11/26/2025
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Posted by Provider Relations
The following sections of the Fidelis Care authorization grids have been updated effective January 1, 2026.
The following has been added to the Medicaid Authorization Grid and requires prior authorization:
IV. Behavioral Health - Outpatient Services
R. Family Psychotherapy
Covered; Authorization Required for CPT Codes 90847
Starting January 1, 2026, Fidelis Care will require notification and concurrent review for Group Psychoeducation (Mental Health) services for any requests beyond the initial 30 visits per calendar year. Note: Substance Use Disorder (SUD) group/family therapy do not require authorization.
Requests for members can be made by email qhcmbh@fideliscare.org, fax (833-561-0098) or by calling 1-888-FIDELIS (1-888-343-3547) and following the prompts for Behavioral Health, or dialing extension 16072.
S. Group Psychotherapy
Covered; Authorization Required for CPT Codes 90853
Starting January 1, 2026, Fidelis Care will require notification and concurrent review for Group Psychoeducation (Mental Health) services for any requests beyond the initial 30 visits per calendar year. Note: Substance Use Disorder (SUD) group/family therapy do not require authorization.
Note: Fidelis Care follows OMH and OASAS best practices and clinical criteria guidelines, such as LOCUS/CALOCUS for Mental Health Services and LOCADTR for Substance Use Disorder Services.
The following has been updated in the Medicare Authorization Grid and requires prior authorization:
II. Outpatient surgery: The following services require prior authorization
D. Services for the following codes require preauthorization if performed in freestanding ambulatory surgery centers (bill type 0831): 20610
Visit: Authorization Grids