For Beacon’s current medical necessity criteria, click here.
The following is medical necessity criteria which has historically been used, but has since been updated or retired by Beacon.
Beacon’s National Medical Necessity Criteria (February 2019-February 2020)
- Introduction to Beacon’s National Medical Necessity Criteria
Including information such as Clinical Philosophy, Determining Medical Necessity, Determining the Appropriate Level of Care, Evaluating Necessity for Continued Care, Discharge Criteria, Clinical Criteria Development, and Account Specific Variations.
- Emergency/Crisis Services
- Inpatient Services
- Residential Treatment Services
- Structured Day Treatment Services
- Case Management Services
- Outpatient Services
- NMNC 2.603.03 Medication Management Adult
- NMNC 3.703.03 Medication Management Child-Adolescent
- NMNC 5.501.04 Outpatient Professional Services
- NMNC 5.502.05 Psychological and Neuropsychological Testing
- NMNC 5.503.03 Biofeedback
- NMNC 5.504.03 Outpatient Psychiatric Home Based Therapy
- NMNC 6.604.05 Applied Behavioral Analysis
- Other Criteria
- Medical Necessity Criteria: Reference List