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December 2013

Mental health medical necessity criteria updated for 2014

The Magellan Behavioral Health Medical Necessity Criteria and Blue Cross Blue Shield of Michigan Behavioral Health Criteria Application Guidelines have been updated. Both will go into effect and be available on web-DENIS starting Jan. 1, 2014.

Keep in mind that the medical necessity criteria, along with the application criteria, must be met.

The new medical necessity criteria encompasses psychiatric and substance abuse treatment. This includes acute medical detoxification, which is considered a behavioral health benefit. Acute medical detoxification is considered a medical benefit for Federal Employee Program® members.

Health care providers may view and print the 2014 guides directly from web-DENIS. Go to web-DENIS and click on:

  • BCBSM Provider Publications and Resources
  • Newsletters and Resources
  • Clinical Criteria and Resources
  • 2014 updated Magellan Behavioral Health Medical Necessity Criteria under Resources

Call Mental Health Behavioral Services at 313-448-7745 if you have any questions or comments.

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2012 American Medical Association. All rights reserved.
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