • H0006 – effective 5/20/19

There is no requirement for notification/submission for in-network providers for these codes/level of care.

Intensive Outpatient CPT codes:

  • S9480 – effective 1/1/21

  • H0015 – effective 11/17/16

There is no requirement for notification/submission for in-network providers for these codes/level of care.

Partial Hospitalization and day treatment related CPT codes:

  • H0035 – effective 1/1/21

  • H0036 – effective 5/20/19

  • H0037 – effective 4/6/21

  • H0038 – effective 5/20/21

While there is no prior authorization requirement, requests for partial hospitalization and/or day treatment services requires a notification of program admission within two (2) business days through our Inpatient (IP) module. The codes related to this level of care require clinical review for approval and are subject to concurrent review.

Residential CPT codes:

  • H0017 – effective 4/27/21

  • H0018 – effective 4/27/21

  • H0019 – effective 4/27/21

While there is no prior authorization requirement, requests for residential services requires a notification of program admission within two (2) business days through our Inpatient (IP) module. The codes related to this level of care require clinical review for approval and are subject to concurrent review.

Lengths of anticipated coverage and criteria used for reviews have not changed.

Please call PacificSource with any questions regarding these changes.


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