![]() Maryland – 11.101 Applied Behavior Analysis (ABA).MCG Health Behavioral Health Care Criteria (formerly known as Milliman Care Guidelines) is used for some plans, as noted on the Network-Specific Pages. ![]() Medical Necessity Criteria can be found on that page.Then, choose Access Clinical Information by clicking on the blue “Learn More” button.From the above link, choose the appropriate plan.Unless custom criteria exists (e.g., LOCADTR in New York) or for Substance Use Lab Testing (which is found in in InterQual ® Behavioral Health Criteria), ASAM criteria is the criteria for substance use treatment services.No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. For information about The ASAM Criteria, see the Introduction to The ASAM Criteria for Patients and Families Copyright 2015 by the American Society of Addiction Medicine.The American Society of Addiction Medicine (ASAM) Criteria focuses on substance use treatment.American Society of Addiction Medicine (ASAM) Criteria.Beacon utilizes Change Healthcare’s InterQual ® Behavioral Health Medical Necessity Criteria for mental health levels of care and substance use lab testing, unless otherwise noted that Custom Criteria should be used.Change Healthcare’s InterQual ® Behavioral Health Criteria.For all Medicare members, first identify relevant NCD or LCD Criteria. ![]() The Medicare Coverage Database (MCD) to contains all National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs).Centers for Medicare and Medicaid (CMS) Criteria.The following are Beacon’s Medical Necessity Criteria: Medical Necessity Criteria is available online via hyperlinks whenever possible and is available upon request. Historical criteria are provided for informational purposes only and are not subject to the same review process/timeframes. If 1-4 above are not met, Beacon’s National Medical Necessity Criteria would be appropriate. ![]()
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