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March 2025 Top of Mind

You may now request additional psychoeducation and peer support services after state limits are met

Beginning Jan. 1, 2025, you can now request approval to provide additional psychoeducation and peer support services once a member reaches the limits set by Kentucky Department for Medicaid Services in 2024. This service exception applies to UnitedHealthcare Community Plan of Kentucky members only. 

Psychoeducation 

  • Billing Code:  H2027
  • Maximum annual limit:  500 units (125 hours) per calendar year, whether provided individually, in a group setting or a combination of each

Note: Peer Support Specialists, Community Support Advocates and Registered Behavior Technicians (modifiers U7 and UC) cannot deliver psychoeducation services

Peer Support Services 

  • Billing Code:  H0038 
  • Maximum annual limit:  800 units (200 hours) per calendar year, whether provided individually, in a group setting or a combination of each

How to request the additional services

Once the limit(s) have been met, you’ll need to complete the Kentucky Community-based Services Request Form located on the Provider Express Kentucky page under the UnitedHealthcare Community Plan section (Provider Express home>Our network>State-specific provider information>Kentucky>Community-based Services Request Form). 

You will need your 10-digit tax identification number (TIN) available. Once submitted, the webpage will indicate confirmation. A decision on the request will be made within 5 calendar days of the submission. 

The review process

  • Submission information will be reviewed against our current Kentucky Medicaid Supplemental Clinical Criteria
  • If a service is deemed medically necessary: The request will be approved, and you’ll receive verbal and written authorization
  • If medical necessity is in question or the case would benefit from a Psychologist or Medical Director input: the Care Advocate may refer to a peer reviewer. Peer reviews can be either a live discussion or providers may request the determination be made based on the original submission and available information 

 


 

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