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LOCAT, ABA & ASAM Guidelines

Helping patients get the right care

You want to recommend the best treatment option for your patients. There are several tools that can help.

Level of Care Assessment Tool

Aetna’s Level of Care Assessment Tool (LOCATSM) helps behavioral health professionals determine the levels and types of care that are medically necessary for patients with mental health conditions. 

Go to LOCAT

Applied Behavioral Analysis Guidelines

The Applied Behavioral Analysis (ABA) Guidelines for the Treatment of Autism Spectrum Disorders are nationally recognized guidelines. They help clinicians decide appropriate levels and types  of services that are medically necessary for a patient. These ABA guidelines can help you with the coverage determination process.

Read the ABA guidelines

American Society of Addiction Medicine Criteria

The American Society of Addiction Medicine (ASAM) has a new edition of its criteria. Addiction specialists use these criteria to help them choose treatment options. The criteria also help patients and their families better understand treatment options.

Read the ASAM Criteria for adolescents
Read the ASAM Criteria for adults

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Level of Care Assessment Tool

By clicking on “I Accept”, I acknowledge and accept that:

Aetna's Level of Care Assessment Tool ("LOCAT") serves as a guideline to help determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. LOCAT does not constitute medical advice. Treating providers are solely responsible for medical advice and treatment of members. Members should discuss any matters related to their coverage or condition with their treating provider.

Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply.

The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. The member's benefit plan determines coverage. Some plans exclude coverage for services or supplies that Aetna considers medically necessary.

Please note also that LOCAT may be updated and is, therefore, subject to change.

Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. In addition, a member may have an opportunity for an independent external review of coverage denials based on medical necessity or regarding the experimental and investigational status when the service in question for which the member is financially responsible is $500 or greater. However, applicable state mandates will take precedence with respect to fully insured plans and self-funded non-ERISA (e.g., government, school boards, church) plans.

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Applied Behavioral Analysis Guidelines for Treatment of Autism Spectrum Disorders

By clicking on “I Accept”, I acknowledge and accept that:

The Applied Behavioral Analysis Guidelines for Treatment of Autism Spectrum Disorders (“ABA Guidelines”) are guidelines to help determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. The ABA Guidelines do not constitute medical advice. Treating providers are solely responsible for medical advice and treatment of members. Members should discuss any matters related to their coverage or condition with their treating provider.

Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply.

The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. The member's benefit plan determines coverage. Some plans exclude coverage for services or supplies that Aetna considers medically necessary.

Please note also that the ABA Guidelines may be updated and are, therefore, subject to change.

Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. In addition, a member may have an opportunity for an independent external review of coverage denials based on medical necessity or regarding the experimental and investigational status when the service in question for which the member is financially responsible is $500 or greater. However, applicable state mandates will take precedence with respect to fully insured plans and self-funded non-ERISA (e.g., government, school boards, church) plans.
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