Updates to Behavioral Health Substance Abuse Criteria for Utilization Management
Sept. 29, 2026
As part of our review to determine medical necessity, we use clinical criteria from the American Society of Addiction Medicine’s Treatment for Addictive, Substance-Related, Co-Occurring Conditions.
We currently use ASAM 4.0 in medical necessity reviews of services rendered to adults. Effective Jan. 1, 2027, we’ll also refer to ASAM’s Criteria 4.0 in our medical necessity reviews of services rendered to adolescents.
The ASAM criteria are designed to support multidimensional assessments and treatments, with an emphasis on integrated care that addresses mental and physical health disorders present in patients with addictions.
If you have questions, please call the number on the member’s ID card.
To access ASAM’s criteria:
- Log into Availity® Essentials
- Select Payer Spaces from the navigation menu and choose BCBSNM
- Select the Resources tab
- Choose Resources in Filter By Category
- Select the American Society of Addiction Medicine Criteria link
This is for informational and educational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider, nor is the information presented intended to replace or supersede any requirements set forth in your contract with Blue Cross and Blue Shield of New Mexico. Physicians and other health care providers should use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment.
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