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 impacted and do not require prior authorization?
H2019-HQ and HR are not impacted and do not require prior authorization
- H2019-HQ: Group Therapy
- H2019-HR: Individual and Family Therapy
- H2019 no modifier
What Provider Type are impacted?
- Community Behavioral Health Services (05)
What health plans does this guidance apply to?
- 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 should prior authorization requests be submitted?
The preferred method is to submit prior authorization requests via fax:
- Form: Download the Outpatient Community Based Services Fax Form (PDF) from the Pre-Auth Check web page
- Fax Number: 1-844-208-9113
Why does the Secure 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, consult 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:
- Provider Support: Finding the Right Contact
- Provider Services: Call 1-844-477-8313
- Secure Provider Portal: Visit the Secure Provider Portal to check member eligibility, submit claims and more.
- Provider Engagement: Use the Find Your Account Manager tool to find the Provider Engagement Account Manager (PEAM) supporting your specialty and region.
- Claim Concerns: Resolve outstanding claims using the Claim Concerns form.
- Provider News: Bookmark Provider News to keep up with the latest updates.
- Provider Newsflash: Subscribe to our e-newsletter to get regular updates.
- Provider Resources: Visit Manuals, Forms and Resources to find provider manuals, important forms, scheduling standards and other resources.
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