Behavioral Health Medical Necessity Criteria
Current Clinical Criteria
Use these documents for admissions on or after Jan. 1, 2021.
- 2021 New Directions Behavioral Health Medical Necessity Criteria (PDF) — The criteria in this document are used by Blue Cross Blue Shield of Michigan and providers to make benefit determinations for mental health and substance abuse services.
- 2021 BCBSM Clinical Criteria for repetitive transcranial magnetic stimulation, or rTMS (PDF) — The criteria in this document are used by BCBSM and providers to make benefit determinations for repetitive transcranial magnetic stimulation services.
- 2021 BCBSM/New Directions Applied Behavior Analysis Medical Necessity Criteria (PDF) — The criteria in this document are used by BCBSM and providers to make benefit determinations for applied behavior analysis services for autism.