Behavioral Health: Upcoming Prior Authorization Changes
Mon, Nov 24, 2025
Effective March 1, 2026, 19 behavioral health codes will be added to the prior authorization list, including those related to partial hospitalization services, intensive outpatient services, transcranial magnetic stimulation, and applied behavioral analysis.
Highmark takes great care in regularly auditing the list of codes requiring authorization and we make changes — both additions and removals — to ensure that appropriate member services are provided while reducing the potential for fraud, waste, and abuse. These additions are a direct result of our commitment to better managing member health care costs and maintaining alignment with established industry benchmarks.
Highmark has also recently decreased turnaround time for urgent and non-urgent authorization requests from approximately five days to one day on average, reflecting our commitment to providing timely access to care.
See the list below for all the March 1 changes.
Prior Authorization List – Codes to be Added on March 1, 2026
Code |
Description |
H0015 |
Alcohol and/or drug services; intensive outpatient treatment |
H0032 |
Mental health service plan development by non-physician |
H0035 |
Mental health partial hospitalization, treatment, less than 24 hours |
H2019 |
Therapeutic behavioral services, per 15 minutes |
S0201 |
Partial hospitalization services, less than 24 hours, per diem. |
S9480 |
Intensive outpatient psychiatric services, per diem |
90867 |
Transcranial magnetic stimulation (TMS) for treatment of major depressive disorder in adults |
90868 |
Therapeutic repetitive transcranial magnetic stimulation (rTMS) |
90869 |
Transcranial magnetic stimulation (TMS) motor threshold re-determination with delivery and management |
97151 |
Behavior identification assessment used for initial or reassessment and treatment plan development by a physician or other qualified healthcare professional |
97152 |
Behavior identification supporting assessment |
97153 |
Adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified healthcare professional, face-to-face with one patient, each 15 minutes |
97154 |
Group adaptive behavior treatment by protocol, administered by a technician under the supervision of a physician or other qualified healthcare professional |
97155 |
Adaptive behavior treatment protocol modification |
97156 |
Family adaptive behavior treatment guidance |
97157 |
Multiple-family group adaptive behavior treatment guidance |
97158 |
Group adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional, face-to-face with multiple patients, each 15 minutes |
0362T |
Adaptive behavior assessment with technician assistance, each 15 minutes |
0373T |
Adaptive behavior treatment with protocol modification |
To view the List of Procedures/DME Requiring Authorization, go here and scroll down to the Prior Authorization Coding List section for your region.
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