Medicare Advantage BH Billing — 2026 MA Plan Rules
Medicare Advantage now covers 51% of Medicare enrollees. MA plans have distinct BH billing rules from traditional Medicare — prior auth patterns, network requirements, and appeal timelines vary significantly.
Top MA Plan BH Rules 2026
- Humana MA — 90837 requires clinical documentation upload
- UHC MA — Behavioral Solutions carve-out for outpatient
- Aetna MA — Optum BH network for MA members
- Elevance/Anthem MA — Carelon BH carve-out
- Kaiser Senior Advantage — internal BH network only
MA vs Traditional Medicare BH Differences
- Prior auth on 90837 (MA yes, Traditional no)
- Network restriction enforced strictly
- Higher IRE appeal success rate (28% vs 12%)
$1.04M case study · Free audit
– KD, Revenant Care