InterQual® Behavioral Health Criteria

The Adult and Geriatric Psychiatry module supports initial and continued stay decisions across the behavioral health continuum for patients or members aged 18 and older. The criteria allow care managers to consider symptoms, functional status, quality of support systems, and safety as determinants for the most appropriate setting of care.

Designed for patients ages 4 through 17, the Child and Adolescent Psychiatry module helps care managers optimize initial and continued-stay level of care behavioral health decisions. The module’s continuum format lets clinicians address multiple symptoms simultaneously to provide a comprehensive picture of the patient’s condition.  

The Substance Use Disorders module helps clinicians plan and deliver appropriate substance use care for patients and members aged 12 and older. The criteria allow for greater transparency and alignment among stakeholders within and across organizations.   

The Behavioral Health Services module supports medical necessity determinations and documentation for behavioral health procedures including applied behavior analysis, psychological testing, electroconvulsive therapy, neuropsychological testing, and vagus nerve stimulation, as well as other medications, tests, programs and procedures. The module is aligned with our Ambulatory Care Planning Criteria and is presented in the same Q&A format.