Prior Authorization Update: Behavioral Health Visit Limits
Dear Provider Partners,
Effective January 1, 2026, Meridian Health Plan of Michigan will implement a prior authorization (PA) requirement for behavioral health services after a member’s 24th visit within a benefit period (see table below for details).
Additionally, code 90870 ELEC-CONVULS THERAP; SNGL SEIZURE
will require prior authorization for all providers.
These changes align with Meridian’s ongoing commitment to ensure members receive appropriate, clinically necessary care while supporting high-quality outcomes.
What This Means for Providers
- Visits 1-24: No prior authorization is required. Members will continue to have uninterrupted access to behavioral health services during this initial period.
- After 24 Visits: Providers will be required to obtain prior authorization for additional sessions beyond the 24th visit. This process will confirm that ongoing treatment remains medically necessary and tailored to the member’s individual needs.
Code | Code Description | ARQ Edit |
|---|---|---|
90870 | ELEC-CONVULS THERAP; SNGL SEIZURE | Prior authorization required for all providers. |
90785 | PSYCHOPHYSIOLOGICAL THERAPY | Prior authorization required after 24 visits. |
90791 | PSYCH DIAGNOSTIC EVALUATION | Prior authorization required after 24 visits. |
90792 | PSYCH DIAG EVAL W/MED SRVCS | Prior authorization required after 24 visits. |
90832 | Psytx W Pt 30 Minutes | Prior authorization required after 24 visits. |
90834 | Psytx W Pt 45 Minutes | Prior authorization required after 24 visits. |
90836 | Psytx W Pt W E/M 45 Minutes | Prior authorization required after 24 visits. |
90837 | Psytx W Pt 60 Minutes | Prior authorization required after 24 visits. |
90839 | Psytx Crisis Initial 60 Min | Prior authorization required after 24 visits. |
90840 | Psytx Crisis Ea Addl 30 Min | Prior authorization required after 24 visits. |
Our commitment to Providers
Meridian values its provider partnerships and is dedicated to ensuring that this process is streamlined and efficient.
- Providers will receive clear guidance and supporting tools to submit authorization requests quickly.
- Our goal is to minimize administrative burdens while maintaining access to essential behavioral health services.
Next Steps
Additional resources for submitting authorization requests will be distributed prior to implementation. Please review your current processes to ensure readiness for this change.