HumanaCommercial Clinical Policy

Substance Use Disorder Partial Hospital Program Services - Medicare Advantage Form

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Substance Use Disorder Partial Hospital Program Services

Notes: Humana may consider The ASAM Criteria in interpreting or supplementing the above criteria to determine medical necessity.

Indications

(3069) Are the services reasonably expected to improve or maintain the individual’s condition and functional level and to prevent relapse or hospitalization? 
(3070) Is there a need for active treatment of the condition to maintain a functional level and prevent relapse or hospitalization? 
(3071) Is the member able to cognitively and emotionally participate in the active treatment process and capable of tolerating the intensity of a PHP program? 
(3072) Does the program incorporate an individualized treatment plan with a multidisciplinary team approach to member care under the direction of a physician? 

Contraindications

(3073) Is the PHP service considered primarily a diversionary activity, social or recreational therapy, or vocational rehabilitation? 
Effective Date

01/01/2024

Last Reviewed

NA

Original Document

  Reference



Management Committee

Clinical policy is not intended to preempt the judgment of the reviewing medical director or dictate to health care providers how to practice medicine. Health care providers are expected to exercise their medical judgment in rendering appropriate care.

Coverage Determination

Coverage Limitations

Identification of selected

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