Fidelis Care Authorization Grids Effective April 1, 2020

The following sections of the Fidelis Care authorization grids have been updated effective April 1, 2020.


Section IV.  Behavioral Health – Outpatient Services

O. Children and Family Treatment & Support Services (CFTSS)

Effective 4/1/2020, utilization management requirements for Children and Family Treatment and Support Services will be discontinued. The CFTSS are as follows:

1. OLP - Other Licensed Practitioner (90791, H0004, H2011, 90882)
2. CPST – Community Psychiatric Supports and Treatment (H0036)
3. PSR- Psychosocial Rehabilitation (H2017)
4. FPSS- Family Peer Support Services (H0038)
5. YPSS – Youth Peer Supports and Services (H0038)
6. CI – Crisis Intervention (H2001, S9484, S9485) - no previous authorization requirements

Prior authorization was never required for these services. Concurrent review is no longer required.

If there are questions related to these changes, providers may contact Fidelis Care by telephone at 1-888-FIDELIS (1-888-343-3547) and follow the prompts.