Medical Necessity Guidelines for Pennsylvania Behavioral Health HealthChoices

Community Care uses the state of Pennsylvania Appendix T criteria for most levels of mental health care and for substance use disorder services for adults. View the Appendix T criteria or ASAM criteria. If you cannot access these criteria via the website, please contact us for a paper copy.

The Medical Necessity Guidelines for Intensive Behavioral Health Services (IBHS) delivered through Individual Services, ABA Services and Group Services can be found in Appendix S(2) of Pennsylvania’s Program Standards and Requirements Appendices.
 

Some supplemental levels of care are not addressed in Appendix T. Community Care has developed supplemental medical necessity guidelines for these levels of care. Not all of these supplemental levels of care are available in each county.