Dec. 31, 2024
As part of our reviews to determine medical necessity, we use clinical criteria from the American Society of Addiction Medicine’s “Treatment Criteria for Addictive, Substance-Related and Co-Occurring Conditions.”
In a change to our previous announcement, we will delay implementation of ASAM’s new fourth-edition criteria in our medical necessity reviews of substance use services rendered to adults. We will continue to apply ASAM’s third-edition criteria in our reviews of these services rendered to adults and adolescents.
Watch News and Updates and Blue Review for updates to our behavioral health program.
The American Society of Addiction Medicine is an independent company that has contracted with Blue Cross and Blue Shield of New Mexico to provide utilization management support for members with coverage through BCBSNM. BCBSNM makes no endorsement, representations or warranties regarding third-party vendors and the products and services they offer.
This is for informational and educational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider, nor is the information presented intended to replace or supersede any requirements set forth in your contract with BCBSNM. Physicians and other health care providers should use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment.