2024 Medical Necessity Criteria
Lucet Health (Lucet) utilizes medical necessity criteria to make medical necessity determinations. The medical necessity criteria set applied varies according to the behavioral health service being requested. To determine which criteria set will be used, please refer to the list below:
Placement Criteria
Level of Care Utilization System (LOCUS)
Used to evaluate behavioral health treatment requests for adults age 19+ years.
LOCUS Guide for Patients and Families
Child and Adolescent Level of Care Utilization System (CALOCUS)
Used to evaluate mental health treatment requests for children and adolescents ages 6-18 years.
Early Childhood Service Intensity Instrument (ECSII)
Used to evaluate mental health treatment requests for infants, toddlers and children ages birth through 5 years.
ECSII Guide for Patients, Families, and Providers
ASAM Criteria
Used to evaluate substance use disorder service and treatment requests.
Medical Policies
2024 Lucet Medical Policies (and related documents)
Apply to the following treatments and services, as applicable.
2024 Lucet – ABA for Treatment of ASD
2024 Lucet – ABA for Treatment of ASD for Federal Employee program (FEP) members
2024 Lucet – ABA for the Treatment of Down Syndrome
2024 Lucet – TMS for Treatment of Resistant Depression
- Psychological/Neuropsychological Testing Request Form (Revised 2024)
- Psycological/Neuropsychological Testing Guide – Corporate
- Psychological/Neuropsychological Testing Guide – Florida
2024 Lucet – 23-Hour Observation
2024 Health Plan Medical Policies
Lucet is required to utilize some medical policies produced by our health plan clients.
BCBS Arkansas #2011053 – Autism Spectrum Disorder in Children, Applied Behavioral Analysis
BCBS Arkansas #2023005 – Autism Spectrum Disorder in Adults, Applied Behavioral Analysis
BCBS Arkansas / Walmart #1028 – Autism Spectrum Disorder, Applied Behavior Analysis
Medicare National Coverage Determinations (NCD) & Local Coverage Determinations (LCD)
Lucet is required to utilize some Medicare National Coverage Determinations (NCD) & Local Coverage Determinations (LCD) policies. NCD and LCD information is available at: MCD Search (cms.gov).
LOCUS was developed by the American Association of Community Psychiatrists (AACP). CALOCUS was developed by AACP in collaboration with the American Academy of Child and Adolescent Psychiatry (AACAP). Both are maintained by Deerfield Solutions, LLC. ECSII was developed by AACAP. The ASAM Criteria was developed by the American Society of Addiction Medicine.
Lucet administers each benefit as designed by the health plan and set out in the member’s benefit agreement. The presence of a specific level of care criteria within a criteria set does not constitute the existence of a specific benefit. Providers and facilities should verify the member’s available benefits online when available, or by contacting the applicable Customer Service department.
Copyright 2015 by the American Society of Addiction Medicine. Reprinted with permission. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM.
Quick References
For benefit information, call the number on the back of your insurance card.
Autism Helpline
877-563-9347
General Inquiries
877-887-1797
Substance Use Hotline
877-326-2458