BCBS TexasMedium ImpactPrior Auth
Update: Behavioral Health Substance Use Criteria for Utilization Management
Published January 12, 2026Effective January 2, 2025
AI Summary
Blue Cross Blue Shield of Texas is delaying implementation of ASAM's fourth-edition criteria for substance use disorder medical necessity reviews. They will continue using the third-edition criteria for both adult and adolescent substance use services instead of switching to the newer fourth-edition criteria as previously announced.
Action Required
Immediately: Behavioral health providers treating substance use disorders should continue following ASAM third-edition criteria for medical necessity documentation and treatment planning. Monitor Blue Review and News and Updates for future implementation timeline of fourth-edition criteria. No changes to current prior authorization processes are needed at this time.
Plan Types
All Plans
States
TX
Specialties
psychiatry