Colorado: New behavioral health prior authorization and notification requirements

Effective July 1, 2025, we’re updating prior authorization requirements for certain CPT® codes for Rocky Mountain Health Plans. These changes apply to situations where Rocky Mountain Health Plans is the primary payer. Please review the following chart for the updated CPT codes and related prior authorization and notification requirements.

This change applies to 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 health plans

This information is subject to change and not a complete list of services. The full list of services will be available on July 1.

Rocky Mountain Health Plans behavioral health codes and prior authorization requirements

CPT code	Service	Prior authorization and notification requirement
H2033, T2022	Multisystemic Therapy (MST), Enhanced MST	Requires pre-service notification, authorization necessary for services provided more than 90 days
H0036, T2022	Functional Family Therapy (FFT), Enhanced FFT	Requires pre-service notification, authorization necessary for services provided more than 90 days
G0137, H0015, Rev code 906	Substance use disorder intensive outpatient programming (SUD IOP)	Requires pre-service notification, authorization necessary for services greater than 15 sessions
S9480, Rev code 905	Behavioral health intensive outpatient programming (BH IOP)	Requires pre-service notification, authorization necessary for services greater than 15 sessions
Rev. code 0911	Psychiatric Residential Treatment Facility (PRTF)	Requires prior authorization
H0019	Psychiatric Residential Treatment Facility (PRTF)	Requires prior authorization
H0017	All services associated with H0017, including Acute Treatment Unit (ATU)	Requires prior authorization
96132, 96133, 96136, 96137, 96138, 96139, 96146, 96130, 96131	Neuropsychological and psychological testing (and related codes)	Requires prior authorization
96116, 96121	Neurobehavioral status exam	Requires prior authorization