Ohio Medicaid psychological testing coverage: codes, limits and prior authorization
The short answerOhio's behavioral health prior authorization sheet (revised May 2019) lets providers bill 96130, 96131, 96112, 96113, 96116 and 96121 up to 12 hours per patient per year, and 96132 and 96133 up to 8 hours, before PA is needed. It is an old document, so check the current rule.
By Javier Alvarez · Updated · 1 min read
1 row: Medicaid (by state) · Ohio. Public policy, not the member's benefits.
Ohio Medicaid
Prior Authorization Requirements for Behavioral Health Services (revised May 2019) · Ohio
| 96116 | Listed (up to 12 hours or encounters per patient per calendar year before PA) [1] |
|---|---|
| 96121 | Listed (up to 12 hours or encounters per patient per calendar year before PA) [1] |
| 96130 | Listed (up to 12 hours or encounters per patient per calendar year before PA) [1] |
| 96131 | Listed (up to 12 hours or encounters per patient per calendar year before PA) [1] |
| 96132 | Listed (up to 8 hours per patient per calendar year before PA) [1] |
| 96133 | Listed (up to 8 hours per patient per calendar year before PA) [1] |
| Visit limits | Ohio Medicaid's behavioral health PA sheet (revised May 2019, services under OAC 5160-27): up to 12 hours or encounters per patient per calendar year for 96130, 96131, 96112, 96113, 96116 and 96121, and 8 hours for 96132 and 96133. The sheet does not name 96136 to 96139. [1] |
| Prior authorization | Per Ohio Medicaid's May 2019 behavioral health PA sheet, prior authorization is required only when the annual limit is reached. Check the current rule and the member's managed care plan. [1] |
What Ohio Medicaid's documents say
The table above has every field we found for Ohio Medicaid, with numbered sources. In short:
- Prior authorization. Per Ohio Medicaid's May 2019 behavioral health PA sheet, prior authorization is required only when the annual limit is reached. Check the current rule and the member's managed care plan.
- Visit limits. Ohio Medicaid's behavioral health PA sheet (revised May 2019, services under OAC 5160-27): up to 12 hours or encounters per patient per calendar year for 96130, 96131, 96112, 96113, 96116 and 96121, and 8 hours for 96132 and 96133. The sheet does not name 96136 to 96139.
- Codes. 96116, 96121, 96130, 96131, 96132 and 96133 are listed.
Other psychological testing rows for Ohio
Check Ohio Medicaid's claim against the row
Before the claim goes out, compare it with the row above: the evaluation and administration codes pair the way the policy says, the hours fit any cap, the referral question is documented, and prior authorization covers the units. The psychological testing table compares Medicaid with every other payer we checked.