Behavioral Health Medical Necessity Criteria

What is this about?

These documents are for Blue Cross Blue Shield of Michigan PPO members or providers. They describe the criteria a patient or provider needs to meet to be approved for tests and procedures related to a behavioral disorder.

If you have a Blue Care Network plan and you're looking for this information, call the behavioral health number on the back of your ID card.

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.