ASAM Criteria

ASAM (American Society of Addiction Medicine) Criteria is the standard assessment framework for matching patients to the appropriate level of substance use treatment. Currently in its 4th Edition (published October 2023), which most commercial payers now reference in their medical-necessity policies. The criteria evaluate six dimensions including withdrawal risk, biomedical conditions, emotional/behavioral conditions, readiness for change, relapse potential, and recovery/living environment to recommend a level of care from outpatient through medically managed inpatient. ASAM-aware EMRs like Navix automate parts of this assessment and flag mismatches between documented dimensions and the assigned level of care.