ASAM levels of care: the complete Fourth Edition guide
Every ASAM level of care in the Fourth Edition, from 1.0 to 4 Psychiatric: what each one is, its service hours, and which three levels were cut.
In this article
- What changed from the ASAM Third Edition to the Fourth Edition?
- What are the ASAM levels of care in the Fourth Edition?
- Level 1: Outpatient and remission monitoring
- Level 2: Intensive outpatient and high-intensity outpatient
- Level 3: Residential treatment
- Level 4: Medically managed inpatient treatment
- How does ASAM determine the appropriate level of care?
- How ASAM levels of care affect billing and prior authorization
- Common ASAM-related authorization and billing problems
- How AI can support ASAM documentation workflows
- Frequently asked questions about ASAM levels of care
- Sources and further reading
The ASAM levels of care describe a continuum of substance use disorder (SUD) treatment, from early intervention and outpatient services to medically managed inpatient care. The American Society of Addiction Medicine (ASAM) Criteria help clinicians determine the intensity and type of treatment a patient needs based on a multidimensional assessment, rather than diagnosis alone.
The Fourth Edition reorganizes the continuum, adds new levels, integrates withdrawal management into the main structure, and changes how clinicians assess patient needs. For clinicians, treatment center operators, and revenue cycle teams, understanding these changes matters for placement decisions, treatment planning, prior authorization, and continued-stay documentation.
The most important Fourth Edition changes are:
- Three levels are eliminated: Level 0.5, Level 3.2 and Level 3.3.
- Levels 1.7 and 2.7 are added to the continuum for medically managed outpatient treatment.
- Level 2.5 is now called High-Intensity Outpatient, replacing the Partial Hospitalization Program (PHP) terminology.
- Withdrawal management is integrated into the main continuum, rather than being presented as a separate set of levels.
- The six assessment dimensions are updated, with Person-Centered Considerations replacing Readiness to Change as a standalone dimension.
One important distinction: ASAM publishes clinical standards, not regulations. States, Medicaid programs, commercial insurers, and other payers determine when and how the Fourth Edition is adopted. A program's clinical recommendation and the level a payer currently recognizes may therefore differ.
What changed from the ASAM Third Edition to the Fourth Edition?
The Fourth Edition was released in 2023. It retains four broad treatment levels, numbered 1 through 4, but changes the decimal-level structure and integrates medical management more directly into the continuum.
| Area | Third Edition | Fourth Edition |
|---|---|---|
| Level 1 | Outpatient services, with separate withdrawal management designation | Level 1.0 Long-Term Remission Monitoring is introduced; Level 1.5 is Clinically Managed Outpatient |
| Level 1.7 | No equivalent standalone level | Medically Managed Outpatient |
| Level 2 | Intensive outpatient and partial hospitalization, with separate withdrawal management designation | Level 2.1 Intensive Outpatient; Level 2.5 High-Intensity Outpatient; Level 2.7 Medically Managed Intensive Outpatient |
| Level 3 | Residential levels included 3.1, 3.3, 3.5, and 3.7, with separate withdrawal management designations | 3.3 is removed as a distinct level; 3.1 and 3.5 remain clinically managed residential levels; 3.7 is medically managed residential |
| Level 4 | Medically managed intensive inpatient | Level 4 remains hospital-level care, with a separate Level 4 Psychiatric designation |
| Assessment dimensions | Readiness to Change was Dimension 4 | Person-Centered Considerations becomes Dimension 6; readiness to change is considered across dimensions and treatment planning |
Source: ASAM Criteria Fourth Edition and ASAM Criteria FAQ.
1. Levels 0.5, 3.2 and 3.3 are eliminated
Three Third Edition levels are gone from the Fourth Edition continuum.
Level 3.3, Clinically Managed Population-Specific High-Intensity Residential Services, is no longer a separate level.
Level 3.2 WM, Clinically Managed Residential Withdrawal Management, has been integrated into Level 3.5, with the condition that patients in withdrawal, or expected to be, have a medical evaluation before admission.
Level 0.5, Early Intervention, has been removed and replaced with the term Early Intervention and Secondary Prevention. That is not a rename. It repositions early intervention as a public health approach, including primary care and emergency department conversations, rather than a level of addiction treatment.
Sources: Washington State Health Care Authority, ASAM 4th Edition transition guidebook (August 2026) · ASAM Criteria FAQ
This does not mean patients previously treated at 3.3 no longer need residential treatment. Their placement should be reassessed using the Fourth Edition's dimensional admission criteria, the patient's current needs, and the applicable transition policy.
There is no automatic one-to-one conversion from Third Edition 3.3 to Fourth Edition 3.5. A clinician should not simply change the level designation on an existing treatment plan. The updated assessment must support the recommended level, and the payer's implementation requirements must be checked.
2. Levels 1.7 and 2.7 are added
The Fourth Edition adds medically managed outpatient options:
- Level 1.7: Medically Managed Outpatient.
- Level 2.7: Medically Managed Intensive Outpatient.
These levels address patients who need integrated medical management alongside addiction treatment but do not require residential or hospital care.
Medical management can be needed for withdrawal, medication initiation or titration, biomedical conditions, or other needs that cannot be safely and reliably managed through external services alone.
The distinction between 2.1 and 2.7 is not simply the number of treatment hours. Level 2.7 includes integrated medical management when the patient's clinical needs and monitoring requirements call for it.
3. Level 2.5 is renamed High-Intensity Outpatient
Level 2.5 is now called High-Intensity Outpatient (HIOP). It replaces the Partial Hospitalization Program terminology used in the Third Edition.
ASAM explains that PHP is a misnomer because these services are not delivered in a hospital setting. The label changed; the PHP billing codes your payer recognizes may not have.
Level 2.5 provides more intensive clinically managed outpatient treatment than Level 2.1. The Fourth Edition does not define it as a medically managed level. When integrated medical management is required, Level 2.7 may be indicated instead.
The label change does not automatically change a payer's benefit definitions, authorization rules, or billing codes. Clinicians and billing teams should verify how their state and payer have adopted the new terminology.
4. Withdrawal management is integrated into the continuum
In the Third Edition, withdrawal management had separate level designations. The Fourth Edition integrates these services into the main continuum.
| Third Edition withdrawal management level | Fourth Edition integration |
|---|---|
| Level 1 WM | Level 1.7 |
| Level 2 WM | Level 2.7 |
| Level 3.2 WM | Integrated into Level 3.5, with conditions including a pre-admission medical evaluation for patients in or expected to be in withdrawal |
| Level 3.7 WM | Level 3.7 |
This integration reflects the principle that withdrawal management is part of a broader treatment plan, not a standalone episode disconnected from ongoing SUD care.
The required medical capabilities still matter. A patient who needs medically managed withdrawal or medical monitoring beyond a clinically managed program's capacity should not be placed at a lower level simply because the program offers residential services.
5. The six dimensions are updated
The Fourth Edition retains a multidimensional approach but updates the dimension names and how they contribute to placement.
| Dimension | Fourth Edition focus |
|---|---|
| 1 | Intoxication, Withdrawal, and Addiction Medications |
| 2 | Biomedical Conditions |
| 3 | Psychiatric and Cognitive Conditions |
| 4 | Substance Use-Related Risks |
| 5 | Recovery Environment Interactions |
| 6 | Person-Centered Considerations |
The Third Edition's Readiness to Change dimension no longer independently determines the recommended level of care. Readiness remains clinically relevant, but it informs clinical judgment, services, and treatment planning across dimensions.
Dimension 6 addresses barriers to care, social determinants of health, patient preferences, and shared decision-making about the level of care the patient is willing and able to engage in.
The Fourth Edition also distinguishes the Level of Care Assessment from the more comprehensive Treatment Planning Assessment and repeated reassessments. These tools serve different purposes throughout the treatment journey.
What are the ASAM levels of care in the Fourth Edition?
The Fourth Edition continuum includes clinically managed outpatient, medically managed outpatient, residential, and inpatient treatment. Decimal designations distinguish intensity and the type of services provided.
The following overview describes the adult continuum. Adolescent and transition-aged youth standards have their own volume and may differ.
| ASAM level | Name | General treatment setting |
|---|---|---|
| 1.0 | Long-Term Remission Monitoring | Recovery management checkups and rapid reengagement for people in sustained remission |
| 1.5 | Clinically Managed Outpatient | Outpatient SUD treatment without integrated medical management as a defining requirement |
| 1.7 | Medically Managed Outpatient | Outpatient treatment with integrated medical management |
| 2.1 | Intensive Outpatient | Structured, clinically managed outpatient treatment |
| 2.5 | High-Intensity Outpatient | Higher-intensity clinically managed outpatient treatment |
| 2.7 | Medically Managed Intensive Outpatient | Intensive outpatient treatment with integrated medical management |
| 3.1 | Clinically Managed Low-Intensity Residential | Residential support and structured clinical services |
| 3.5 | Clinically Managed High-Intensity Residential | High-intensity residential treatment |
| 3.7 | Medically Managed Residential | Residential treatment with medical management |
| 3.7 BIO | Medically Managed Residential with Enhanced Biomedical Capabilities | Level 3.7 with additional biomedical capabilities |
| 4 | Medically Managed Inpatient | Hospital-level medical management |
| 4 Psychiatric | Medically Managed Inpatient Psychiatric | Hospital-level psychiatric care |
The continuum also includes Co-Occurring Enhanced (COE) designations for specified levels: 1.5 COE, 1.7 COE, 2.5 COE, 2.7 COE, 3.5 COE, and 3.7 COE. Level 4 Psychiatric is separately designated.
COE identifies enhanced capability to provide integrated treatment for co-occurring mental health conditions. It is not simply a label for a patient who has a mental health diagnosis.
The Fourth Edition also identifies recovery residence as a support that may be recommended alongside outpatient care. It is not itself a numbered treatment level.
Level 1: Outpatient and remission monitoring
Level 1.0: Long-Term Remission Monitoring
Level 1.0 is new in the Fourth Edition. It is intended for people in sustained remission who benefit from ongoing recovery management checkups and a clear route back into treatment if needs change.
It reflects a chronic-care approach to SUD. A person may no longer need active treatment at a higher intensity but can still benefit from monitoring, recovery support, and timely reengagement.
Level 1.5: Clinically Managed Outpatient
Level 1.5 provides clinically managed outpatient SUD treatment. Patients attend scheduled services while continuing to live in their usual environment.
It may be appropriate when the person's needs can be addressed through outpatient clinical services and they do not require the greater intensity of Level 2 treatment, residential support, or integrated medical management.
Documentation should connect the patient's risks and functioning to the outpatient treatment plan, including why a more intensive setting is not currently required.
Level 1.7: Medically Managed Outpatient
Level 1.7 adds integrated medical management to outpatient addiction treatment.
It may be indicated when a patient needs medical assessment, medication initiation or titration, withdrawal-related care, or monitoring of biomedical or psychiatric concerns that can be managed safely in an outpatient setting.
The decision should reflect both the severity of the patient's symptoms and how frequently medical management or nursing monitoring is needed.
Level 2: Intensive outpatient and high-intensity outpatient
Level 2.1: Intensive Outpatient
Level 2.1 provides structured, clinically managed treatment while the patient continues living outside a residential setting.
It may be appropriate when outpatient treatment at Level 1.5 is not sufficient to address the patient's substance use-related risks, functioning, or recovery environment, but residential treatment is not indicated. Our Level 2.1 guide covers eligibility, service hours and billing in detail, and IOP billing codes covers the coding side.
Clinicians should document why the patient needs more structure and treatment intensity than standard outpatient services and how the proposed schedule and interventions address those needs.
Level 2.5: High-Intensity Outpatient
Level 2.5 is the Fourth Edition's High-Intensity Outpatient level. It is designed for patients who need a higher intensity of clinically managed outpatient services than Level 2.1.
Service-hour expectations under the Fourth Edition run roughly as follows: under 9 hours a week at Level 1.5, 9 to 19 hours at Level 2.1, and more than 20 hours at Level 2.5. Level 3.1 sits at 9 to 19 hours available seven days a week, and Level 3.5 at more than 20 hours available seven days a week.
These are service characteristics, not billing thresholds. A payer's authorization and unit rules are separate, and they frequently differ.
Sources: Washington State Health Care Authority, ASAM 4th Edition service grid · Virginia Administrative Code 12VAC30-130-5090
Level 2.5 does not itself provide the integrated medical management that defines Level 2.7. If the patient needs medical management for withdrawal, medication initiation or titration, or significant biomedical concerns, the clinician should evaluate whether Level 2.7 or a more intensive level is indicated.
Level 2.7: Medically Managed Intensive Outpatient
Level 2.7 combines intensive outpatient addiction treatment with integrated medical management.
It may be appropriate when the patient can remain in the community but needs more frequent or integrated medical care than Level 2.1 or 2.5 provides.
For example, a patient may need intensive psychosocial treatment alongside medication titration and regular medical monitoring. The assessment should establish why these services need to be integrated with addiction treatment rather than coordinated entirely through outside providers.
Level 3: Residential treatment
Level 3 includes residential services, with differences in clinical intensity and medical capabilities. Residential care is not the same as hospital inpatient care.
Level 3.1: Clinically Managed Low-Intensity Residential
Level 3.1 provides a structured residential setting with clinical services and support for daily functioning and recovery.
It may be indicated when the patient needs a stable living environment and structured support but does not require the intensity of Level 3.5 or the medical management of Level 3.7.
The assessment should explain why the patient's current environment is insufficient to support recovery and what residential structure is expected to address.
Level 3.5: Clinically Managed High-Intensity Residential
Level 3.5 provides high-intensity residential treatment for patients whose needs require a structured, 24-hour treatment environment and intensive clinical services.
It may be indicated when substance use-related risks, difficulty functioning in the current environment, or other dimensional needs cannot be adequately addressed in outpatient or lower-intensity residential care.
Level 3.5 is clinically managed, not medically managed. A program must have appropriate clinical staffing, emergency procedures, and access to medical services, but it is not designed to substitute for a medically managed setting when the patient requires that level of care.
The Fourth Edition also includes Level 3.5 COE for programs with enhanced capabilities to treat co-occurring mental health conditions. Our Level 3.5 guide covers who qualifies, the 3.5 against 3.7 boundary, and what happened to Level 3.3.
Level 3.7: Medically Managed Residential
Level 3.7 provides residential treatment with integrated medical management. It is intended for patients whose needs require medical oversight and services beyond the capabilities of clinically managed residential treatment.
Medical management may be needed for withdrawal, biomedical conditions, addiction medication, or psychiatric and cognitive conditions that require more intensive medical involvement.
The key distinction from Level 3.5 is not simply greater clinical intensity. It is the patient's need for medical management and the program's capacity to provide it.
Level 3.7 BIO: Enhanced Biomedical Capabilities
Level 3.7 BIO adds enhanced biomedical capabilities to medically managed residential treatment.
It is intended for patients with biomedical comorbidities requiring capabilities beyond standard Level 3.7. The designation should be supported by the patient's actual medical needs and the program's ability to provide the required services.
What happened to Level 3.3?
Level 3.3 was the Third Edition's Clinically Managed Population-Specific High-Intensity Residential Services designation. It is no longer a distinct level in the Fourth Edition.
The Fourth Edition does not establish an automatic conversion from 3.3 to 3.5. The patient's current needs must be reassessed using the Fourth Edition's dimensional criteria, and the resulting recommendation should reflect the required clinical intensity and capabilities.
For programs transitioning from the Third Edition, review:
- Whether the payer or state has formally adopted the Fourth Edition.
- Whether existing authorizations remain valid during the transition.
- How the payer maps legacy 3.3 authorizations to its current benefit structure.
- Whether the patient's current assessment supports 3.1, 3.5, 3.7, or another level.
A legacy authorization or program label alone is not sufficient evidence of current medical necessity.
Level 4: Medically managed inpatient treatment
Level 4 is hospital-level care. It is distinct from residential treatment because the setting operates within a hospital's broader regulatory and clinical framework.
Level 4: Medically Managed Inpatient
Level 4 is appropriate when the patient requires hospital-level medical management that cannot be safely delivered in a residential or outpatient setting.
The Fourth Edition determination rules direct patients requiring Level 4 in any relevant subdimension to hospital-level care or transfer.
Level 4 Psychiatric
Level 4 Psychiatric is a hospital-level psychiatric designation for patients whose needs require that level of psychiatric care.
It is distinct from a residential program that offers routine psychiatric consultation or co-occurring capable services. The designation reflects the patient's assessed need for hospital-level psychiatric treatment.
How does ASAM determine the appropriate level of care?
ASAM placement is based on a multidimensional assessment, not solely on the substance used, a diagnosis, a requested length of stay, or a program's available bed.
The Fourth Edition separates three assessment activities:
- Level of Care Assessment: Collects the information needed to identify the appropriate level of care.
- Treatment Planning Assessment: Provides a fuller biopsychosocial assessment to develop an individualized treatment plan.
- Repeated assessments: Track progress, identify new needs, update the plan, and guide transitions to more or less intensive treatment.
The adult Fourth Edition assessment guide uses dimensions 1 through 5 to develop the level recommendation. Dimension 6 is addressed through shared decision-making to determine which level the patient is willing and able to engage in. Our guide to the level of care assessment walks through that process step by step.
The placement process
At a high level, the determination rules consider the most intensive need identified across the relevant subdimensions:
| Clinical need identified | General placement direction |
|---|---|
| Hospital-level medical or psychiatric need | Level 4 or Level 4 Psychiatric, as indicated |
| Need for medically managed care, with residential-level needs | Level 3.7 or 3.7 BIO, depending on biomedical needs |
| Need for medically managed care with outpatient-level needs | Level 2.7 or 1.7, depending on the intensity of treatment required |
| Need for clinically managed residential care | Level 3.5 or 3.1, based on the intensity of clinical services required |
| Need for clinically managed outpatient care | Level 2.5, 2.1, or 1.5, based on the highest indicated outpatient intensity |
This is a simplified overview, not a substitute for the Fourth Edition's complete determination rules and assessment guide. Clinicians should use the official tools and the applicable state or payer implementation requirements.
How ASAM levels of care affect billing and prior authorization
A clinically appropriate ASAM recommendation does not automatically guarantee payment. Payers may have different adoption dates, covered services, authorization rules, documentation requirements, and billing code structures.
For billing and utilization review, the central task is to connect the patient's assessed needs to the services actually delivered.
1. Confirm which edition the payer recognizes
Before submitting a request, verify whether the payer uses the Third Edition, Fourth Edition, or a state-specific adaptation.
Check the payer's provider manual, authorization portal, fee schedule, and applicable state Medicaid guidance. Confirm how the payer treats renamed or newly introduced levels, including 1.7, 2.7, and the new Level 2.5 terminology.
Do not assume a new ASAM designation automatically has a separate billing code or is covered under the same benefit as its predecessor.
2. Connect the assessment to medical necessity
The assessment should explain why the patient needs the recommended level rather than a less intensive setting.
A useful clinical narrative addresses:
- The specific dimensional risks and needs supporting placement.
- Why lower-intensity services are insufficient.
- The clinical services, staffing, and monitoring the patient requires.
- How the treatment plan addresses the identified needs.
- Why the program has the capabilities required to deliver the recommended care.
A diagnosis or a statement that the patient needs "more structure" does not replace the dimensional rationale.
3. Document continued stay and transition decisions
ASAM supports treatment duration based on the patient's progress and evolving needs rather than a predetermined number of days.
For continued-stay requests, document the patient's current functioning, remaining risks, response to treatment, and why the current level remains necessary. Include the anticipated transition plan and the services or supports needed at the next level.
If the patient's needs increase, reassess whether a more intensive level is indicated. If the patient no longer requires the current intensity, document the rationale for step-down and the supports needed to maintain progress.
4. Avoid treating ASAM levels as universal billing codes
ASAM level designations describe clinical service intensity and capabilities. They are not universal CPT, HCPCS, or revenue codes.
The same clinical level may be reimbursed differently across state Medicaid programs, commercial payers, and contracts. Confirm the applicable code set, authorization rules, place-of-service requirements, and program certification before billing.
For more on denials and payer documentation, see our behavioral health billing guide for treatment centers and the ASAM Criteria explainer, which covers why payer policies and clinical editions drift apart.
Common ASAM-related authorization and billing problems
| Problem | Why it creates risk | Documentation response |
|---|---|---|
| Using a Third Edition level without checking payer adoption | The payer may use a different edition or transition mapping | State the assessment edition and verify the payer's current requirements |
| Treating 3.3 as automatically equivalent to 3.5 | Fourth Edition does not provide a universal one-to-one conversion | Reassess current needs and document the dimensional rationale |
| Recommending 2.5 when medical management is required | Level 2.5 is clinically managed; Level 2.7 includes integrated medical management | Document medical and nursing needs and evaluate the appropriate medically managed level |
| Confusing residential care with hospital inpatient care | Levels 3 and 4 have different settings and capabilities | Describe the actual setting and the medical or psychiatric services required |
| Submitting a diagnosis without a dimensional narrative | A diagnosis alone does not establish the required treatment intensity | Link specific risks and functional needs to the requested level |
| Repeating the admission rationale in continued-stay requests | The patient's current condition and treatment response may have changed | Update current risks, response, remaining needs, and transition criteria |
How AI can support ASAM documentation workflows
AI can assist with documentation and revenue cycle tasks, but it should not independently assign a level of care or replace a qualified clinician's assessment.
When used within approved privacy and security workflows, AI-supported tools can help teams organize clinical information, identify missing documentation, and prepare records for review.
For example, an AI-assisted workflow may help a clinician or reviewer:
- Organize assessment findings by the relevant ASAM dimensions.
- Flag when the narrative does not clearly explain why a lower level is insufficient.
- Identify missing information in an authorization or continued-stay packet.
- Compare a draft treatment plan with the documented clinical needs.
- Prepare a summary for a qualified clinician or utilization review professional to verify.
The clinician remains responsible for the assessment, placement recommendation, and clinical rationale. Staff should verify all generated content against the original record, current ASAM materials, payer rules, and applicable law.
ASAM also places restrictions on inputting its copyrighted Criteria and intellectual property into AI systems. Organizations should review ASAM's current terms and use only tools and workflows authorized for the materials involved.
For treatment centers managing documentation, claims and payer follow-up, our behavioral health billing resource has the operational context, and prior authorization in behavioral health covers the review step itself.
Frequently asked questions about ASAM levels of care
What are the ASAM levels of care?
The Fourth Edition includes Levels 1.0, 1.5, 1.7, 2.1, 2.5, 2.7, 3.1, 3.5, 3.7, 3.7 BIO, 4, and 4 Psychiatric, along with specified Co-Occurring Enhanced variants. The levels range from long-term remission monitoring and outpatient treatment to residential and hospital-level care.
What is Level 2.5 of care in the ASAM Criteria?
Level 2.5 is High-Intensity Outpatient (HIOP) in the Fourth Edition. It replaces the Partial Hospitalization Program terminology. It provides intensive clinically managed outpatient treatment and does not itself include the integrated medical management that defines Level 2.7.
What is the difference between ASAM 2.1 and 2.5?
Both are clinically managed outpatient levels. Level 2.5 provides a higher intensity of outpatient clinical services than Level 2.1. The appropriate level depends on the patient's assessed needs and the Fourth Edition determination rules, not solely on hours attended.
What is the difference between ASAM 2.5 and 2.7?
Level 2.5 is High-Intensity Outpatient and is clinically managed. Level 2.7 is Medically Managed Intensive Outpatient and includes integrated medical management. The distinction is based on the patient's need for medical management and the intensity of outpatient treatment required.
What happened to ASAM Level 3.3?
Level 3.3, Clinically Managed Population-Specific High-Intensity Residential Services, was eliminated as a distinct level in the Fourth Edition. Patients previously placed at 3.3 should be reassessed under the Fourth Edition. There is no automatic one-to-one conversion to 3.5.
What is the difference between ASAM 3.5 and 3.7?
Level 3.5 is Clinically Managed High-Intensity Residential Treatment. Level 3.7 is Medically Managed Residential Treatment. Level 3.7 is intended for patients who need integrated medical management beyond the capabilities of clinically managed residential treatment.
Is ASAM the same as a payer's medical necessity policy?
No. ASAM provides a clinical framework for assessment, placement, treatment planning, and transitions. States and payers determine whether and how the Criteria are adopted into their regulations, coverage policies, and authorization requirements. Clinicians should use the applicable edition and payer-specific rules.
What happened to ASAM Level 0.5?
Level 0.5, Early Intervention, was removed. It is replaced by the term Early Intervention and Secondary Prevention, which repositions the work as a broad public health approach, including conversations in primary care and emergency departments, rather than a level of addiction treatment. That is a change in what the service is, not a relabel, so do not look for a Fourth Edition equivalent code.
How many hours a week is each ASAM level?
Under the Fourth Edition: below 9 hours at Level 1.5, 9 to 19 at Level 2.1, more than 20 at Level 2.5. On the residential side, Level 3.1 is 9 to 19 hours available seven days a week and Level 3.5 is more than 20 hours available seven days a week. These are service characteristics. Your payer's authorization and unit rules are set separately.
Are there separate ASAM levels for adolescents?
Yes. Volume 2, Adolescents and Transition-Aged Youth, went digital on March 31, 2026 and to print in June 2026, and it uses its own designations, such as Level 1.5Y and Level 2.1Y. Use the volume that matches the patient, and check which one your state and payer have adopted.
When did the ASAM Fourth Edition take effect?
ASAM released the Fourth Edition in 2023. There is no single universal implementation date for every state and payer. ASAM states that public entities and payers determine when to adopt the standards into their networks or regulatory frameworks.
Sources and further reading
- American Society of Addiction Medicine. ASAM Criteria Fourth Edition.
- American Society of Addiction Medicine. About the ASAM Criteria.
- American Society of Addiction Medicine. ASAM Criteria FAQ.
- American Society of Addiction Medicine. Fourth Edition Assessment Guides.
- American Society of Addiction Medicine. ASAM Criteria.
- American Society of Addiction Medicine. Implementation Tools.
- Washington State Health Care Authority. (2026, August). Transition to the American Society of Addiction Medicine Criteria, 4th Edition. https://www.hca.wa.gov/assets/billers-and-providers/asam-fourth-edition-transition-guidebook.pdf
- Virginia Administrative Code. 12VAC30-130-5090, intensive outpatient services (ASAM Level 2.1).
- Supa. The ASAM Criteria explained.
- Supa. ASAM level of care assessment.
- Supa. Behavioral health billing for treatment centers.
This guide is for educational purposes and is not a substitute for the full ASAM Criteria, clinical judgment, payer policy, or legal advice. Confirm current state and payer requirements before making placement, authorization, or billing decisions.
RCM expert at Supa. 20+ years building revenue cycle operations in healthcare; Adjunct Professor at Concordia University-St. Paul teaching healthcare MBA.
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