ASAM Criteria 4th Edition Service Updates and Rate Revisions (IB 25-31 revised 11.5.25)
Date: 11/06/25
Louisiana Healthcare Connections is sharing ASAM Criteria 4th Edition Service Updates and Rate Revisions (IB 25-31) was revised on November 5, 2025.
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.
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. The chart excerpt from the Specialized Behavioral Health Services Fee Schedule is for informational purposes
only. Please referto the link above for the most current fee schedule on file.
Questions regarding this Informational Bulletin may be sent to Cindy Casarez at Cindy.Casarez2@la.gov.
A high level overview is below:
Code | Description | Modifier | Unit | Age | Master's Level (HO) | Bachelor's Level (HN) | Less than Bachelor's (HM) | Other Per Diem |
H0001 | ALCOHOL AND/OR DRUG ASSESSMENT - Effective 1/1/2026 |
| Visit | 0-17 | $81.59 | $67.95 | $54.30 |
|
H0001 | ALCOHOL AND/OR DRUG ASSESSMENT - Effective 1/1/2026 |
| Visit | 18+ | $81.59 | $79.81 | $78.03 |
|
H0004 | ALCOHOL AND/OR DRUG SERVICES - INDIVIDUAL - Effective 1/1/2026 |
| 15 min | 0-17 | $17.66 | $15.97 | $14.28 |
|
H0004 | ALCOHOL AND/OR DRUG SERVICES - INDIVIDUAL - Effective 1/1/2026 |
| 15 min | 18+ | $18.57 | $16.80 | $15.02 |
|
H0005 | ALCOHOL AND/OR DRUG SERVICES - GROUP (PER PERSON) - Effective 1/1/2026 | HQ | Visit | 0-17 | $11.54 | $9.84 | $8.15 |
|
H0005 | ALCOHOL AND/OR DRUG SERVICES - GROUP (PER PERSON) - Effective 1/1/2026 | HQ | Visit | 18+ | $11.54 | $11.03 | $10.51 |
|
H0005 | ALCOHOL AND/OR DRUG SERVICES - FAMILY (PER FAMILY MEMBER) - Effective-1/1/2026 | HR or HS | Visit | 0-17 | $26.91 | $22.98 | $19.04 |
|
H0005 | ALCOHOL AND/OR DRUG SERVICES - FAMILY (PER FAMILY MEMBER) - Effective-1/1/2026 | HR or HS |
| 18+ | $26.91 | $25.52 | $24.12 |
|
H0011 | ALCOHOL AND/OR DRUG SERVICES - ACUTE DETOX 3.7-WM - Effective 1/1/2026 | TG | Day | 21+ |
|
|
| $425.61 |
H0014 | ALCOHOL AND/OR DRUG SERVICES - AMBULATORY DETOX 2.7 - Effective 1/1/2026 |
| Day | 0+ |
|
|
| $202.38 |
H0015 | ALCOHOL AND/OR DRUG SERVICES - INTENSIVE OUTPATIENT 2.1 GROUP - Effective 1/1/2026 |
| Day | 0+ | $180.00 | $150.00 | $120.00 |
|
| H2034 | ALCOHOL AND/OR DRUG SERVICES - HALFWAY HOUSE 3.1 - EFFECTIVE 10/1/24 | DAY | 0-17 | $75.19 | ||||
| H2034 | ALCOHOL AND/OR DRUG SERVICES - HALFWAY HOUSE 3.1 - EFFECTIVE 1/1/2026 | DAY | 18+ | $120.26 | ||||
| H2034 | ALCOHOL AND/OR DRUG SERVICES - HALFWAY HOUSE 3.1 (PRENATAL/POST PARTUM) - Effective- 1/1/2026 | TH | Day | 18-59 | $150.55 | |||
| H2036 | ALCOHOL AND/OR DRUG TREATMENT PROGRAM - 3.5 - Effective- 10/1/24 | Day | 0-17 | $265.59 | ||||
| H2036 | ALCOHOL AND/OR DRUG TREATMENT PROGRAM Effective 10/1/24 | TH | Day | 10-17 | $265.59 | |||
| H2036 | ALCOHOL AND/OR DRUG TREATMENT PROGRAM - 3.5 (PRENATAL/POST PARTUM)- Effective 1/1/2026 | TH | Day | 18-59 | $364.24 | |||
| H2036 | ALCOHOL AND/OR DRUG TREATMENT PROGRAM - 3.7 - Effective 1/1/2026 | TG | Day | 18+ | $404.13 |