Behavioral Health medical necessity criteria

Priority Health's Behavioral Health standards and criteria were written using evidence in the clinical literature, industry-wide clinical practice guidelines and recommendations from clinical bodies such as the American Psychiatric Association.
View the list of supporting documentation

Go to an overview of medical necessity/care determination criteria

Read definitions for levels of care

Psychiatric medical necessity criteria by type of care

• 23 hour observation (all age groups)
• Inpatient (acute care) psychiatric: (adult, child adolescent)
• Adult crisis residential (adult, adolescent)
• Partial hospitalization - psychiatric care: (adult, child/adolescent)
• Intensive outpatient therapy - psychiatric care: (adult, child/adolescent)
• Outpatient care
  
• Residential treatment (RTC, domiciliary care) - psychiatric care: (child/adolescent)

Substance use disorders medical necessity criteria by type of care

See the definitions page.

Printable version

Print the Medical Necessity and Level of Care Determination Criteria (153KB PDF)


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