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Provider Tips for Behavioral Health
Behavioral Health is defined as the treatment of mental and substance use disorders and the support of those who experience and/or are in recovery from these conditions, along with their families and communities. Below are the DHMP benefits by line of business (LOB) for BH services and the entity that is responsible for review and management of BH services.
Medicare
Commercial
Children Health Plan Plus (CHP+)
Managed by Denver Health Medical Plan (DHMP)
DHMP requires prior authorization for some behavioral health services. Outpatient behavioral health therapy (individual or group) does not require prior authorization when provided in network. Please refer to the Member handbook for benefits and exclusions.
- Member handbooks for each line of business can be found under Members in the blue navigation bar at the top of this website
- Services Requiring Prior Authorization
- DHMP Prior Authorization Request form
Medicaid
DHMP is responsible for the six (6) initial visits of group or individual therapy sessions, in primary care settings, for each of the following codes.
- 90791 Diagnostic Evaluation without Medical Services
- 90832 Psychotherapy-30 minutes
- 90834 Psychotherapy-45 minutes
- 90837 Psychotherapy-60 minutes
- 90846 Family Psychotherapy (w/o patient)
- 90847 Family Psychotherapy (with patient)
Colorado Access (COA) manages behavioral health after six (6) visits.
After the sixth behavioral health visit, per code, the benefits are covered by the COA administered capitated behavioral health benefit for Medicaid members. Benefits are held exclusively by the RAE for review and subsequent approval or denial. DHMP has no authority over capitated BH benefits as well as any Wrap BH Benefits administered by Health First Colorado (fee-for-service); therefore, DHMP-UM cannot issue an approval or denial.
Capitated Behavioral Health Benefit Covered Services and Diagnoses