H0032 Mh svc plan dev by non-mdMental health service plan development by non-physician
Status I: not valid for Medicare (Medicare uses another code).
6 of 6 payer prior-auth lists that name H0032 require prior authorization or set conditions: Blue Shield of California, Blue Shield of California Promise Health Plan, Molina Healthcare of California, Molina Healthcare of Iowa.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Blue Shield of California | Blue Shield commercial | CA | prior auth required | Sep 1, 2026 | Prior Authorization List for Blue Shield | |
| Blue Shield of California Promise Health Plan | Promise Health Plan Medi-Cal | CA | prior auth required | Sep 1, 2026 | Medi-Cal Prior Authorization List | |
| Molina Healthcare of California | California state exceptions (exceptions only) | CA | prior auth required | State exception | Jul 1, 2021 | California PA code exceptions (Marketplace), Q3 2021 |
| Molina Healthcare of California | California state exceptions (exceptions only) | CA | prior auth required | State exception | Jul 1, 2021 | California PA code exceptions (Medi-Cal), Q3 2021 |
| Molina Healthcare of California | Medicaid | CA | prior auth required | State exception | Apr 1, 2026 | Medicaid Prior Auth (PA) Code Matrix (California), effective Q2 2026 |
| Molina Healthcare of Iowa | Medicaid | IA | prior auth required | PA required for Waiver services only, otherwise no PA required | Jul 1, 2023 | IA Prior Authorization Matrix, effective Q3 2023 |
H0032 appears in 6 coverage policies from Aetna, Blue Cross & Blue Shield of Rhode Island, Blue Shield of California, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Home Behavioral Healthcare Services (0730) | listed, no stance | Nov 26, 2025 | payer document |
| Blue Cross & Blue Shield of Rhode Island | Autism Spectrum Disorders Mandate PAYMENT POLICY | 4 | covered if criteria are met | Apr 15, 2026 | payer document |
| Blue Shield of California | Applied Behavior Analysis for Autism Spectrum Disorder or BSC3.01 Pervasive Developmental Disorder | listed, no stance | payer document | |
| Blue Shield of California | Behavioral Health Treatment for Autism Spectrum Disorder or BSC3.01 Pervasive Developmental Disorder | listed, no stance | payer document | |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Medical Policies Moving to MCG Guidelines Autism Spectrum Disorder | 97157, 97158, G8539, G9012, | (BHG) | listed, no stance | Jan 1, 2026 | payer document |
| Premera Blue Cross | Applied Behavior Analysis (ABA) (3.01.510) | listed, no stance | Apr 27, 2026 | payer document |
Prior authorization required or conditional in IN, VA.
From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.