Behavioral health therapy session limitations

Category: Medicaid

 

Effective August 1, 2019, Anthem Blue Cross and Blue Shield Healthcare Solutions will follow the limitations for behavioral therapy sessions from the Medicaid Services Manual. Prior authorization is required once the session’s limitations have been met. Therapy limits apply to the following to codes: 90832, 90833, 90834, 90836, 90837, 90838, 90839, 90845, 90846, 90847, 90849, 90853 and H0004. This is update is in alignment with Web Announcement 1663 issued by the Nevada Department of Health and Human Services on August 13, 2018.

 

Therapy codes have the following limitations:

 

Billing provider type	Number of therapy sessions allowed per recipient per calendar year from all providers without prior authorization
PT 14 (Behavioral Health Outpatient Treatment)	26 (recipient under 18)
PT 14 (Behavioral Health Outpatient Treatment)	18 (recipient 18 and older)
PT 26 (Psychologist)	26
PT 20 (Physician, M.D., Osteopath, D.O.)	No limits
PT 82 (Behavioral Health Rehabilitative Treatment)	Not covered

 

Please refer to Web Announcement 1663 at https://www.medicaid.nv.gov/providers/newsannounce/default.aspx for more information.

 

If you have any questions, contact Provider Services by phone at 1-844-396-2330 or by email at nv1-providerservices@anthem.

 

ANV-NU-0080-19 September 2019