Prior auth removed for behavioral health initial evaluation visits
(July 1, 2010)
Effective July 1, 2010, prior authorization will not be required for behavioral health office visits for initial evaluations or emergent evaluations.
- This change applies to all commercial and self-funded plans.
- This change does not impact Medicare, as prior authorization has not been previously required.
- Prior authorization is required for members with Priority Health Medicaid for outpatient services.
With this change outpatient mental health, substance abuse psychotherapy sessions, and psychological testing procedure codes will not require prior authorization with Priority Health participating providers.
Providers or members do not need to call for prior authorization when seeing a Priority Health participating provider for:
- Initial evaluations for mental health and substance abuse counseling
- Initial evaluations for medication management Health and behavior intervention procedures
- Psychological testing Neuropsychological testing Ongoing treatment:
- Mental health and substance abuse outpatient counseling
- Psychiatric medication management
- Mental health and substance abuse group counseling
- Substance abuse intensive outpatient services
Prior authorization should continue to be obtained for certain services by:
- Facilities prior to admitting a member for inpatient or partial-hospitalization psychiatric and substance abuse care.
- Mental health agencies and outpatient facilities prior to providing intensive outpatient mental health care.
Details are available in the
Behavioral Health section of our online provider manual.
Medical policies for specific treatment authorization requirements are also available in our provider manual.
If you have questions, please contact our Behavioral Health department at 800 673-8043.
