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ASAM Criteria 4th Edition Service Updates and Rate Revisions (IB 25-31)

Date: 10/17/25

Louisiana Healthcare Connections is sharing ASAM Criteria 4th Edition Service Updates and Rate Revisions (IB 25-31) updates to take effect January 1, 2026.

During the 2025 Regular Legislative Session, the Louisiana Legislature appropriated funding to support a rate increase for substance use disorder service providers. The Louisiana Department of Health (LDH) will implement this increase by adopting new rates developed by LDH’s thirdparty actuaries in alignment with the 4th Edition of the American Society of Addiction Medicine (ASAM) Criteria OR by maintaining the temporary 25% rate increase implemented in State Fiscal Year 2025 (effective October 1, 2024), whichever is higher.

ASAM 4th Edition changes will be effective January 1, 2026 for beneficiaries who are 18 or older. Louisiana Medicaid has updated the Specialized Behavioral Health Services (SBHS) fee schedule to reflect the changes in rates and services.

Note: Room and Board rates have been removed from the SBHS fee schedule as these are not State Plan services and are payable at the discretion of Louisiana Healthcare Connections. 

A large number of codes have been added and removed. Providers should review the entire IB for additional informaiton. A high level overview is below:

  • ASAM procedure codes updated and/or removed in alignment with the 4th Edition of the American Society of Addiction Medicine (ASAM) – effective 1.1.2026.  A related Informational Bulletin is under review and will be published shortly. 
  • Age groupings for these ASAM services have been revised to 0-17 and 18+.
  • Rates for these ASAM services have been adjusted to reflect a sliding reimbursement based on degree level.  This may have resulted in decreases for Bachelors and Less than Bachelors rates from the previously published fee schedule.
  • All coding and rates for room and board were removed.  These are not State Plan covered services, but may be paid out by the MCE at their discretion and in consideration of existing federal and state regulations/guidance
  • Prenatal/Post-Partum terminology has been updated to Pregnant/Parenting throughout the fee schedule
  • The telemedicine modifier description has been updated to reflect that it is relative to all eligible services, and not necessarily limited to CPT codes.  All limitations and guidelines related to telehealth still apply. 
  • The description for the HF modifier was updated to reflect that it is also applicable to a Licensed Addiction Counselor.

Louisiana Healthcare Connections will update our claims processing systems to properly adjudicate the ASAM service rates and new age brackets within 90 days of the bulletin.

Also, we will recycle any impacted claims with the date of service on or after January 1, 2026 within 15 days of implementing the system changes.

Questions regarding this Informational Bulletin may be sent to Cindy Casarez at Cindy.Casarez2@la.gov.