Medicare Advantage Plan
Behavioral health and substance abuse services for Virginia Premier Medicare Advantage will be authorized and managed by the Virginia Premier Behavioral Health Utilization Review team. Medicare covers traditional services for behavioral health and substance abuse treatment. Traditional services are defined as inpatient and outpatient services at the individual and group levels of care. Services can be obtained via:
Phone: 1-855-214-3822
Outpatient Fax: 1-804-343-0304
Inpatient Fax: 1-804-799-5105
Web Portal: https://www.virginiapremier.com/providers/medicaid/provider-portals/
Virginia Premier bases all service determinations on medical necessity/level of care (LOC) criteria.
For additional information regarding Medicare coverage for behavioral health and substance abuse services go to:
- https://www.medicare.gov/coverage/mental-health-care-outpatient
- https://www.authorization.virginiapremier.com
CCC Plus – Elite Plus
Community Mental Health Services (CMHS) and Addiction Recovery Treatment Services (ARTS) provided for CCC Plus members are authorized and covered through Virginia Premier.
Authorization for Virginia Premier CCC Plus members receiving Community Mental Health Services (CMHS) and Addiction Recovery Treatment Services (ARTS) can be obtained via:
Phone: 1-855-214-3822
Outpatient Fax: 1-804-799-5104
Inpatient Fax: 1-804-799-5105
Web Portal:https://www.virginiapremier.com/providers/medicaid/provider-portals/
Virginia Premier bases all behavioral health service determinations on medical necessity/level of care (LOC) criteria.
Medallion – Elite Individual
Community Mental Health Services (CMHS) and Addiction Recovery Treatment Services (ARTS) provided for Medallion 4.0 members are authorized and covered through Virginia Premier.
Authorizations for Virginia Premier Medallion members receiving CMHS and ARTS can be obtained via:
Phone: 1-855-214-3822
Outpatient Fax: 1-804-343-0304
Inpatient Fax: 1-804-799-5105
Web Portal: https://www.virginiapremier.com/providers/medicaid/provider-portals/
Virginia Premier bases all behavioral health service determinations on medical necessity/level of care (LOC) criteria.
Behavioral Health Service Authorization Requests
Service authorization forms for ARTS and CMHS are accessible on the Department of Medical Assistance Services Webpage:
In the grid of CMHRS services below:
A indicates a service that requires an authorization
R indicates a service that requires a registration
* For More information regarding Behavioral Health Services Coverage please read our Provider Manual chapter on Mental Health Services.
Behavioral Health Services Administrator (BHSA)
Magellan of Virginia serves as the behavioral health services administrator (BHSA) for Virginia Premier and is responsible for the management and administration of the behavioral health benefit programs under contract with DMAS.
Magellan works with:
- individuals receiving fee-for-service Medicaid benefits
- children receiving any Medicaid benefit in need of residential treatment services (including therapeutic group homes)
For more information about Magellan of Virginia, please contact them at 800-424-4536 or VAProviderQuestions@MagellanHealth.com.
Community Mental Health Rehabilitation Services | Procedure Code | Registration vs Authorization Initial Request | Registration vs Authorization Continued Stay Request |
|---|---|---|---|
Mental Health Case Management (MH CM) | H0023 | R | R |
Therapeutic Day Treatment (TDT) for Children | H2016 UG, U7 | A | A |
Mental Health Partial Hospitalization Program (MH-PHP) | H0035 | A | A |
Assertive Community Treatment (ACT) | H0040 U1-U5 | A | A |
Mental Health Skill-Building Services (MHSS) | H0046 | A | A |
Intensive In-Home | H2012 | A | A |
Psychosocial Rehab | H2017 | A | A |
Mental Health Peer Support Services-Individual | H0025 | R | A |
Mental Health Peer Support Services-Group | H0024 | R | A |
Mental Health Intensive Outpatient Services (MH-IOP) | S9480 | A | A |
Psychotherapy for Crisis provided for a member in MH-PHP | 90839
90840 | A | A |
Multisystemic Therapy (MST) (effective 12/1/21) | H2033 | A | A |
Functional Family Therapy (effective 12/1/21) | H0036 | A | A |
Mobile Crisis Response (effective 12/1/21) | H2011 | R | No continued stay |
Community Stabalization (effective 12/1/21) | S9482 | A | A |
23-Hour Crisis Stabalization (effective 12/1/21) | S9485 | R | No continued stay |
Residential Crisis Stabilization Units (effective 12/1/21) | H2018 | R | A |
Applied Behavior Analysis (effective 12/1/21) | 97153-97158
0373T | A | A |
