All PlansPrior AuthMedium impact
Update: Behavioral Health Substance Use Criteria for Utilization Management
BCBS Texas·TX · Psychiatry, Family Medicine, Internal Medicine +1 more·Prior Authorization
Effective date
Jul 1, 2025
We identified it
Jan 12, 2026
Summary
Blue Cross Blue Shield of Texas is updating their substance use disorder medical necessity reviews to use ASAM's fourth-edition criteria for adults effective July 1, 2025, while continuing to use third-edition criteria for adolescents. This changes their utilization management and prior authorization processes for behavioral health substance use services.
Action Required
By July 1, 2025: Providers treating adult substance use disorders must ensure documentation aligns with ASAM's fourth-edition criteria for prior authorization approvals and medical necessity reviews. Continue using third-edition criteria documentation for adolescent patients. Monitor Blue Review and BCBSTX News and Updates for additional program changes.