Partial hospitalization and intensive outpatient services for mental health disorders

Coverage varies by member plan.

Applies to:

Group HMO, EPO, POS and PPO plans

Individual MyPriority® HMO, POS and PPO plans

Medicare Advantage plans don't cover day programs but may cover components of a day program

Medical policy

The term "medical necessity" is used to mean care that is determined to be effective, appropriate and necessary to treat a given patient's disorder. To determine medical necessity for partial hospitalization, the Priority Health Behavioral Health department relies on InterQual® Behavioral Health criteria and Priority Health medical policies:


Prior authorization isn't required for substance use intensive outpatient programming.

Members must meet InterQual® Behavioral Health medical necessity criteria for partial hospitalization.

We also require ongoing clinical reviews to ensure that the member continues to meet medical necessity criteria for treatment.

In network providers

Submit authorizations through GuidingCare.

Request an authorization

Out of network providers

Out of network providers request mental health and substance use disorder services using our Behavioral Health authorization form.