Colorado Medicaid Introduces New Prior Authorization Rules for Behavioral Health Services
From July 1, 2025, Rocky Mountain Health Plans plans to update the prior authorization procedures for a few of the CPT® codes when it is the primary payer. The chart inside this update lists the new CPT codes and their connections to prior authorization and notification requirements.
These updates affect the following Rocky Mountain Health Plans:
- Medicaid RAE/PRIME
- Child Health Plan Plus (CHP+)
- Medicare Advantage
- Dual Eligible Special Needs (D-SNP)
- Individual and Family Plans
Please keep in mind that the details may change and the list given here is not complete. People can see the list on July 1, 2025.
Rocky Mountain Health Plans Behavioral Health Codes and Authorization Requirements
| CPT Code | Service | Prior Authorization and Notification Requirements |
| H2033, T2022 | Multisystemic Therapy (MST), Enhanced MST | Pre-service notification required; authorization needed for services exceeding 90 days |
| H0036, T2022 | Functional Family Therapy (FFT), Enhanced FFT | Pre-service notification required; authorization needed for services exceeding 90 days |
| G0137, H0015, Rev code 906 | Substance Use Disorder Intensive Outpatient Programming (SUD IOP) | Pre-service notification required; authorization needed for services exceeding 15 sessions |
| S9480, Rev code 905 | Behavioral Health Intensive Outpatient Programming (BH IOP) | Pre-service notification required; authorization needed for services exceeding 15 sessions |
| Rev. code 0911 | Psychiatric Residential Treatment Facility (PRTF) | Prior authorization required |
| H0019 | Psychiatric Residential Treatment Facility (PRTF) | Prior authorization required |
| H0017 | All services associated with H0017, including the Acute Treatment Unit (ATU) | Prior authorization required |
| 96132, 96133, 96136, 96137, 96138, 96139, 96146, 96130, 96131 | Neuropsychological and Psychological Testing (and related codes) | Prior authorization required |
| 96116, 96121 | Neurobehavioral Status Exam | Prior authorization required |
For any questions, please contact UHC at rmhp_updates@uhc.com.
