Beacon-Health-Options Coverage Criteria
Latest Beacon-Health-Options coverage criteria updates3
- Coverage CriteriaClinical/Medical PolicyEff. 2026-02-15Behavioral health medical necessity criteria (Massachusetts)Defines Carelon Behavioral Health's medical necessity criteria for inpatient and diversionary behavioral health services (psychiatric and substance use) applicable to Massachusetts members and providers using Carelon/Baycon standards and referenced external criteria (InterQual, ASAM, CMS).All Beacon-Health-Options updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-01-01Behavioral Health Medical Necessity Criteria — Inpatient, Diversionary, Residential, and Community Behavioral Health ServicesDefines Carelon Behavioral Health's Medical Necessity Criteria (MNC) for inpatient and diversionary behavioral health services in Massachusetts, describing admission, continued stay, discharge, and exclusion criteria for multiple levels of care and guidance for determining applicable criteria.All Beacon-Health-Options updates
- Coverage CriteriaClinical/Medical PolicyVoluntary Care Management (VCM) - Coverage CriteriaDefines eligibility and program purpose for families with children under 18 who have a primary mental health or substance use disorder and who seek assistance to access appropriate behavioral health services and address barriers to care.All Beacon-Health-Options updates
Tool Description
Search Beacon-Health-Options coverage criteria and medical necessity requirements across 21,000+ policies from 170+ payers.
Search a drug (“Wegovy”), a procedure (“knee replacement”), or a policy name, then filter by payer, specialty, policy type, or effective year. Or start from the largest publishers: UnitedHealthcare coverage criteria and Cigna coverage criteria.
Each result links the full policy page, which lists the clinical requirements, covered codes, and effective dates from the source document.
Pair a criteria search with the prior authorization lookup for approval requirements, the timely filing lookup for claim deadlines, the live policy updates feed for the newest payer publications, and payer profiles for contacts and coverage context.
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Coverage policies are updated every day. Follow payer coverage policy updates in the live policy feed, or browse all CPT, HCPCS and DRG billing codes.
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