H2021 Com wrap-around sv, 15 minCommunity-based wrap-around services, per 15 minutes
Status I: not valid for Medicare (Medicare uses another code).
6 of 6 payer prior-auth lists that name H2021 require prior authorization or set conditions: Humana, Molina Complete Care (Virginia), Molina Healthcare of California, Molina Healthcare of Iowa, UnitedHealthcare Community Plan.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Humana | Humana LTSS (Healthy Horizons) | VA | prior auth required | Jul 1, 2025 | Humana Healthy Horizons® in Virginia Long-Term Services and Supports (LTSS) Prior Authorization and Notification List | |
| Molina Complete Care (Virginia) | Virginia state exceptions to the national Medicaid grid (exceptions only) | VA | prior auth required | State exception | Apr 1, 2025 | Virginia Medicaid PA Code Matrix and Virginia code/benefit exceptions, effective Q2 2025 |
| Molina Complete Care (Virginia) | Medicaid | VA | prior auth required | State exception | Apr 1, 2025 | Virginia Medicaid PA Code Matrix and Virginia code/benefit exceptions, effective Q2 2025 |
| 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 | Jul 1, 2023 | IA Prior Authorization Matrix, effective Q3 2023 | |
| UnitedHealthcare Community Plan | Massachusetts Senior Care Options (SCO) and OneCare | MA | prior auth required | Oct 1, 2026 | Prior authorization requirements for Massachusetts MA SCO OneCare Effective October 1, 2026 |
H2021 appears in 2 coverage policies from Aetna, Premera Blue Cross.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Home Behavioral Healthcare Services (0730) | listed, no stance | Nov 26, 2025 | payer document |
| Premera Blue Cross | Non-covered Services and Procedures Page | 16 of 30 | ∞ | not covered | Jun 1, 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.