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BH Provider Authorizations Information

Overview

In our November 2025 Buckeye Health Plan Provider Bulletin, we announced four new Behavioral Health policies (OH.UM.04, OH.UM.06, OH.UM.07, OH.UM.09) effective January 1, 2026. 

In a special Provider Alert email on December 23, 2025, we notified you that we were placing a temporary hold on these policies until the Ohio Department of Medicaid (ODM) completes the American Rescue Plan Act (ARPA) reconciliation process, which may take up to 60 days. Buckeye must ensure services delivered to members are medically necessary, so these services will continue to be subject to retrospective utilization review. 

As of 1/20/2026, these policies are still on hold. However, we would like to provide you with the latest information on these policies and provide FAQs to assist you in understanding the changes that will be going into effect later this year.

 

The policy provides an overview of Buckeye’s utilization management approach and prior authorization limits for Therapeutic Behavioral Services (TBS) and Psychosocial Rehabilitation (PSR). 

  • H2020 – Up to 25 units allowed per calendar year; PA required after 25 units
  • H2019 – Up to 8 units per day and 80 units per calendar year; PA required after limits
  • H2017 – Up to 8 units per day and 120 units per calendar year; PA required after limits.

FAQs for OH.UM.04 Therapeutic Behavioral Services (TBS) and Psychosocial Rehabilitation (PSR)

To ensure appropriate utilization, prevent duplication of services, and maintain program integrity within the Ohio Medicaid behavioral health benefit, this policy establishes limits on billing multiple rehabilitative behavioral health services for the same member on the same date of service.

  • H0036, H2019, H2017 are limited to 16 combined units per day
  • When billed on the same date as per diem codes H0015, H2020, or H0015TG, the following codes H0036, H2019, and H2017 are limited to 4 combined units per day.

FAQs for OH.UM.06 Multiple Services on Same Date of Services

The policy provides an overview of Buckeye’s utilization management approach and prior authorization limits for Peer Support Services.

  • H0038 – Up to 24 units per week for a maximum of 26 weeks per year

FAQs for OH.UM.07 Peer Support Services

The policy provides an overview of Buckeye’s utilization management approach and prior authorization limits for Intensive Outpatient Treatment (IOP) Services for members with substance use disorders.

  • H0015 – Up to 27 units per calendar year; PA required after 27 units

FAQs for OH.UM.09 Intensive Outpatient Program

Buckeye Health Plan Behavioral Health Prior Authorization Request Form

Availity FAQs