Oklahoma Medicaid (SoonerSelect) psychological testing coverage: codes, limits and prior authorization
The short answerSince April and May 2025, all three SoonerSelect plans require prior authorization for 96130 to 96133 and 96136 to 96139, whatever the number of units. Neurobehavioral codes 96116 and 96121 and automated 96146 do not. Authorizations run 6 months and a decision is due within 72 hours.
By Javier Alvarez · Updated · 1 min read
1 row: Medicaid (by state) · Oklahoma. Public policy, not the member's benefits.
Oklahoma Medicaid (SoonerSelect)
SoonerSelect plans: Oklahoma Complete Health, Aetna Better Health of Oklahoma, Humana Healthy Horizons · Oklahoma
| 96116 | Listed (no prior authorization required) [1] |
|---|---|
| 96121 | Listed (no prior authorization required) [1] |
| 96130 | Listed (prior authorization required) [1] |
| 96131 | Listed (prior authorization required) [1] |
| 96132 | Listed (prior authorization required) [1] |
| 96133 | Listed (prior authorization required) [1] |
| 96136 | Listed (prior authorization required) [1] |
| 96137 | Listed (prior authorization required) [1] |
| 96138 | Listed (prior authorization required) [1] |
| 96139 | Listed (prior authorization required) [1] |
| 96146 | Listed (no prior authorization required) [1] |
| Visit limits | Request units per code: 1 unit equals 1 hour for evaluation services (including report writing and feedback) and 1 unit equals 30 minutes for test administration and scoring. More units need a new authorization request. [1] |
| Prior authorization | Required for 96130, 96131, 96132, 96133 and 96136 to 96139 for all three plans, whatever the number of units or hours. Start dates: April 1, 2025 for Oklahoma Complete Health and Aetna Better Health; May 1, 2025 for Humana. The 90791 diagnostic interview, 96116, 96121, 96146 and 90887 do not need PA. Decisions come within 72 hours when documentation is complete; authorizations last 6 months. [1] |
| Referral | Members may self-refer if a physician, psychiatrist, psychologist or licensed mental health professional has recommended or requested the evaluation, and that recommendation must be documented with the PA request. A diagnostic interview (90791) before testing is expected, or equivalent clinical information. [1] |
| Managed care plans | The three plans use different criteria: InterQual at Oklahoma Complete Health, Milliman Care Guidelines at Aetna Better Health of Oklahoma, and MCG plus OHCA criteria at Humana Healthy Horizons. All use Availity Essentials for PA. [1] |
| Also | Not appropriate when results are used for academic placement or purposes or to diagnose a learning disorder only; other school referrals are reviewed case by case. Testing is not medically necessary when used primarily for legal or judicial purposes such as competency. Mood diagnoses that a full diagnostic interview can establish do not need testing. [1] |
What Oklahoma Medicaid (SoonerSelect)'s documents say
The table above has every field we found for Oklahoma Medicaid (SoonerSelect), with numbered sources. In short:
- Prior authorization. Required for 96130, 96131, 96132, 96133 and 96136 to 96139 for all three plans, whatever the number of units or hours. Start dates: April 1, 2025 for Oklahoma Complete Health and Aetna Better Health; May 1, 2025 for Humana. The 90791 diagnostic interview, 96116, 96121, 96146 and 90887 do not need PA. Decisions come within 72 hours when documentation is complete; authorizations last 6 months.
- Visit limits. Request units per code: 1 unit equals 1 hour for evaluation services (including report writing and feedback) and 1 unit equals 30 minutes for test administration and scoring. More units need a new authorization request.
- Codes. 96116, 96121, 96130, 96131, 96132, 96133, 96136, 96137, 96138, 96139 and 96146 are listed.
Other psychological testing rows for Oklahoma
Medicare, Novitas (AR, CO, DE, DC, LA, MD, MS, NJ, NM, OK, PA, TX) and BCBS Illinois, New Mexico and Oklahoma (HCSC).
Check Oklahoma Medicaid (SoonerSelect)'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.