2026 Medical Necessity Criteria and Request Forms
To reference 2025 Medical Necessity Criteria, please click here.
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
2026 Lucet Medical Policies (and related documents)
Apply to the following treatments and services, as applicable.
2026 Lucet – ABA for Treatment of ASD
2026 Lucet – ABA for Treatment of ASD for Federal Employee program (FEP) members
2026 Lucet – ABA for the Treatment of Down Syndrome
2026 Lucet – TMS for Treatment of Resistant Depression
2026 Lucet – TMS for Treatment of Resistant Depression for Florida Blue
- Psychological/Neuropsychological Testing Request Form (Revised 2026)
- Psychological/Neuropsychological Testing Guide – Corporate
- Psychological/Neuropsychological Testing Guide – Florida
WEBPASS
WebPass is an online service from Lucet which allows providers and office staff to check eligibility and benefits of Lucet’s Members, request authorizations (including ABA, ECT, PNT, and TMS), contact Provider Relations, update your online profile, and more.
To obtain access to WebPass, please email PRWebpass@lucethealth.com with your name, email address, and Tax ID number. Contact 877-709-6822 for any additional questions.
2025 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 / Walmart #1028 – Autism Spectrum Disorder, Applied Behavior Analysis
Medicare National Coverage Determinations (NCD) & Local Coverage Determinations (LCD)
In accordance with 42 CFR §422.101, our coverage criteria are designed to ensure that members receive safe, effective, and medically necessary care. The rationale for our criteria is based on established, evidence-based practices from traditional National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs). We supplement these with nationally recognized placement criteria and Lucet’s internal medical policies, which are developed and regularly updated using current, publicly available evidence from widely used, reputable treatment guidelines and peer-reviewed clinical literature.
These criteria are intended to provide significant clinical benefits by ensuring that healthcare services are appropriate and clinically effective. By adhering to these standards, we help members avoid unnecessary or potentially harmful procedures, treatments, and services, which are risks that can arise from care that is not medically indicated. While we recognize that the application of these criteria may, in some cases, result in delayed or decreased access to certain items or services, we have determined that these clinical benefits are highly likely to outweigh any potential clinical harms. This approach promotes the health and safety of our members by ensuring the highest standard of care based on scientific evidence.
Note that the placement criteria and medical policies are not authorizations, contracts or guarantees of benefits as applicability would be specific to the member’s practitioner’s recommended treatment and care delivery, which may require additional individualized review.
Lucet Policies are copyrighted and unauthorized use and disclosure is strictly prohibited.
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.
You have the right to receive a free copy of the criteria used to make medical necessity determinations. You may request the criteria by emailing compliance@lucethealth.com
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