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Therapeutic Behavioral Onsite Services (H2019) Prior Authorization: Frequently Asked Questions (FAQ)

Date: 11/06/25

Effective January 1, 2026, prior authorization is required for therapeutic behavioral onsite services. This change applies to all providers except those who render services to members ages 0-3 years old.

What codes are impacted?

H2019: Therapeutic Behavioral Onsite Services (TBOS)

What modifiers are impacted?

H2019-HO, HM and HN are included and require prior authorization

  • H2019-HN: Therapeutic behavioral on-site services, behavioral management
  • H2019-HM: Therapeutic behavioral on-site services, therapeutic support
  • H2019-HO: Therapeutic behavioral on-site services, therapy

What modifiers are not be impacted and don’t require prior authorization?

H2019-HQ and HR are not be impacted and do not require prior authorization

  • H2019-HQ: Group Therapy
  • H2019-HR: Individual and Family Therapy
  • H2019 no modifier  

What Provider Type will be impacted?

Community Behavioral Health Services (05)

What health plans will this impact?

  • Sunshine Health Medicaid (MMA)
  • Comprehensive Long Term Care (LTC)
  • Sunshine Health Pathway to Shine Child Welfare Specialty Plan (CWSP)
  • Sunshine Health Mindful Pathways Serious Mental Illness Specialty Plan (SMI)
  • Sunshine Health Power to Thrive HIV/AIDS Specialty Plan (HIV)
  • Children’s Medical Services (CMS) Health Plan

When must a prior authorization request be submitted?

Prior authorization is required for services provided on or after January 1, 2026.

How are prior authorization requests submitted?

The preferred method is to submit prior authorization requests via the Secure Provider Portals, but a faxing option will also be available.

Online: Please only submit the modifiers required for H2019 through the portal. The portal will not specify which modifiers are required for prior authorization.

Fax: Complete and fax the Outpatient Community Based Services Fax Form (PDF) available on the Pre-Auth Check web page. 

Why does the provider portal state that prior authorization is required for all modifiers?

The portal does not have the ability to distinguish which modifiers require prior authorization. Authorizations must be submitted for impacted modifiers, as outlined below:

  • H2019-HO, HM and HN are included and require prior authorization
  • H2019-HR and HQ are not impacted and do not require prior authorization

What clinical information should be submitted with a prior authorization request?

  • Initial assessment
  • Description of service
  • The most up-to-date treatment plan evidence of the member’s participation and progress in the program
  • Up-to-date clinical notes showing evidence of required care

For more information about submitting clinical information, visit the Sunshine Health Outpatient Treatment Requests (OTR) Done Right resource.

What are the turnaround times (TAT) for prior authorization requests?

Providers should receive a response within five days of submitting the request.

How can providers verify which codes require prior authorization?

Check the codes using the Medicaid Pre-Auth tool.

Who can answer providers’ questions about this process?

Call Sunshine Health Provider Services at 1-844-477-8313 or contact your Provider Engagement Account Manager.

AHCA Resources

Questions?

Sunshine Health has a wealth of resources available to help answer your questions and address your concerns:

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