BH Community-Based Acute Treatment/Youth Clinical Crisis Stabilization (CBAT/YCCS) Program and Intensive Community-Based Acute Treatment (ICBAT) Program Form

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Clinical Review Criteria Related to
Community-Based Acute Treatment/Youth Clinical Crisis Stabilization (CBAT/YCCS) Program and
Intensive Community-Based Acute Treatment (ICBAT) Program – Medical Policy
Updated Revision Effective: October 1, 2025 Policy Number: UM349POL Approval Date: 8/14/2025

Line(s) of Business:

Commercial
Medicare Advantage
Medicaid (BeHealthy)

Description

Clinically Based Acute Treatment (CBAT), called Youth Clinical Crisis Stabilization services (YCCS) in Massachusetts, and Intensive Community Based Acute Treatment (ICBAT) are acute residential placements best suited to the treatment of children and adolescents who are experiencing an acute or subacute behavioral health crisis, but do not present with safety concerns or other issues that would require an inpatient psychiatric hospitalization for appropriate management.

Per MA DOI guidance, prior authorization for initiation of treatment at CBAT/ICBAT level of care is not required for initial placement as long as the member has been evaluated by a licensed behavioral health clinician who has recommended this level of care for the member. Concurrent review and continued authorization are based on the guidelines documented below.

 Line of Business

Commercial:
Refer to criteria under the Policy section in this medical policy.

Medicaid – BeHealthy:
Medical necessity review is performed by the Massachusetts Behavioral Health Partnership (MBHP).

Medicare:
This policy does not apply.

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Policy

I. CBAT/YCCS is considered medically necessary when ALL of the following are met:

A. The need for a 24-hour, 7-day-a-week, awake, staff-secure (unlocked) treatment setting; AND

B. Member requires short-term crisis stabilization and therapeutic services, to include but not limited to psychiatric and pharmacological assessment; AND

C. Member requires continuous monitoring to provide an ongoing assessment of risk of harm to self and/or others; AND

D. Member’s symptoms require a time-limited period of intensive treatment for stabilization and successful transitioning back to the community; AND

E. A higher level of care is not required to appropriately treat the member.

II. ICBAT is considered medically necessary when all of the above criteria are met AND

A. The member requires a higher level of intensity of services than can be provided in a CBAT setting, that will include daily psychiatric and pharmacological evaluation and treatment; AND

B. More intensive staffing and service delivery than can be provided at CBAT level of care; AND

C. A higher level of care is not required to appropriately treat the member.

III. CBAT/YCCS and ICBAT are considered investigational for the following:

A. Treatment of acute intoxication or a substance use disorder in the absence of another active DSM-5 mental health diagnosis

B. Treatment of antisocial behavior in the absence of an active DSM-5 diagnosis

C. Treatments of symptoms or behaviors that are due to a condition which cannot be impacted in a short- term treatment setting

D. All other conditions not specified above

Coding Guidance

Code
Description
PA H0017 Behavioral health; residential (hospital residential treatment program), without room and board, per diem
Yes H0018 Behavioral health; short-term residential (non-hospital residential treatment program), without room and board, per diem Yes

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Note: CPT/HCPCS codes are included for informational purposes and may not be all inclusive. Inclusion or exclusion of a CPT/HCPCS code(s) does not signify or imply that the service described by the code is a covered or non-covered health service. Benefit coverage for health services is determined by the member’s specific benefit plan document and applicable laws that may require coverage for a specific service. The inclusion of a code does not imply any right to reimbursement or guarantee of payment. Other policies and coverage determination guidelines may apply.

References

Division of Insurance (2023, January 4). Bulletin 2023-07; Coverage for Certain Behavioral Health Acute Treatment; Issued 1/4/2023.

https://www.mass.gov/doc/bulletin-2023-07-coverage-for-certain-behavioral-health-acute-treatment- issued-january-4-2023/download

Division of Insurance (2018, December 14). Bulletin 2018-07; Access to services to treat child-adolescent mental health disorders; Issued 12/14/18.

https://www.mass.gov/news/bulletin-2018-07-access-to-services-to-treat-child-adolescent-mental-health- disorders-issued-121418

Policy Implementation

Approved by the Medical and Pharmacy Policy Committee

Kate McIntosh MD MBA

Chief Medical Officer

Nathan P. Somers MD

Behavioral Health Medical Director

Date Update 12/16/2009 Initial policy effective date 5/2023 New template. Policy language clarified.
1/2024 Added Line of Business section 2/2024 Youth Clinical Crisis Stabilization services (YCCS) defined 8/14/2025 No changes made

Medical Criteria Disclaimer

Property of Health New England. All rights reserved. The treating physician or primary care provider must submit to Health New England the clinical evidence that the patient meets the criteria for the treatment, testing or surgical procedure. Without this documentation and information, Health New England will not be able to properly review the request for prior authorization. The clinical review criteria reflect how Health New England determines whether certain services or supplies are medically necessary. Health New England established the clinical review criteria based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other

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relevant factors). Health New England expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information. Each benefit program defines which services are covered. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered and/or paid for by Health New England, as some programs exclude coverage for services or supplies that Health New England considers medically necessary. If there is a discrepancy between this guideline and a member's benefits program, the benefits program will govern. In addition, coverage may be mandated by applicable legal requirements of a state, the Federal Government or the Centers for Medicare & Medicaid Services (CMS) for Medicare and Medicaid members. All coding and web site links are accurate at time of publication. Health New England has adopted the herein policy in providing management, administrative and other services to its Health Plan.