All PlansCoverageMedium impact
Partial Hospitalization for Substance Use Disorders 3.01.18
Excellus BlueCross BlueShield·NY · Psychiatry·Behavioral Health (Psychiatry/Psychology)
Effective date
Aug 21, 2025
We identified it
Jun 20, 2026
Summary
This policy establishes medical necessity criteria for Substance Use Disorder Partial Hospitalization Programs (PHP) using ASAM 2.5 criteria. It defines admission, continuing stay, and discharge requirements for intensive outpatient substance abuse treatment providing at least 20 hours per week.
Action Required
By August 21, 2025: Billing teams must ensure proper documentation of ASAM 2.5 criteria for all Substance Use Disorder Partial Hospitalization claims using HCPCS S0201. Verify that treatment plans include required psychiatric/medical assessments, DSM-5-TR substance use disorder diagnosis, and weekly SUD evaluations with medication assessments. Claims without proper ASAM criteria documentation will be denied.