Coverage varies by member plan
Applies to:
Group HMO, EPO, POS and PPO plans
Individual MyPriority® HMO, POS and PPO plans
Medicare Advantage plans
Residential/rehabilitation substance use disorder treatment authorization
Page last updated on: 6/13/25
Residential/rehabilitation medical policies
Residential/rehabilitation medical policies
The term "medical necessity" is care that is determined to be effective, appropriate and necessary to treat a given patient's disorder. To determine medical necessity for mental health residential treatment, the Priority Health Behavioral Health department relies on InterQual® Behavioral Health criteria and Priority Health medical policies:
- Medical Necessity - 91447
- Behavioral Health Residential Treatment - 91625
- Detoxification - 91104
Residential/rehabilitation authorization
Residential/rehabilitation authorization
In network providers
Submit authorizations through GuidingCare.
Out of network providers
Out of network providers request mental health and substance use disorder services using our Behavioral Health authorization form. If you're located within the state of Michigan and would like to join our provider network, visit our credentialing page.