CommercialCoverageMedium impact
Treatment of Gambling Disorder and Other Repetitive Behaviors 3.01.19
Excellus BlueCross BlueShield·NY · Psychiatry·Behavioral Health (Psychiatry/Psychology)
Effective date
Feb 19, 2026
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield has established a new policy for gambling disorder and repetitive behaviors treatment coverage, effective February 19, 2026. The policy uses NYS OASAS LOCADTR-G tool for gambling disorder level of care determinations and considers Partial Hospital Programs investigational for standalone gambling disorder treatment.
Action Required
Before February 19, 2026: Billing team must review all gambling disorder treatment claims to ensure comorbid psychiatric disorders are documented when billing for Partial Hospital Programs (PHP). Update prior authorization protocols to use LOCADTR-G tool for gambling disorder level of care determinations. Flag standalone gambling disorder PHP services as investigational and likely non-covered unless comorbid conditions are present.