Behavioral health services
This information applies to:
- Commercial group HMO, EPO, POS and PPO plans
- Commercial individual MyPriority plans
- Priority Health Medicare Advantage plans
Behavioral health definition
Behavioral health refers to a continuum of services for individuals at risk of, or suffering from, mental, behavioral, or addictive disorders. Services can be offered by a physician, psychologist or other qualified health professional, either in person or via telemedicine.
Coverage varies by provider and type of service.
Medical policies
- Autism Spectrum Disorders - 91615
- Detoxification - 91104
- Eating Disorders - 91007
- Electro-convulsive Therapy (ECT) - 91554
- Mental Health Residential Treatment, Adult - 91608
- Mental Health Residential Treatment, Child and Adolescent - 91607
- Neuropsychological and Psychological Testing -91537
- Psychological Evaluation and Management of Non-Mental-Health Disorders - 91546
Specific authorization & billing information
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ADHD care
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Autism services
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Submitting medical records
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Coordination of care
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Depression
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Discharge process
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Electroconvulsive therapy
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Health and behavioral assessments/interventions
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Medicaid behavioral health
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Mental health services
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Neuropsychological vs psychological exams & testing
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Substance use disorder services
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Virtual care
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Transcranial magnetic stimulation
Notify Priority Health immediately
If you identify a member with any one of these indicators, contact Priority Health Behavioral Health immediately.
- Overuse or underuse of medical services
- Non-compliance with treatment plans and/or recommendations
- Complex medical conditions with psychological/behavioral factors
- Complex behavioral health conditions with medical factors
- Inappropriate prescription drug access and use patterns
- Continuity and coordination of care requiring integrated case management
- Significant risk management concerns on cases with both behavioral health and medical factors