MedicaidPrior AuthHigh impact
Behavioral Health Recertification Refresher
Missouri Medicaid (MO HealthNet)·MO · Psychiatry·Provider Notice
Effective date
Jul 28, 2022
We identified it
Jun 20, 2026
Summary
Behavioral health providers can deliver up to 14 hours of psychotherapy services per rolling year without precertification, but must obtain precertification to continue services beyond 14 hours. All behavioral health services for children under age 3 require precertification except psychiatric diagnostic evaluations.
Action Required
Immediately: Billing team must update system to track psychotherapy hours per participant per rolling year and require precertification after 14 hours for CPT codes 90832, 90834, 90837, 90846, 90847, and 90853. Set automatic precertification requirements for all behavioral health services for participants under age 3 except CPT 90791 and 90792. Update encounter forms to alert providers when approaching the 14-hour threshold.