Non Medicaid: Outpatient Group Therapy

• Clinical Coverage Policy 8C

Submission Requirements

• Service Authorization Request (SAR)

Authorization Duration and Limits

Adult Mental Health/Substance Use
No Prior Authorization required

• Mental Health Billing limits: 52 sessions fiscal year limit (2 sessions per week, 9 per month when provided using a promising practice or evidenced based approach)
• Substance Use Billing limits: 180 sessions fiscal year limit (3 sessions per week, 15 sessions per month)

Child Mental Health/Substance Use
No Prior Authorization required

• Mental Health Billing limits: 52 sessions fiscal year limit (2 sessions per week, 9 per month when provided using a promising practice or evidenced based approach)
• General group therapy: 16 sessions

ASAM Level of Care

1