# Carelu > Carelu is the front office of care — an AI intake and lead-response platform for ABA therapy and behavioral-health providers. When a family reaches out by phone, chat, web form, or text, Carelu answers instantly, completes the intake, gathers records, and verifies insurance eligibility — so providers admit more families with the same team, instead of losing them to slow follow-up or after-hours gaps. Carelu is built specifically for Applied Behavior Analysis (ABA) and behavioral-health organizations of every size, from single-site clinics to multi-site groups and enterprise providers. It is HIPAA compliant, SOC 2 Type II, and signs a BAA with every provider. ## Machine-readable versions - [llms-full.txt](https://carelu.com/llms-full.txt): every Carelu article in full, plus the index of all ABA payer guides, as plain Markdown. - [Payer directory index (Markdown)](https://carelu.com/payers.md): every ABA payer guide by state, with links to each guide's Markdown twin at https://carelu.com/payers/.md (coverage rules, prior authorization, diagnosis requirements, code-level coverage, Medicaid rates and sources). - Every article is also available as Markdown at https://carelu.com/resources/.md. ## What Carelu does - **Answers every inbound family, 24/7** — across phone calls, live chat, web forms, and text. No missed calls, no after-hours voicemail, no lead sitting in an inbox overnight. - **Completes intake end to end** — from first contact to admitted patient: greeting, scheduling, collecting demographics and documents, and verifying insurance eligibility up front. - **Verifies insurance and benefits** before a human ever picks up, so staff spend time on the families most likely to start care. - **Unifies every channel into one live queue** — phone, chat, forms, faxes, and EHR referrals land in a single, searchable place with live status on each family. - **Frees your team for the human work** — the calls and the trust only people can build. Carelu handles the rote front-office work around them. ## Who it is for - ABA therapy providers (single-site, multi-site, and enterprise) - Behavioral-health and autism-services organizations - Home care, mental health, addiction treatment, hospice, IDD (intellectual and developmental disability) services, and adult day program intake teams ## The problem Carelu solves ABA and behavioral-health providers lose a large share of new families to slow or after-hours intake — industry drop-off between first inquiry and first appointment commonly runs 40–85%. Families reach out to several providers at once; the first one to actually respond and complete intake wins the placement. Carelu makes sure that is always you, without adding front-desk headcount. ## Key pages - [Home](https://carelu.com/): What Carelu is and how it runs your entire intake. - [For ABA therapy](https://carelu.com/for/aba-therapy): Intake and lead response built for ABA providers. - [For home care](https://carelu.com/for/home-care): Intake automation for home-care agencies. - [For mental health](https://carelu.com/for/mental-health): Intake for mental-health practices. - [For addiction treatment](https://carelu.com/for/addiction-treatment): Fast, compassionate intake for treatment centers. - [For hospice](https://carelu.com/for/hospice): Compassionate, rapid intake for hospice providers. - [For IDD services](https://carelu.com/for/idd): Intake for intellectual and developmental disability service providers — families, support coordinators, waivers, and documents. - [For adult day programs](https://carelu.com/for/adult-day-programs): Enrollment intake for adult day programs — caregivers, case managers, funding, tours, and paperwork. - [Single-site clinics](https://carelu.com/solutions/single-site): Carelu for a single location. - [Multi-site groups](https://carelu.com/solutions/multi-site): Carelu across multiple locations. - [Enterprise](https://carelu.com/solutions/enterprise): Carelu for enterprise provider networks. - [Company](https://carelu.com/carelu/company): About Carelu. - [Book a demo](https://carelu.com/demo): See Carelu handle a live intake. ## Original research & tools - [The Intake Gap (research report)](https://carelu.com/research/the-intake-gap): Carelu Research's Intake Data Report №1 — findings from 185,054 family conversations across 120 ABA provider organizations in 48 states (aggregated and de-identified). Key statistics: 48% of family conversations start outside business hours; median same-store demand grew 35% year over year; Georgia and North Carolina together account for 27% of national demand; 46% of families report Medicaid as their payer; 22% of families reach out before receiving a diagnosis; providers whose intake feeds their CRM grew about 7x faster month over month (observational). Citable with attribution: Carelu Research, "The Intake Gap" (2026). - [ROI Calculator](https://carelu.com/tools/intake-leak-calculator): Free interactive tool — enter monthly intakes and what an intake is worth per year to see the additional families and annual profit a 40% intake uplift with Carelu adds. ## Guides & resources - [The Carelu Blog](https://carelu.com/blog): Index of every Carelu guide for ABA practice owners, grouped by topic: growing a practice, intake and operations, payers and billing, research and tools. - [ABA waitlist management](https://carelu.com/resources/aba-waitlist-management): How to keep waitlisted families engaged, verified, and ready to start — with a free intake checklist. - [The ABA client intake process](https://carelu.com/resources/aba-client-intake-process): Step-by-step intake from first contact to first session, with benchmarks for each step, a full ABA intake document library (35 documents with how often each is really required), state-by-state diagnosis and referral requirements across 19 states, and templated conditions for when to show or hide each document. - [ABA intake forms](https://carelu.com/resources/aba-intake-forms): The seven sections every intake packet needs, plus a free printable form template. - [ABA intake drop-off](https://carelu.com/resources/aba-intake-drop-off): Why 40–85% of families disappear between inquiry and first session, and how to fix each leak. - [Free ABA intake checklist (PDF)](https://carelu.com/downloads/aba-intake-checklist.pdf): Printable checklist covering the full intake process. - [Free ABA intake form template (PDF)](https://carelu.com/downloads/aba-intake-form-template.pdf): Printable intake packet template with all seven sections. - [Consent & authorization templates (PDF)](https://carelu.com/downloads/aba-consent-packet-templates.pdf): Five adaptable templates — consent to treat and service agreement, privacy acknowledgement, communication consent for email/text, financial responsibility, release of information. - [Records request templates (PDF)](https://carelu.com/downloads/aba-records-request-templates.pdf): Records request to a diagnosing clinician, fax cover sheet, physician referral and order request, short diagnosis confirmation form. - [Consent authority templates (PDF)](https://carelu.com/downloads/aba-consent-authority-templates.pdf): Consent authority attestation, authorized representative designation, foster care and agency consent record. - [Setting consent templates (PDF)](https://carelu.com/downloads/aba-setting-consent-templates.pdf): Telehealth consent, photo and recording release, in-home safety and access agreement, community outing permission. - [Document requirements worksheet (PDF)](https://carelu.com/downloads/aba-document-requirements-worksheet.pdf): Worksheet for recording what a state and payer require, and turning it into conditional intake-form rules. - [Free pediatrician email and phone list (pediatric referral contacts)](https://carelu.com/resources/pediatrician-referral-contacts): Free CSV dataset of 150,325 pediatricians and child-development professionals across all 50 U.S. states and Washington D.C. — names, titles, organizations, locations, 9,721 verified emails, and 149,475 phone numbers (direct lines where verified, practice lines otherwise, each labeled) — built on the federal NPI registry and enriched through dozens of provider sources, for building pediatrician referral relationships. Downloadable per state or combined. Each state has a browsable directory page at /resources/pediatrician-referral-contacts/ (e.g. /california, /texas, /new-york) with the contact table, role breakdown, and top cities and organizations. ## Growing an ABA practice (channel & operations playbooks) - [How to grow an ABA practice](https://carelu.com/resources/how-to-grow-an-aba-practice): The pillar playbook — the growth equation (inquiries x answered x qualified x documents x verified x started), the five channels that produce ABA families (Google Ads, Meta, SEO and AI search, physician and school referrals, and the families a practice already has), the order of operations for fixing intake before buying demand, and the scoreboard to run it on. Includes demand data from 185,054 family conversations: +35% median year-over-year inquiry growth, Georgia and North Carolina at 27% of national demand, 46% Medicaid, 48% after hours, a median of about 24 leads a month per provider, and the top payers named in each of 12 states. - [Google Ads for ABA](https://carelu.com/resources/google-ads-for-aba): Campaign structure, payer-qualified keywords, the negative-keyword list (employment and training terms are the largest source of waste), landing-page rules, call tracking, ad scheduling versus after-hours coverage, and measuring cost per started client rather than cost per lead. - [Meta ads for ABA](https://carelu.com/resources/meta-ads-for-aba): Reaching parents before they search, why borrowed intent decays within minutes, targeting without restricted health interests, creative that speaks to the worry rather than the modality, instant forms versus landing pages, the five-minute response discipline, and feeding downstream conversions back to the platform. - [SEO for ABA practices (and AI search)](https://carelu.com/resources/seo-for-aba-practices): The three kinds of ABA search, the location and payer pages worth building, why Google Business Profile outranks the website for "near me," and what changes when a parent asks an AI assistant instead of reading a results page. Extended treatment of reviews — why recency, volume and specificity matter, the trigger/owner/one-tap/reminder mechanics of asking, why review gating and incentives are off limits, how to respond without confirming someone is a client, and how Carelu sends the review request by text at the moment you choose. - [ABA pediatrician referrals](https://carelu.com/resources/aba-pediatrician-referrals): Who actually decides where referrals go, the one-page leave-behind, the four-touch loop that keeps a referral stream alive (acknowledge same day, report contact, report outcome, decline fast), removing friction from how offices refer, and tracking referrals as a channel. - [ABA records requests and releases](https://carelu.com/resources/aba-records-request): Why diagnostic reports stall a start, the required elements of a valid HIPAA authorization, when one general ROI can cover a class of recipients (HIPAA requires the name or other specific identification of the person(s) or class of persons — categories such as "Primary Care Physicians," "School Personnel," or "Treating Providers involved in the client's care" are generally appropriate), how to identify the child and signer so a request is fulfilled first time, and a day-three/day-seven chase schedule. - [ABA leads without a diagnosis](https://carelu.com/resources/aba-evaluation-referrals): 22% of families reach out before receiving a diagnosis. Checking whether the payer and state actually require one, building a named evaluation referral path, owning the months of waiting, and counting the cohort as its own channel. - [ABA follow-up sequences](https://carelu.com/resources/aba-follow-up-sequences): Why "thank you for your inquiry" loses families, the six elements of a follow-up that earns a reply, cadence from minutes to a monthly hold, segmenting by what is blocking the start, what should never be automated, and consent guardrails. - [ABA intake metrics](https://carelu.com/resources/aba-intake-metrics): The eight numbers — inquiries by channel, answer rate, speed to first contact, after-hours share, qualified rate and reasons, intake completion, verification turnaround, inquiry-to-started and days to start — plus cost per started client, attribution back to ad channels, and the weekly twenty-minute review. Includes the test that separates a lead-quality problem from an intake problem: call within minutes for two weeks, and conclude the channel is at fault only if both halves fail — very few families respond even to an immediate call, and very few of those who do are in the service area, on an accepted payer, or in the age band. - [After-hours intake coverage for ABA](https://carelu.com/resources/after-hours-intake-coverage): 48% of family contacts arrive outside business hours. What parents do when they reach voicemail, the four coverage options compared, why taking a message is not coverage, and how to measure whether after-hours conversion matches business-hours conversion. - [Who should answer your ABA intake line](https://carelu.com/resources/who-should-answer-aba-intake-calls): Intake coordinator vs. BCBA vs. owner vs. answering service. Speed is table stakes and trust wins the family: among Carelu's providers, the fastest-growing have a BCBA or the owner talk to every qualified family early (often the same day) while an always-on intake layer answers every inquiry instantly and qualifies it. Covers who calls (48% after hours, 22% pre-diagnosis, median child age 6 with 27% aged 10+, 40% of website leads are job seekers), how to run the same-day trust call, and what to measure. ## Answers (billing, software and AI questions) - [ABA CPT codes 97151–97158 explained](https://carelu.com/resources/aba-cpt-codes): All ten ABA codes (97151–97158, 0362T, 0373T) in plain language: who renders each, 15-minute units and the CPT midpoint rule, CMS daily unit limits (97153 = 32 units/day), 97153 + 97155 concurrent billing, HM/HN/HO/HP credential modifiers, the two-step prior authorization, the five most common denial reasons, and current published Medicaid rates for 97153 and 97155 in 15 states (e.g. North Carolina $20.81 / $32.22, Utah $19.67 / $37.51, New York $14.45 / $19.26 per unit). - [Best ABA intake software (2026)](https://carelu.com/resources/best-aba-intake-software): A buyer's guide: the four kinds of intake tools ABA practices use (practice-management intake modules, general CRMs, answering services, AI intake platforms), what each does well and poorly, twelve questions to ask every vendor, and a two-week test on real traffic before buying. - [AI for ABA practices](https://carelu.com/resources/ai-for-aba-practices): Where AI helps an ABA practice grow (answering every inquiry 24/7, qualification, intake, benefits verification, follow-up, marketing attribution, recruiting), AI receptionist vs. answering service, what AI should never decide (medical necessity, hours, treatment plans), the HIPAA/BAA/SOC 2 guardrails, and how to start with after-hours coverage. ## Payer guides (ABA coverage & prior authorization) - [ABA payer directory and prior authorization by payer](https://carelu.com/payers): Coverage and prior-authorization guides for 285 payers across 27 states plus national plans: every state Medicaid program, every Medicaid managed care plan, and the commercial insurers in each state. Includes a table of whether each payer requires prior authorization for the ABA assessment (97151) and for treatment, source-verified, plus a searchable database of every policy rule (CPT codes, documentation, supervision, telehealth, reauthorization), each linked to its primary source. - [CareSource Georgia (Medicaid CMO) ABA guide](https://carelu.com/payers/caresource-georgia): How CareSource administers the GA Medicaid ABA benefit under MCD-MM-0212 (aligned to the DCH manual), with in-house PA and a 2026 reimbursement change. - [Peach State Health Plan (GA Medicaid CMO) ABA guide](https://carelu.com/payers/peach-state-georgia): GA.CP.BH.504 — hour parameters, the 80%-attendance rule, and 0373T requirements. - [Amerigroup Georgia (Medicaid CMO) ABA guide](https://carelu.com/payers/amerigroup-georgia): CG-BEH-02 adaptive behavioral treatment, aligned to the DCH manual. - [Georgia Medicaid ABA guide](https://carelu.com/payers/georgia-medicaid): Coverage under EPSDT for members under 21, Katie Beckett access for higher-income families, separate assessment and treatment prior authorizations in 6-month increments, CMO landscape, codes and modifiers. - [Aetna ABA guide](https://carelu.com/payers/aetna): ASD-only coverage under CPB 0554, precertification via form GR-69017-4 (eff. 1/1/2026), provider qualifications, telehealth codes. - [Cigna ABA guide](https://carelu.com/payers/cigna): No prior auth on assessment codes; treatment authorization under EN0499; treatment-plan and session-note standards; all ABA codes covered via telehealth. - [UnitedHealthcare / Optum ABA guide](https://carelu.com/payers/unitedhealthcare-optum): Two-step authorization via Provider Express, 4–6 month reviews, code clusters, 80% utilization threshold, telehealth attestation. - [Anthem BCBS Georgia ABA guide](https://carelu.com/payers/anthem-bcbs-georgia): CG-BEH-02 criteria, billing and documentation rules, and how Ava's Law and MHPAEA parity affect Georgia coverage. - [North Carolina Medicaid ABA guide](https://carelu.com/payers/north-carolina-medicaid): ABA as Research-Based Behavioral Health Treatment (RB-BHT) under Clinical Coverage Policy 8F — under 21, service authorization, 6-month treatment-plan reviews. - [Indiana Medicaid (IHCP) ABA guide](https://carelu.com/payers/indiana-medicaid): Medically necessary ABA with prior auth on all services; 2026 shift to EPSDT-only and the under-21 limit; telehealth restrictions. - [Virginia Medicaid (DMAS) ABA guide](https://carelu.com/payers/virginia-medicaid): EPSDT coverage under 21, prior authorization with per-code unit requests (eff. Oct 2025), diagnosis and FBA documentation. - [TennCare (Tennessee Medicaid) ABA guide](https://carelu.com/payers/tenncare-tennessee-medicaid): Coverage through age 21 via EPSDT with no annual benefit limit, prior auth and medical necessity, TN LBA licensure, MCO administration. - [Ohio Medicaid ABA guide](https://carelu.com/payers/ohio-medicaid): Adaptive behavior services under Ohio Administrative Code 5160-34-02 — prior auth on all ABA, DSM-5-TR diagnosis, 6-month medical-necessity reviews. - [Free verification-call checklist (PDF)](https://carelu.com/downloads/aba-verification-call-checklist.pdf): Every question to ask on an ABA benefits-verification call. ## Platform integrations - [Integrations directory](https://carelu.com/integrations): Every system Carelu connects to, by category — CRMs (Salesforce, HubSpot, Zoho, monday.com, ClickUp, GoHighLevel), practice management and EHR (CentralReach, Rethink, Aloha ABA, Chorus), call tracking (CallRail), Google Calendar, Gmail, Meta Ads, Google Ads, webhooks, email delivery, and CSV export. - [Carelu + Salesforce integration](https://carelu.com/integrations/salesforce): Carelu completes intake and delivers each admitted family into Salesforce as a complete, field-mapped record — contact, child, insurance, documents, consents, source, and stage. - [Carelu + HubSpot integration](https://carelu.com/integrations/hubspot): Two-way contact and deal sync with property mapping; HubSpot Original Traffic Source filled from the campaign Carelu captured. - [Carelu + Zoho CRM integration](https://carelu.com/integrations/zoho-crm): Leads and contacts created and updated in Zoho with the full intake record attached. - [Carelu + monday.com integration](https://carelu.com/integrations/monday): Each family becomes an item on the board and group you choose, columns filled from the intake. - [Carelu + ClickUp integration](https://carelu.com/integrations/clickup): Intakes arrive as tasks in the list you pick with custom fields populated. - [Carelu + GoHighLevel integration](https://carelu.com/integrations/gohighlevel): Contacts and opportunities pushed into your sub-account with tags and pipeline stage. - [Carelu + CallRail integration](https://carelu.com/integrations/callrail): Every tracked call recorded and transcribed, matched to the family or created as a new lead automatically, logged on the profile timeline — review calls at scale. - [Carelu + Google Calendar integration](https://carelu.com/integrations/google-calendar): Assessments booked onto your calendar in the same conversation that qualified the family. - [Carelu + Gmail integration](https://carelu.com/integrations/gmail): Follow-ups and intake links sent from a coordinator's own address; send-only scope. - [Carelu + Meta Ads integration](https://carelu.com/integrations/meta-ads): Facebook and Instagram spend attributed to sessions, leads, and admitted families. - [Carelu + Google Ads integration](https://carelu.com/integrations/google-ads): Campaign spend attributed to the families it generated, down to cost per admitted family. - [Carelu webhooks](https://carelu.com/integrations/webhooks): Every lead, stage change, or completed intake sent as mapped JSON to any endpoint with delivery history; PHI never routed through consumer automation tools. - [Carelu + Aloha ABA integration](https://carelu.com/integrations/aloha-aba): Carelu answers and admits families 24/7, then delivers complete records into your practice-management system. - [Carelu + CentralReach integration](https://carelu.com/integrations/centralreach): Carelu connects with CentralReach — intake completed conversationally, records delivered into the EHR with no re-keying. - [Carelu + Rethink integration](https://carelu.com/integrations/rethink-behavioral-health): Carelu fills the Rethink platform: instant response, verification, documents, and complete records delivered in. - [Carelu + Chorus integration](https://carelu.com/integrations/chorus): Carelu completes intake and captures clean insurance data, feeding Chorus's revenue-cycle platform (eligibility, remits, claims) verified records from day one. - [Carelu vs. a CRM](https://carelu.com/carelu-vs-crm): Why a CRM (Salesforce, HubSpot, Zoho, Monday, ClickUp) is software your team operates, while Carelu is a care enablement platform that does ABA intake for you — and integrates with your CRM so you never leave it, or serves as your system of record. - [Carelu vs. Salesforce](https://carelu.com/carelu-vs-salesforce): Salesforce for ABA intake vs. Carelu — combine (Carelu works inside Salesforce) or use Carelu as your CRM. - [Carelu vs. HubSpot](https://carelu.com/carelu-vs-hubspot): HubSpot vs. Carelu for ABA intake — integrate or replace. - [Carelu vs. Zoho](https://carelu.com/carelu-vs-zoho): Zoho CRM vs. Carelu for ABA intake — integrate or replace. - [Carelu vs. monday.com](https://carelu.com/carelu-vs-monday): monday.com vs. Carelu for ABA intake — integrate or replace. - [Carelu vs. ClickUp](https://carelu.com/carelu-vs-clickup): ClickUp vs. Carelu for ABA intake — integrate or replace. ## Compliance & risk - [Zapier & Make are not HIPAA compliant](https://carelu.com/zapier-make-hipaa-risk): Neither Zapier nor Make signs a Business Associate Agreement or supports PHI, so routing ABA intake data through them can put a provider in HIPAA violation. Covers the dangers, HIPAA penalty tiers, and the front-office risks. General info, not legal advice. - [The biggest ABA front-office risks](https://carelu.com/aba-front-office-risks): The compliance, revenue, and clinical risks that live in the front office — PHI/BAA handling, claim denials from bad intake data, prior-authorization gaps, assessment and documentation errors, unverified eligibility, breach exposure, and audit/recoupment risk. ## Common questions - **How do I stop losing ABA families to slow intake?** Respond to every inquiry the moment it arrives — across every channel, day and night — and complete intake before a competitor does. Carelu automates that first response and the full intake so no family waits. - **What is ABA waitlist management?** Keeping prospective families engaged, informed, and moving from inquiry to first appointment instead of going cold on a waitlist. Carelu keeps every family warm with instant response and automated follow-up. - **How does an AI intake agent work for ABA?** It answers calls, chats, forms, and texts; collects the family's information and documents; verifies insurance eligibility; schedules the first appointment; and routes anything needing a human to your team — with a full record on every family. - **Is Carelu HIPAA compliant?** Yes — HIPAA compliant, SOC 2 Type II, and Carelu signs a BAA with every provider. ## Contact - Website: https://carelu.com - Demo: https://carelu.com/demo --- # Articles --- --- title: The ABA client intake process, step by step. url: "https://carelu.com/resources/aba-client-intake-process" description: "The complete ABA intake process — from first contact to first session — with benchmarks, a full document library with state-by-state requirements, and templated rules for when to ask for each document." updated: 2026-09-10 --- # The ABA client intake process, step by step. **Short answer:** ABA intake runs in five steps: first contact, qualification and insurance verification, documents and consents, assessment scheduling, then authorization and onboarding. Aim for a first response under 5 minutes, benefits verified within 24–48 hours, documents complete within a week, and under two weeks from inquiry to first appointment where authorization timelines allow. Intake is the funnel every ABA practice lives or dies by, and most practices have never mapped theirs. A family reaches out; days or weeks later they either start services with you — or with whoever answered first. Everything between those two moments is the intake process. Here is the full sequence, what belongs at each step, and where families are most likely to disappear — followed by the full document library: every document an ABA intake might need, how often it is really required, what changes state to state, and the conditions that decide whether a family should ever be asked for it. ## Step 1 — First contact (the first five minutes) A parent calls, chats, texts, or submits a form — usually after contacting several providers in one sitting. Speed decides this step: families overwhelmingly start with the provider who responds first with something substantive. Answer instantly, capture the essentials (child's age, diagnosis status, insurance, zip code, availability), and set the expectation for what happens next. If first response takes longer than a few minutes — or the call hits voicemail — assume a competitor has them. ## Step 2 — Qualification & insurance verification Verify benefits before anything else moves: payer, plan, ABA coverage, deductible status, and whether you're in network. Practices that verify up front stop wasting assessment slots on families who can't clear benefits — and stop losing eligible families to the multi-week "we're checking your insurance" black hole. Target: verification complete within 24–48 hours of first contact. ## Step 3 — Documents & consents The diagnosis report, insurance card, intake packet, and consent signatures. This is the step where momentum goes to die — long PDF packets, printer-and-scanner requests, and week-long email silences. Collect digitally, in small pieces, with automatic reminders. A family should be able to finish the packet on their phone the same week they first called. ## Step 4 — Assessment scheduling Book the initial assessment while the family is engaged — ideally on the very first interaction, contingent on verification clearing. Every additional day between "you qualify" and a scheduled date measurably increases no-shows and dropouts. ## Step 5 — Authorization & onboarding After the assessment: submit the auth request, track it against payer timelines, and keep the family informed while they wait. Then convert the authorization into a real schedule — team assignment, session times, and a clear first-day experience. Silence during the auth wait is the last big drop-off point; a weekly one-line status update largely eliminates it. ## The benchmarks to hold yourself to - **First response:** Under 5 minutes, any hour a family might reach out — including evenings and weekends, when a large share of inquiries arrive. - **Insurance verified:** Within 24–48 hours of first contact. - **Documents complete:** Within one week of first contact. - **Inquiry to first appointment:** Under two weeks wherever auth timelines allow. Every week added costs measurable conversion. ## The documents: what to collect, and how often you really need it Ask ten practices for their intake packet and you get ten different stacks of paper, but the underlying set is remarkably consistent. What differs is which documents apply to which family, and that is the part most packets get wrong: everyone is asked for everything, so most families are asked for things they do not have and do not need. The tables below are the full set, grouped the way an intake form should be grouped. "How often needed" is the honest frequency across payers and states, not a policy claim about any one plan. The trigger column is the condition that should decide whether a family ever sees the question at all. | Document | What it is for | How often needed | Ask for it when | | --- | --- | --- | --- | | Insurance card, front and back | Member ID, group number, the payer name families often get wrong, and the behavioral-health number printed on the reverse. | Always | Every insured family, at first contact. Hide the whole block for private pay. | | Consent to treat / service agreement | The legal authority to assess and treat, and the terms of service. | Always | Before the assessment. Signed by whoever holds consent authority, which is not always the caller. | | Notice of privacy practices acknowledgement | Documents that HIPAA privacy practices were provided to the family. | Always | With the consent packet. Acknowledgement only, never a gate on scheduling. | | Communication consent (email and text) | Permission to send reminders, status updates, and document requests. | Always | At first contact, before any automated follow-up runs. | | Financial responsibility acknowledgement | Deductible, coinsurance, private-pay rates, and no-show terms in writing. | Always | After verification returns real cost-share numbers, not before. | | Release of information | Lets you exchange records with the diagnosing clinician, the pediatrician, the school, and other therapies. | Usually | The moment a family names an outside provider you will need records from. | | Photo ID of the responsible party | Confirms who is signing and who the plan lists as the subscriber. | Conditional | When the subscriber is not the child’s parent, or the names on the card and the intake do not match. | - [Consent & authorization templates (PDF)](https://carelu.com/downloads/aba-consent-packet-templates.pdf): Five one-page templates: consent to treat and service agreement, privacy acknowledgement, communication consent for email and text, financial responsibility, and a release of information. Bracketed placeholders throughout — swap in your practice and use them. ## Clinical documents This group decides whether the child is eligible and whether the authorization gets approved. It is also where intake stalls: the evaluation lives in a parent’s email from eighteen months ago, or with a diagnosing clinician who has not answered a records request in three weeks. | Document | What it is for | How often needed | Ask for it when | | --- | --- | --- | --- | | Comprehensive diagnostic evaluation | The report the payer actually reads: diagnosing clinician and credentials, instrument used, date, and severity level. | Always | Every family. It is the single most-requested document in ABA intake and the most common reason a start slips. | | Diagnosis letter or script | A short signed statement of the diagnosis, accepted in place of a full evaluation by some programs. | Conditional | In states and plans that accept a physician or psychologist statement instead of a full evaluation. | | Physician referral or written order for ABA | An independent referral that is itself the eligibility gate in several states, separate from the diagnosis. | Conditional | Wherever the state or plan gates the benefit on a referral. Pair it with a way to request it from the doctor directly. | | Standardized instrument scoring reports | Complete scoring reports (adaptive behavior and behavior-rating scales) that some plans require inside the authorization package. | Conditional | When the payer names the instruments. Usually your own assessment produces these, occasionally the outside evaluator’s. | | Medical history and current medications | Clinical intake, safety planning, and coordination with prescribers. | Usually | Before the assessment for every family; treat as required for center-based placements. | | Recent physical exam or well-child form | Licensing and program requirements for a child attending a center. | Conditional | Center-based and school-based placements only. Never ask an in-home family for it. | | Immunization record | Required where the site is licensed as a childcare or day facility. | Conditional | Center-based placements, in states where the site license requires it. | | Other therapy documentation (speech, OT, PT) | The plan of care has to document coordination with everything else the child receives. | Usually | Once a family names another active therapy. Ask for the provider’s name first, the document second. | | Prior ABA records: discharge summary, last treatment plan, prior authorization | Shows hours already used against annual or lifetime caps and can save a duplicate assessment. | Conditional | When the family says the child has had ABA before, including a program they left. | - [Records request templates (PDF)](https://carelu.com/downloads/aba-records-request-templates.pdf): Four templates for the documents you do not have yet: a records request to the diagnosing clinician, a fax cover sheet, a referral and order request for the physician to sign and return, and a short diagnosis confirmation form. ## Coverage documents Most of this group should be invisible to most families. Each row is triggered by something the family already told you during verification, which is why asking for all of it up front reads as bureaucratic and costs completion. | Document | What it is for | How often needed | Ask for it when | | --- | --- | --- | --- | | Medicaid ID or eligibility letter | Which program the child is on decides the entire authorization path. | Conditional | When a family names Medicaid but cannot produce a card. | | Managed-care plan enrollment letter | Names the plan administering the benefit. Families frequently name the wrong one. | Conditional | In states where Medicaid runs through multiple managed-care plans. | | Secondary insurance card | A second plan changes verification, the billing order, and often the family’s out-of-pocket entirely. | Conditional | Only after a family answers yes to "any other coverage?" Never show it by default. | | Coordination of benefits form | Payers hold claims until coordination of benefits is on file. | Conditional | Same trigger as the secondary card, and any time verification flags an unresolved other-coverage record. | | Waiver or state program paperwork | Funds services outside the medical benefit, or covers what the plan will not. | Conditional | When the family names a waiver or program, or where the state pathway effectively requires one. | | Denial or appeal letters | Tells you what a payer already refused, and why, before you request the same thing. | Rare | When a family reports a previous denial, at this practice or another. | | Employer plan documents (summary of benefits) | Self-funded employer plans are not bound by state autism mandates. | Rare | Only when verification comes back ambiguous on funding type. | ## Consent and custody: who is allowed to sign The quietest source of rework in ABA intake is a signed consent from someone without the authority to sign it. Ask about the household structure early and let the answer decide which of these appear. | Document | What it is for | How often needed | Ask for it when | | --- | --- | --- | --- | | Custody order or parenting plan | Establishes which parent can consent to treatment and receive records. | Conditional | When the family reports separated or divorced parents, or two households on the intake. | | Guardianship or conservatorship order | Names the person who can legally sign for an adult client or a court-supervised minor. | Conditional | When the client is 18 or older, or the family reports an appointed guardian. | | Foster placement letter or agency consent authority | Says who may consent for a child in state custody, which is rarely the person calling. | Conditional | When a caregiver or caseworker reports foster care or state custody. | | Power of attorney or authorized representative form | Lets someone other than a parent sign paperwork and speak to the plan. | Rare | When the person completing intake is neither parent nor guardian. | - [Consent authority templates (PDF)](https://carelu.com/downloads/aba-consent-authority-templates.pdf): Three templates for the households where the person calling may not be the person who can sign: a consent authority attestation, an authorized representative designation, and a foster care and agency consent record. ## Setting documents: home, center, school, telehealth Where services happen decides this whole group. A single question about setting, asked early, removes six to eight irrelevant document requests from most families’ forms. | Document | What it is for | How often needed | Ask for it when | | --- | --- | --- | --- | | IEP, IFSP, or 504 plan | Belongs in the authorization package in several states, and sets the school hours you cannot double-count. | Conditional | School-age or early-intervention children, and any school-based placement. | | School schedule or enrollment verification | Several states weigh school hours against the ABA hours you request. | Conditional | School-age children in states that count school hours. | | School district authorization | Permission to be in the building and to deliver billable hours there. | Conditional | School-based settings only. | | Telehealth consent | A separate consent from the general consent to treat in most states. | Conditional | Only when telehealth is on the service list for that family. | | Home address verification and safety attestation | Who is in the home, access, pets, and anything a technician should know before the first visit. | Conditional | In-home services only. | | Electronic visit verification acknowledgement | Visit verification is mandatory for home and community Medicaid services. | Conditional | In-home and community services billed to Medicaid. | | Photo, video, and recording release | Session recording for supervision and clinical review, telehealth recording, and any marketing use. | Usually | With the consent packet, as an opt-in. Never a condition of starting. | | Transportation or community outing permission | Consent for community-based programming away from the home or center. | Rare | Community settings only. | - [Setting consent templates (PDF)](https://carelu.com/downloads/aba-setting-consent-templates.pdf): Four templates that should only ever reach some families: telehealth consent, photo and recording release with separate opt-ins per use, an in-home safety and access agreement, and community outing permission. ## Templated conditions: when to show a document, and when to hide it A document request is a question, and every question a family does not need is a chance to abandon the form. These are the conditions worth templating once and reusing across every form you run. Each one reads the same way: a fact you already have, and what it should do to the packet. - **When** The family is in a state that does not gate ABA on an autism diagnosis **then** Do not ask for the autism report. Ask for the most recent comprehensive evaluation instead, and keep the family qualified while it is missing. - **When** The state or plan gates the benefit on a physician referral or written order **then** Show the referral upload, and behind it a "my doctor has it" path that collects the practice name, phone, and fax so your team can request it directly. - **When** The family answers that they do not have a diagnosis yet **then** Hide the diagnosis upload entirely and route to the evaluation path: who diagnoses in their area, what the wait looks like, and a referral out if you do not test in house. Never dead-end the form. - **When** The evaluation is older than the state or plan recency window **then** Treat the document as missing, not present. Date every clinical document at upload and re-ask when the clock has run out. - **When** The family is paying privately **then** Hide the insurance card, secondary card, coordination of benefits, and program paperwork. Show the fee agreement and payment authorization instead. - **When** The family names a second insurance **then** Show the secondary card and the coordination of benefits form. Both stay hidden for everyone else. - **When** The caregiver reports two households, or the parents’ last names differ from the child’s **then** Show the custody order or parenting plan, and ask which parent holds consent authority before sending anything to sign. - **When** The client is 18 or older **then** Replace the parental consent block with client consent, and show guardianship or power of attorney only when the family reports an appointed guardian. - **When** The child is in foster care or state custody **then** Show the placement letter and collect the agency contact who holds consent authority. Suppress the parent-signature consents that person cannot legally sign. - **When** Services will be delivered in a school **then** Show the IEP or 504, the school schedule, and the district authorization together, with the school contact block. All four stay hidden for home and center families. - **When** Services will be delivered in the home **then** Show address verification, the safety and pets attestation, and the visit-verification acknowledgement. Hide the center-only medical forms. - **When** Telehealth is on the service list **then** Show the telehealth consent. Otherwise it never appears. - **When** The child has received ABA before **then** Ask for the discharge summary, the last treatment plan, and the prior authorization letter, and record hours already used against annual or lifetime caps. - **When** The document arrives through another channel, or in the wrong slot **then** Stop asking for it. File it by what it actually is, use it for verification and the authorization packet, and take the question off the family’s screen. - **When** The document is required but the family does not have it on their phone right now **then** Let them finish the rest of intake and chase the document in follow-up. A required document should never be the reason a family abandons the form. ## What changes from state to state Three things vary by state, and they are the three that decide whether a family can start: whether an autism diagnosis is the gate at all, whether an independent physician referral or order is required alongside it, and how fresh the evaluation has to be. School documentation is a fourth, in the states that weigh school hours against requested ABA hours. The pattern worth internalizing: the states that do not require an autism diagnosis usually replace it with something stricter about the evaluation or the referral. "No diagnosis needed" almost never means "no document needed." | State | Autism diagnosis | What actually gates the start there | | --- | --- | --- | | [Arizona](https://carelu.com/payers/arizona-ahcccs) | Not required | The state behavior-analysis policy covers autism and other diagnoses justified by medical necessity, so a family without a diagnosis is not automatically out. Commercial plans still want the report, and some plan criteria look for an evaluation within the past five years. | | [Colorado](https://carelu.com/payers/colorado-medicaid) | Not required | Three separate doorways open the benefit, but a signed comprehensive evaluation within the past twelve months is the real gate, and school hour counts have to ride along with pediatric requests. | | [Florida](https://carelu.com/payers/florida-medicaid) | Not required | The gate is a physician referral plus a written order plus a comprehensive diagnostic evaluation. Complete adaptive-behavior and behavior-rating scoring reports attach to every request, and school-based hours need the IEP or 504. | | [Georgia](https://carelu.com/payers/georgia-medicaid) | Required | A DSM-5 autism diagnosis from a qualified professional. Evaluations are read on a five-year window with tighter recency on assessments, and the IEP or IFSP belongs in the authorization package when one exists. | | [Indiana](https://carelu.com/payers/indiana-medicaid) | Required | Autism established by a doctoral-level psychologist, physician, or advanced practice clinician, plus a physician referral and an assessment that includes an adaptive-behavior scale. Evaluations carry a one-year freshness expectation. | | [Kansas](https://carelu.com/payers/kansas-medicaid) | Required | Diagnosis validated by a physician or licensed psychologist within the last six months, and from September 2026 it has to come from a state-licensed clinical psychologist or qualified physician using a validated tool, with a grace period for existing diagnoses. | | [Maryland](https://carelu.com/payers/maryland-medicaid) | Required | A confirmed diagnosis through a comprehensive diagnostic evaluation by a qualified health-care professional. Fee-for-service families route through a separate administrator, so ask which one before promising a timeline. | | [Massachusetts](https://carelu.com/payers/masshealth-massachusetts-medicaid) | Required | A comprehensive DSM-aligned assessment by a licensed diagnostician. From January 2026 fully-insured plans also cover a sole Down syndrome diagnosis, so those families should not be turned away at the door. | | [Missouri](https://carelu.com/payers/missouri-medicaid) | Varies | Autism by a licensed physician or psychologist for the standard benefit, but children can qualify with other diagnoses under the pediatric early-and-periodic benefit when medically necessary. | | [Nebraska](https://carelu.com/payers/nebraska-medicaid) | Varies | Autism or a documented developmental or intellectual disability qualifies. Either way the diagnosing provider’s evaluation attaches to the request. | | [New Jersey](https://carelu.com/payers/new-jersey-medicaid) | Required | A diagnosis from a physician or psychologist, but a full comprehensive diagnostic evaluation is not required, so a signed diagnosis statement is enough to keep a family moving. | | [New Mexico](https://carelu.com/payers/new-mexico-medicaid) | Varies | A diagnosis within three years of the referral, or a documented at-risk pathway for very young children. Adult clients need confirmation within the last three years from a qualifying practitioner. | | [New York](https://carelu.com/payers/new-york-medicaid) | Required | The under-21 baseline governs, and some plans want the evaluation authenticated by a state-licensed clinician and re-validated annually, which is a recurring document, not a one-time upload. | | [North Carolina](https://carelu.com/payers/north-carolina-medicaid) | Required | The diagnosis has to be established with a validated diagnostic instrument. Screening tools alone are rejected, and very young children may start on a provisional diagnosis. | | [Ohio](https://carelu.com/payers/ohio-medicaid) | Required | A diagnosis from a child psychiatrist, psychologist, child neurologist, or developmental pediatrician, with evaluations accepted inside a five-year window. | | [Tennessee](https://carelu.com/payers/tenncare-tennessee-medicaid) | Varies | Autism or another qualifying diagnosis can support the benefit, and the managed-care plans share one universal request form, so the packet is unusually consistent across plans. | | [Texas](https://carelu.com/payers/texas-medicaid) | Required | The diagnosis has to be made or reconfirmed within the past three years and paired with a signed prescriber referral, and it has to come from a developmental pediatrician, neurologist, psychiatrist, licensed psychologist, or a diagnostic team. | | [Utah](https://carelu.com/payers/utah-medicaid) | Required | A written diagnosis using evidence-based standardized measures, and the completed diagnostic tool itself has to travel with the first authorization request. | | [Virginia](https://carelu.com/payers/virginia-medicaid) | Required | A diagnosis from a qualified professional, with a licensed-clinician attestation signature on the initial service-authorization form. | Reviewed September 2026, focused on each state’s Medicaid pathway, where variation is widest. Commercial plans are more uniform and mostly require an autism diagnosis regardless of state. Rules move constantly, so verify against the plan before turning any of this into a required field on your form. ## How to template this in your own intake form Everything above collapses into six rules. Build them once and every form you run afterwards inherits them. - **One slot per document, never one packet:** A single "upload your paperwork" field produces a folder nobody can bill from. Name each document, and know which slot a file landed in. - **Condition on facts you already hold:** State, payer, age, setting, and who holds consent are all known before the document page. Every one of them should be able to hide a question. - **Date the document, not just its presence:** Recency windows are the most-missed rule in ABA intake. A stored evaluation that has aged past the payer’s window is a missing document, and your form should treat it as one. - **Give every gate a fallback:** For each required document, offer the "I do not have it" path that collects what your team needs to go get it: the clinician, the practice, the phone, the fax. - **Accept documents from any channel:** Families send the card by text, the evaluation by email, and the referral by whatever their doctor’s office uses. File by what the document is, and stop asking once it arrives. - **Let families continue without it:** Keep the requirement visible, keep chasing it after the fact, but never let a missing PDF end the intake. The family who abandons the form at the document page does not come back. - [Document requirements worksheet (PDF)](https://carelu.com/downloads/aba-document-requirements-worksheet.pdf): Two working pages: one to record what a state and payer actually require, and one to turn that into the when/then rules your intake form runs on. [Download the free ABA intake checklist (PDF)](https://carelu.com/downloads/aba-intake-checklist.pdf): The full process on one printable page — use it to map your own funnel and find your leaks. ## Frequently asked questions ### How long should ABA intake take? From first contact to first appointment: under two weeks where authorization timelines allow. The paperwork itself rarely needs more than a few days — the delay is almost always waiting on responses. ### Where do most families drop out of intake? At the very start (no response, or a voicemail) and during document collection. Both are solved by speed and small, digital, phone-friendly steps with automatic follow-up. ### Can the intake process be automated? Most of it — first response, qualification, insurance verification, document collection, reminders, and scheduling are all rote and time-sensitive. That's exactly what Carelu automates, with your team handling the conversations that need a human. ### Which documents does every ABA intake need? Five are close to universal: the insurance card front and back, the comprehensive diagnostic evaluation, consent to treat, the privacy acknowledgement, and communication consent. Everything else — referrals, custody paperwork, school plans, secondary coverage, setting-specific forms — should be conditional on something the family already told you. ### Do we need an autism diagnosis before starting ABA? It depends on the state and the payer, and getting this wrong turns away families who would have qualified. Several state Medicaid programs open the benefit on medical necessity, functional impairment, or a physician referral rather than an autism diagnosis, while commercial plans almost always require one. Where a diagnosis is not required, expect a stricter rule about the evaluation or the referral in its place. ### What should happen when a family does not have the diagnosis report? Never end the form. Let them finish everything else, collect who diagnosed the child (or route them to evaluation if nobody has), and chase the document in follow-up. Losing the family at the upload page costs far more than a document that arrives three days late. ### How long is a document good for? Recency windows vary from six months to five years depending on state and plan, and they are the most-missed rule in ABA intake. Store the date of every clinical document, not just the file, and treat one that has aged past the payer's window as missing. ## How Carelu runs the intake sequence for you This page is a lot of rules: five steps, four benchmarks, dozens of documents that apply to some families and not others, and a state table that keeps changing. No coordinator can hold all of it on every call. Carelu holds it for them. It covers the first three steps from the first minute: answering, qualifying, verifying, and collecting documents. The assessment, the authorization request, and every clinical judgment stay with your team. What changes is that your team starts that work with a verified family and a complete packet, not a phone number and a promise to call back. - **First contact, any hour:** Every family is answered within seconds by phone, website chat, text or web form, in English or Spanish. Service area, payer, age and diagnosis status are captured in that first conversation. - **Verification before staff time:** Eligibility, ABA coverage, in-network status and referral requirements are checked automatically during intake, well inside the 24–48 hour benchmark. - **Payer rules per state, built in:** Diagnosis requirements and prior-auth rules for each state and payer come from Carelu’s payer directory. A family without a diagnosis goes down an evaluation path instead of being turned away. - **A packet finished on a phone:** The intake is prefilled from the conversation. Consents and releases are e-signed, each one saved as a PDF in the family’s packet. Cards and reports can be uploaded by text or on the form, and families can resume where they left off. - **Chased and routed:** Follow-up flows chase missing documents and unfinished intake. Each family is routed to the right coordinator by state or ZIP and shows up in one live queue with its status. ## The same steps — done for you, in a fraction of the time. Those benchmarks assume a fully-staffed team hitting every step on time. Carelu holds the whole sequence to the fast end of the range automatically, around the clock — so the delays that lose families never happen. | Step | Doing it manually | With Carelu | | --- | --- | --- | | First response | Under 5 min — if someone is available | Instant, 24/7, on every channel | | Insurance verification | 24–48 hours, staff by phone | At first contact, automatically | | Documents & consents | ~1 week, with staff chasing | Same session, chased automatically | | Which documents to ask for | One packet, same for every family | Only what the state, payer, and setting require | | Assessment scheduling | After verification clears | Booked in the first conversation | | Inquiry → first appointment | Under 2 weeks (the goal) | Days — no waiting on callbacks | ## Keep reading - [Records requests that come back](https://carelu.com/resources/aba-records-request): Releases, recipients, and the details that decide. - [The full growth playbook](https://carelu.com/resources/how-to-grow-an-aba-practice): Where intake sits in the growth equation. - [Families without a diagnosis](https://carelu.com/resources/aba-evaluation-referrals): When the diagnostic report does not exist yet. - [The numbers to watch](https://carelu.com/resources/aba-intake-metrics): Eight metrics that locate the leak. Source: Carelu — https://carelu.com/resources/aba-client-intake-process. Free to cite with attribution. --- --- title: "ABA CPT codes 97151–97158 explained: who bills each one, and what Medicaid pays." url: "https://carelu.com/resources/aba-cpt-codes" description: "Every ABA billing code in plain language: 97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, 0362T and 0373T. Who can render each, how 15-minute units work, daily unit limits, concurrent billing, credential modifiers, and current Medicaid rates for 97153 and 97155 in 15 states." updated: 2026-09-23 --- # ABA CPT codes 97151–97158 explained: who bills each one, and what Medicaid pays. **Short answer:** ABA is billed with ten codes in 15-minute units: 97151 (BCBA assessment), 97152 and 0362T (supporting assessment), 97153 (technician 1:1 therapy, most billed hours), 97154/97158 (group), 97155 (BCBA protocol modification), 97156/97157 (parent training) and 0373T (severe behavior). Medicaid pays 97153 from about $12 to $24 per unit depending on the state. ABA is billed with ten codes: eight Category I CPT codes (97151–97158) and two Category III codes (0362T and 0373T) for severe destructive behavior. They took effect January 1, 2019, and replaced the old temporary set. Every code is billed in 15-minute units. The codes split along two lines, and once you see them the whole set makes sense. The first is assessment versus treatment. The second is who is in the room: a technician working from a protocol, or a qualified healthcare professional (usually a BCBA) who can change the protocol. After that, the only other questions are one patient or a group, and whether the caregiver is the person being taught. This page walks through each code, then covers the rules that decide whether a claim actually pays: units, daily limits, concurrent billing, credential modifiers and prior authorization. It ends with current Medicaid rates by state, taken from our payer directory. ## The ten ABA codes at a glance "QHP" is the qualified healthcare professional: a BCBA, a licensed behavior analyst, or another licensed professional allowed by the payer and state. "Technician" is usually an RBT, though some states and payers accept other credentials. | Code | What it is | Who renders it | Patient | | --- | --- | --- | --- | | 97151 | Behavior identification assessment: the initial or re-assessment, scoring, report and treatment plan | QHP | One patient (and caregivers) | | 97152 | Supporting assessment: technician-run data collection that feeds the QHP’s assessment | Technician, directed by QHP | One patient | | 0362T | Supporting assessment for severe destructive behavior | Two or more technicians, QHP on site | One patient | | 97153 | Adaptive behavior treatment by protocol: the direct 1:1 therapy hours | Technician, directed by QHP | One patient | | 97154 | Group adaptive behavior treatment by protocol | Technician, directed by QHP | 2–8 patients | | 97155 | Treatment with protocol modification: the QHP working with the child, often directing the technician | QHP | One patient | | 97156 | Family adaptive behavior treatment guidance: parent training | QHP | Caregivers (child present or not) | | 97157 | Multiple-family group guidance | QHP | Up to 8 families, child not present | | 97158 | Group treatment with protocol modification | QHP | 2–8 patients | | 0373T | Treatment with protocol modification for severe destructive behavior | Two or more technicians, QHP on site | One patient | ## Assessment codes: 97151, 97152 and 0362T 97151 covers the BCBA’s assessment work: observing the child, interviewing caregivers, running standardized tools, scoring and interpretation, and writing the report and treatment plan. It is the one ABA code that includes time without the child present, since writing the plan counts. Most payers require a prior authorization for it, cap the units per assessment, and allow a re-assessment roughly every six months to renew treatment. Some states pay it differently: Colorado Medicaid pays 97151 as one flat amount per assessment, billable once every 365 days, instead of per unit. 97152 is the technician’s part of an assessment, for example running a preference assessment or collecting baseline data while the BCBA directs. 0362T is the version for severe destructive behavior. It needs the QHP on site, two or more technicians, and an environment set up for the child’s behavior. It is billed per 15 minutes of technician time, and not every state covers it. Whether assessment codes need a prior auth varies a lot. Virginia Medicaid, for example, needs no authorization for 97151, 97152 or 0362T, while most commercial plans want one before the first unit. Check the specific plan before scheduling, not after. ## Treatment codes: 97153 through 97158 and 0373T 97153 is the bulk of every ABA practice’s revenue: the technician delivering direct 1:1 therapy from the BCBA’s protocol. The hours a family is authorized for are almost always 97153 hours, and the gap between authorized and delivered 97153 units is where most practices leak money. 97155 is the BCBA working face to face with the child and adjusting the protocol, often while directing the technician in the same session. It is also the code for most direct supervision. 97156 is parent training, with or without the child present. Payers increasingly treat it as a required part of the plan, not an optional one. The group codes, 97154, 97157 and 97158, cover social-skills groups, multi-family parent groups and group sessions with a BCBA modifying the protocol. Most payers cap groups at eight. 0373T is the severe-behavior treatment code, with the same on-site-QHP, two-technician structure as 0362T. ## Units: the 15-minute rule Every ABA code is a 15-minute unit. Under the CPT time convention, you can bill a unit once you pass the midpoint, meaning 8 minutes of a 15-minute unit. Some payers follow the CMS rule of adding up all timed minutes in a day and dividing instead. Either way, bill the minutes you documented, not the minutes you scheduled. Session notes need start and stop times that support the units on the claim. There is also a daily ceiling. Many plans apply the CMS medically unlikely edits (MUEs) for ABA: 97151 and 97153 at 32 units a day (8 hours), 0373T at 32, 97155 at 24, 97154 at 18, and 97152, 97156, 97157, 97158 and 0362T at 16. A claim over the ceiling usually denies outright, even when the hours were authorized. Some plans set tighter per-day limits of their own, and those win. ## Concurrent billing: 97153 and 97155 at the same time The most common billing question in ABA is whether the technician’s 97153 and the BCBA’s 97155 can both be billed for the same minutes, when the BCBA is in the session directing the technician. The CPT descriptors allow it: 97155 explicitly "may include simultaneous direction of a technician," and each person bills their own code. What the payer allows is a separate question, and the answers differ. Some plans pay both lines when both people are face to face with the child and the BCBA is directing. Some pay only the BCBA line. Some say nothing, which is not the same as permission. One person can never bill 97153 and 97155 for the same minutes. Our payer guides record a concurrent-billing answer for each plan where the plan publishes one, and mark it "not published" where it doesn’t. When it’s unpublished, ask the plan in writing before you build a supervision model around it. ## Credential modifiers: HM, HN, HO, HP and state U-codes Many Medicaid programs, and some commercial plans, pay the same code at different rates depending on who delivered it. The level is reported with a modifier. The common set is HM (less than a bachelor’s, typically an RBT), HN (bachelor’s level, typically a BCaBA), HO (master’s level, typically a BCBA) and HP (doctoral level). Some states use their own U-modifiers instead. Indiana uses U1–U3, and New Mexico uses U1 through U9 across its practitioner levels. The spread is large. In Virginia Medicaid, 97155 pays $23.48 per unit from a licensed assistant behavior analyst and $46.63 from a licensed behavior analyst. A missing or wrong modifier either denies the claim or quietly pays it at the lowest level, so modifier logic belongs in your billing setup, not in someone’s memory. Telehealth adds its own modifier (95 or GT), and a few plans don’t pay certain codes by telehealth at all. ## Prior authorization: what gets approved, and when Almost every payer authorizes ABA in two steps. First the assessment (97151, sometimes with 97152), then a treatment authorization built from the assessment’s plan: a number of 97153 hours per week, plus 97155 and 97156 units, usually for six months. Renewal needs a re-assessment and progress data. The front end of this is intake, and it is where most delays start. The assessment auth usually needs the diagnosis report, sometimes a physician referral or order, and in some states a diagnosis from a specific kind of clinician or one issued within a set time frame. A missing diagnostic report can hold up the first unit by weeks. Our records-request guide, linked below, covers how to shorten that. ## What Medicaid pays for 97153 and 97155, by state Medicaid is the one payer type that publishes its ABA rates. Commercial rates are contract-specific and never public. The table shows the published fee-for-service or state benchmark rate per 15-minute unit. Where a state pays by credential, both ends of the range are shown. Managed care plans in most states pay at or above the state schedule by contract, but confirm with each plan. Each row links to that state’s full payer guide and sources. | State Medicaid | 97153 (per unit) | 97155 (per unit) | Schedule effective | | --- | --- | --- | --- | | [Arizona (AHCCCS)](https://carelu.com/payers/arizona-ahcccs) | $17.91–$23.69 office, by credential | $25.05–$37.28 office, by credential | Nov 2023 | | [Colorado](https://carelu.com/payers/colorado-medicaid) | $17.20 | $25.80 | Oct 2025 | | [Florida](https://carelu.com/payers/florida-medicaid) | $12.26 | $19.17 (lead analyst) | Jan 2025 | | [Indiana](https://carelu.com/payers/indiana-medicaid) | $16.04 | $20.54 (BCaBA) / $25.97 (BCBA) | Apr 2026 | | [Maryland](https://carelu.com/payers/maryland-medicaid) | $19.17 (RBT) – $24.41 (BCBA) | $38.34 | Feb 2026 | | [Massachusetts (MassHealth)](https://carelu.com/payers/masshealth-massachusetts-medicaid) | $16.37 | $30.73 | Oct 2024 | | [Missouri](https://carelu.com/payers/missouri-medicaid) | $16.37 (RBT) / $20.13 (BCaBA, BCBA) | By credential | Jul 2024 | | [Nebraska](https://carelu.com/payers/nebraska-medicaid) | $18.70 | $22.72 | Aug 2025 | | [New Jersey](https://carelu.com/payers/new-jersey-medicaid) | $15.00 | $21.25 | Feb 2022 | | [New Mexico](https://carelu.com/payers/new-mexico-medicaid) | $19.85 (BT) – $38.02 | $39.69 (BCBA) – $55.55 | Jan 2025 | | [New York](https://carelu.com/payers/new-york-medicaid) | $14.45 | $19.26 | Apr 2026 | | [North Carolina](https://carelu.com/payers/north-carolina-medicaid) | $20.81 | $32.22 | Oct 2025 | | [Texas](https://carelu.com/payers/texas-medicaid) | $14.50 | $20.08 (HN) / $25.10 (HO) | Sep 2025 | | [Utah](https://carelu.com/payers/utah-medicaid) | $19.67 | $37.51 | Jul 2026 | | [Virginia](https://carelu.com/payers/virginia-medicaid) | $15.00 (technician) | $23.48 (LABA) – $46.63 (LBA) | Dec 2021 | Per 15-minute unit, from each state’s published Medicaid fee schedule as recorded in the Carelu payer directory. Rates change; the linked guide carries the source document and the date we last checked it. Tennessee and Georgia do not publish a public ABA schedule, so they are not listed. ## The five reasons ABA claims deny most often - **No authorization, or the wrong one:** Units billed outside the authorized dates, above the authorized count, or under a code the authorization did not include. Track authorized against used units per code, every week. - **Eligibility changed:** The family’s coverage lapsed, changed plans or moved to a Medicaid managed care plan mid-authorization. Re-verify eligibility monthly, not only at intake. - **Credential or modifier mismatch:** A technician not yet certified or enrolled, a missing HM/HN/HO/HP modifier, or a rendering provider not credentialed with that plan. - **Daily unit ceilings:** A long day that exceeds the plan’s per-day limit for the code, even though the weekly hours were authorized. - **Documentation that doesn’t support the units:** Session notes without start and stop times, without the targets worked on, or signed late. These denials come back on audit, sometimes months later. ## Frequently asked questions ### What is CPT code 97153? 97153 is adaptive behavior treatment by protocol: direct 1:1 ABA therapy delivered by a technician (usually an RBT) under the direction of a BCBA or other qualified professional, billed in 15-minute units. It accounts for most of an ABA practice’s billed hours. ### What is the difference between 97153 and 97155? 97153 is the technician delivering therapy from an existing protocol. 97155 is the BCBA or other qualified professional working face to face with the child and modifying the protocol, which can include directing the technician in the same session. 97155 pays more and is often the code for direct supervision. ### Can 97153 and 97155 be billed at the same time? The CPT descriptors allow it when the technician and the BCBA are both face to face with the child and the BCBA is directing the technician, with each person billing their own code. Whether the payer pays both lines varies by plan. Some do, some pay only one line, and many don’t publish a rule. One person can never bill both codes for the same minutes. ### How many units of 97153 can be billed per day? Many plans apply the CMS medically unlikely edit of 32 units (8 hours) per day for 97153. The authorization sets the weekly total, and some plans set a lower per-day limit of their own. ### Is 97151 billed per unit or per assessment? Per 15-minute unit in most states and plans, with an authorized number of units per assessment. A few Medicaid programs pay it differently. Colorado, for example, pays a flat amount per assessment, once every 365 days. ### What are 0362T and 0373T? They are Category III codes for children with severe destructive behavior: 0362T for the supporting assessment and 0373T for treatment with protocol modification. Both need the qualified professional on site, two or more technicians, and a setting customized to the child’s behavior. Coverage varies by state. ## How Carelu gets a family to the first billable unit Nothing on this page bills until a family is enrolled, verified and authorized. Carelu handles everything before the first unit: it answers the family, checks the payer’s rules for that state, verifies benefits and collects the documents the assessment authorization needs. Your team starts with an authorizable case instead of a phone number. Claims, coding and the authorization itself stay with your billing team and your practice management system. Carelu’s job is to make sure what reaches them is complete. - **Benefits checked during intake:** Eligibility, ABA coverage, in-network status and referral requirements are verified automatically while the family is still in the conversation, before any staff time is spent. - **Payer rules applied per state:** Diagnosis requirements, referral and order rules and assessment prior-auth rules from our payer directory are built into intake, so each family is asked for exactly what their plan and state require. - **The authorization packet, collected:** Diagnosis report, insurance card front and back, signed consents and releases, gathered by text or on a phone-friendly intake form, with each signed document saved as a PDF in the family’s packet. - **Handed to your system:** The verified, documented case goes to your coordinator’s queue and into CentralReach, Rethink, Aloha or your CRM, ready for the assessment auth. ## Getting to the first authorized unit, by hand and with Carelu | Step | Doing it manually | With Carelu | | --- | --- | --- | | Benefits check | Queued after intake, often days later | Verified automatically during the first conversation | | Payer rules | Coordinator remembers each plan’s diagnosis and referral rules | State and payer rules built into intake | | Diagnosis report | Family asked to email it; follow-up by phone | Uploaded by text or on the form, with reminders until it arrives | | Consents and releases | Paper or PDF packet, signed at the first visit | E-signed on a phone, a PDF generated for each document | | Handoff to billing | Re-typed into the practice management system | Pushed to your queue and your practice management system or CRM | ## Keep reading - [The payer directory](https://carelu.com/payers): ABA coverage, prior-auth and diagnosis rules for 260+ plans across 27 states. - [Records requests](https://carelu.com/resources/aba-records-request): Getting the diagnostic report fast enough to file the assessment auth. - [The ABA intake process](https://carelu.com/resources/aba-client-intake-process): Every step from first contact to first session, with state-by-state requirements. - [The numbers to watch](https://carelu.com/resources/aba-intake-metrics): Verification turnaround and days to start, alongside the rest of the scoreboard. Source: Carelu — https://carelu.com/resources/aba-cpt-codes. Free to cite with attribution. --- --- title: The family has no diagnosis yet. That is the beginning of the conversation, not the end. url: "https://carelu.com/resources/aba-evaluation-referrals" description: Families who reach out before a diagnosis are the largest segment most ABA practices throw away. How to check your own payer rules, build an evaluation path, and own the months of waiting so the family starts with you. updated: 2026-09-17 --- # The family has no diagnosis yet. That is the beginning of the conversation, not the end. **Short answer:** Don’t send them away: 22% of families reach out before a diagnosis, and some payers don’t require one, so check each payer’s rule in each state first. Then give the family an evaluation path (named evaluators with payers and wait times, plus early intervention for under-threes), check in every three to four weeks, and make starting a single step when the report arrives. Ask a coordinator what happens when a parent calls without a diagnosis and you will usually hear a version of the same sentence: "We tell them to come back once they have one." It is said without embarrassment, because it sounds like the correct clinical answer. It is also the most expensive sentence in the practice. You paid to reach that family. They chose you. And you handed them back to a system with evaluation waits that commonly run from several months to well over a year, during which they will talk to a dozen other people, at least one of whom will be a practice that stayed in touch. This is not a rare case. In our published research across 120 provider organizations and 185,000 family conversations, 22% of families reached out before receiving a diagnosis. Better than one in five. It is the largest recoverable segment in most ABA funnels, and working it costs almost nothing. ## Where the family actually is A parent contacting you pre-diagnosis is somewhere on a path that takes months and that nobody is guiding them through. They noticed something. They may have raised it with a pediatrician who said to wait and see. Possibly there has been a screening. Somewhere ahead is an evaluation appointment with a long queue, then a report, then insurance, then a provider. They are not shopping. They are lost. The practice that gives them a map is the practice they remember when the report finally arrives. ## First, check whether you actually need the diagnosis Practices routinely turn away families under a rule that does not apply to them. Diagnosis requirements are set per payer and per state, not by ABA as a field, and they vary more than most teams assume. Some Medicaid programs require a confirmed DSM-5-TR autism diagnosis produced by a specified tool. Some accept a provisional diagnosis for young children so treatment can start while confirmation proceeds. At least one state’s behavior-analysis benefit does not require an autism diagnosis at all, operating instead on a physician referral and order with a comprehensive diagnostic evaluation. Commercial plans differ again, and several care about the recency of the diagnosis rather than only its existence. Before writing any policy about undiagnosed families, write down the actual rule for each of your top payers in each state you serve. A meaningful number of "we cannot help you yet" conversations turn out to be avoidable. ## Build an evaluation path and name it out loud A referral to "a developmental pediatrician" is not help. A specific name, with a wait time and a payer, is help. Assemble, per service area: several diagnosing providers you have actually verified, what each one takes, roughly how long their queue is, and whether they do telehealth evaluation. Add the state’s early intervention program for under-threes, which is free and which parents are routinely never told about. Keep it current enough to be worth handing over — a stale wait time damages the trust the list was supposed to build. If you evaluate in-house, this is one of the strongest things you can say in any ad, on any page, and to any referring office. It collapses the longest delay in the journey, and most competitors cannot match it. ## Own the waiting period This is the part that actually wins the family, and it is almost never done. From the moment they leave your first conversation to the moment a report exists, a practice can be either the organization that helped or the organization that said no. A workable rhythm: capture the evaluation appointment date if there is one, and if there is not, help them get one. Check in every three or four weeks, not with "just following up" but with something useful — a reminder of what to bring, a note about what the report will need to say for insurance, an update on your own wait. Ask for the report in the week it is expected rather than a month later. And make sure that when it arrives, starting with you is a single step, not a fresh intake. Every one of those touches is a scheduled task rather than a judgment call, which is exactly why they get missed in practices that rely on someone remembering, and exactly why they are easy to automate. ## What to say in the first conversation Three things, in this order. That you believe them and what they are describing is worth evaluating. What the actual path looks like, with names and rough timelines, so the fog lifts. And that you will stay with them through it, with a specific next contact rather than an open invitation to call back. Avoid two failure modes. Do not diagnose, or imply one, in a sales conversation — you are not qualified to in that setting and it is harmful. And do not promise a start date that depends on a report nobody has seen. ## Reminders that fire whether or not anyone remembers The operational core of this page is unremarkable: a set of dated tasks per family that survive staff turnover, vacations, and busy weeks. Evaluation date approaching. Evaluation date passed, ask how it went. Report expected this week. Ninety days with no movement, check whether the family still wants care. Practices that keep these in a coordinator’s head lose them within a month. Practices that keep them in a shared spreadsheet lose them within a quarter. The families in this segment convert on a timescale long enough that only a system survives it. ## Count it as a channel Track pre-diagnosis families as their own cohort, with their own conversion rate and their own time to start. The number will be worse than your diagnosed cohort and far better than zero, which is what it is worth today in most practices. It also tells you something about your marketing: if a large share of your paid leads arrive without a diagnosis, that is not a lead-quality problem to complain about. It is a signal about which channels reach families early, and an argument for building the evaluation path properly rather than turning the channel off. ## Frequently asked questions ### Does ABA always require an autism diagnosis? No. Requirements are set per payer and per state. Many Medicaid programs require a confirmed DSM-5-TR diagnosis from a validated tool, some allow a provisional diagnosis for young children, and at least one state benefit runs on a physician referral and order without an autism-diagnosis requirement. Check the rule for each payer in each state you serve before turning a family away. ### What should we do with leads who have no diagnosis? Give them a specific evaluation path — named diagnosing providers with payers and wait times, plus early intervention for under-threes — then stay in contact every three to four weeks until the report exists, and make starting with you a single step when it does. ### How long are autism evaluation waits? They vary widely by region and provider, and commonly run from several months to over a year. That length is precisely why the waiting period is worth owning: the family will speak to many people during it, and the practice that stayed useful is the one they come back to. ### Should we advertise on evaluation-related searches? Only if you have a real path for those families — in-house testing or a verified referral list. Otherwise you are paying premium prices to say no. With a path, these searches are among the best available, because you reach families before any competitor is talking to them. ### Is it worth keeping pre-diagnosis families in the CRM? Yes, as their own cohort with scheduled touches. They convert at a lower rate and over a longer horizon than diagnosed families, which still makes them far more valuable than the zero they are worth when told to call back later. ## How Carelu keeps pre-diagnosis families with you 22% of families reach out before a diagnosis. This page turns that from a "call us back" into a path, and nearly every step on that path is a scheduled task. Carelu does those tasks: it checks whether the diagnosis is required at all, sends the family down an evaluation path, and stays in touch through the months of waiting. The clinical side stays human. Your team builds and vets the evaluator list, and nobody diagnoses in a sales conversation. Carelu makes sure the family is still with you when the report arrives. - **The real rule, before anyone says no:** Diagnosis requirements are built in for each state and payer, so families who would qualify without a diagnosis are not turned away by habit. - **An evaluation path, not a dead end:** Families without a diagnosis are routed to an evaluation path in the first conversation, on phone, chat, text or form, in English or Spanish. - **Intake done while they wait:** The family completes intake now, with e-signed consents and insurance verified. When the report exists, they upload it by text or on the form and pick up where they left off. - **Months of follow-up that actually happen:** Follow-up flows by text and email keep in touch through the waiting months, until the family responds or opts out. ## The pre-diagnosis family, by hand and with Carelu Nothing on this page requires clinical judgment. It requires that a long list of small, dated follow-ups actually happen over six to twelve months. | Step | Doing it manually | With Carelu | | --- | --- | --- | | First conversation | "Call us back when you have a diagnosis" | Diagnosis requirement checked against that state and payer before anyone says no | | Evaluation referral | A general suggestion to see a specialist | Named local evaluators matched to the family’s plan, area and language | | The waiting months | Silence; the family drifts | Scheduled check-ins every few weeks with something useful each time | | Report arrives | Nobody knows unless the family calls | Asked for in the week it is due, then collected and filed | | Starting | A fresh intake from the beginning | Intake already complete; the report closes the last gap | | Visibility | Segment invisible in reporting | Tracked as a cohort with its own conversion rate and time to start | ## Keep reading - [The full growth playbook](https://carelu.com/resources/how-to-grow-an-aba-practice): Where this cohort sits in the growth equation. - [Meta ads for ABA](https://carelu.com/resources/meta-ads-for-aba): The channel that will send you the most families at this stage. - [Follow-up that reads human](https://carelu.com/resources/aba-follow-up-sequences): What to actually say across six months of waiting. - [Records requests](https://carelu.com/resources/aba-records-request): Getting the report the week it exists. Source: Carelu — https://carelu.com/resources/aba-evaluation-referrals. Free to cite with attribution. --- --- title: ABA follow-up that does not read like a robot wrote it. url: "https://carelu.com/resources/aba-follow-up-sequences" description: "Why \"Thank you for your inquiry, someone will be in touch\" loses families, what a follow-up that earns a reply actually contains, and the cadence, channels and guardrails behind a sequence that works." updated: 2026-09-17 --- # ABA follow-up that does not read like a robot wrote it. **Short answer:** Reply within minutes on the family’s own channel with a message that names the child, their area and plan, and asks one specific question. Then call the same day with a text, alternate touches on days 2, 4, 7 and 12, move to a monthly hold after about two weeks of silence, and stop instantly on an opt-out or a human reply. A parent contacts five ABA practices in one evening. Four send the same automated line: thank you for your inquiry, we appreciate you reaching out, someone will be in touch shortly. The fifth sends a message that names their son, mentions the county they live in, notes the plan they said they had, and asks one specific question. It is not a close call. The fifth practice gets the reply, and frequently gets the child — not because their care is better, but because they were the only one who appeared to have read what the parent wrote. The sameness is not an accident. Most practices never changed the default greeting that shipped with whatever tool sends it, which means a parent contacting several providers in one evening frequently receives near-identical words from all of them. When most of a market opens with the same sentence, writing one real sentence is a competitive advantage available to anyone. Templated acknowledgements are not worthless; they beat silence. But they occupy the moment of highest intent with a message that communicates nothing, and they are the easiest thing in a practice to fix. ## What the parent is actually doing They are comparing. Not clinical models, which they cannot evaluate, but signals of competence and care, which they can. Response speed is one. Whether the reply engages with their particular situation is the other, and it is the stronger of the two. A parent who wrote three sentences about a four-year-old who has stopped sleeping and receives a form letter has learned that nobody read the three sentences. Everything else on your website arguing that you treat every child as an individual is now contradicted by evidence. ## The anatomy of a follow-up that earns a reply Six elements, none of which require creative writing. - **Their specifics, early:** The child’s name, their age, the town or county, the plan. Proof of reading, in the first line, before anything else. - **Something they said, reflected:** The concern in their own words. "You mentioned the transitions at daycare have been hard" outperforms every value proposition ever written. - **One specific ask:** Not "let us know if you have questions." A single question that is easy to answer on a phone: "Is Thursday morning or Friday afternoon better for a ten-minute call?" - **The next step in their language:** What happens next, how long it takes, and what you need from them — without the words intake, authorization, or eligibility. - **A person’s name:** Sent by someone, signed by someone, replyable to someone. Practice-name-only messages read as broadcasts. - **The channel they used:** If they texted, text back. If they filled a web form on a phone at 10pm, a text will be read and an email will not. ## Cadence: fast, then patient The first touch is the one that matters most, and it is measured in minutes. After that the job changes from speed to persistence, and persistence is where most practices quit early — a single voicemail and no further contact is the norm, and it is why so many funnels show a large pool of leads that were "contacted" and never spoken to. - **When** Within minutes of the inquiry **then** A real response on their channel that names their child and confirms you serve their area and plan, or asks the one question needed to find out. - **When** Same day, if no reply **then** A call from a local number, plus a short text saying who called and why. A missed call with no context is ignored; a missed call with a text is returned. - **When** Day 2 and day 4 **then** Alternate channel and change the ask. Vary what you offer: a time to talk, an answer to the coverage question, the intake link. - **When** Day 7 and day 12 **then** Keep going. Most practices have stopped by now, which is exactly why these touches connect. - **When** After roughly two weeks of silence **then** Move to a monthly hold rather than dropping them. Circumstances change: a diagnosis arrives, a plan changes at renewal, another provider falls through. - **When** Always **then** Stop immediately on an opt-out, and stop the sequence the moment a human conversation starts. Nothing undoes a good call like an automated nudge arriving the next morning. ## Write for the stage, not the template A family waiting on an evaluation, a family with a half-finished packet, and a family whose authorization is pending need three different messages, and sending them the same nudge is how a sequence starts feeling like spam. Segment by the thing that is actually blocking the start. Missing document: ask for that document, with a link, and say what it unlocks. Waiting on evaluation: reference the appointment date. Verified and waiting for a slot: tell them where they are and when you expect movement. In every case the message should carry a fact only your practice could know. ## What should never be automated Bad news. Clinical questions. Anything to a family who has expressed frustration. Anything to a family in crisis. A sequence that keeps cheerfully nudging a parent who wrote back upset does more damage than no follow-up at all. The rule worth enforcing in software: any inbound reply pauses everything automated on that family until a human has looked. ## Guardrails Follow-up in healthcare is governed, and the constraints are not onerous but they are real. Capture consent for calls and texts at the point of contact, with language a parent can understand, and honor an opt-out everywhere at once. Respect quiet hours. Keep clinical detail out of unsecured channels — a text can say who is calling and why without naming a diagnosis. And keep an audit trail of what was sent, when, to whom, and on what consent. It protects the practice, and it is the same log that tells you which sequences are working. ## How to tell if the sequence is any good Reply rate per touch, not open rate. The share of leads that ever reach a live conversation. The number of touches before the average connection, which is almost always higher than the number your team makes. And the opt-out rate, which is the honest measure of whether your follow-up feels like help or like pressure. ## Frequently asked questions ### How many times should we follow up with an ABA lead? More than once, which is where most practices stop. A workable pattern is an immediate response, a same-day call with a text, alternating touches on days 2, 4, 7 and 12, then a monthly hold rather than a drop. Stop instantly on an opt-out, and pause everything automated as soon as a human conversation begins. ### Is text or email better for following up with parents? Text, by a wide margin, for parents of young children — provided you have consent and keep clinical detail out of it. Email works for documents and summaries. Best practice is to answer on whatever channel the family used. ### What is wrong with an automated "thank you for your inquiry" message? Nothing, except that it spends the moment of highest intent saying nothing. It is better than silence and far worse than a reply that names the child, confirms the service area and plan, and asks one specific question. ### Can automated follow-up sound personal? Only if it is built from the family’s own record rather than from a template with merge fields. The difference a parent notices is whether the message contains something that could only be true of them — their county, their plan, the concern they described — not whether a name was inserted into a greeting. ### When should follow-up stop? On opt-out, immediately and permanently. On a clear "we started elsewhere," with a short note that the door is open. Otherwise move to a low-frequency hold instead of deleting the family, because diagnoses arrive and plans change. ## How Carelu runs follow-up for every family, at every stage Every practice knows the pattern on this page: reply fast, reply on their channel, write for the stage the family is actually in, and keep going past day three. Only 2% of providers run any automated re-engagement at all. Carelu runs it for every family, without anyone having to remember. The messages that should never be automated stay with your team: bad news, clinical questions, and families who are frustrated or in crisis. Carelu handles the persistence so your coordinators have time for those conversations. - **The first reply, in seconds:** Every family is answered within seconds on the channel they used, whether phone, website chat, text or web form, in English or Spanish. - **A message per stage:** Follow-up flows run per family and per stage, so a missing document, an unfinished intake and a family waiting to start each get their own message. - **Persistence past day three:** Flows keep going by text and email until the family responds or opts out, not one voicemail and done. - **Consent guardrails:** Follow-up runs within the family’s consent, and an opt-out is honored. ## Follow-up, by hand and with Carelu Every practice knows what good follow-up looks like. What they lack is the twenty hours a week it would take to write it by hand, for every family, forever. | Step | Doing it manually | With Carelu | | --- | --- | --- | | First reply | Template acknowledgement, or nothing until morning | Written from the conversation, in minutes, on their channel | | Personalization | Merge fields in a generic body | Built from the family’s own record — child, area, plan, what they said | | Persistence | One voicemail, then the lead goes cold | Multi-touch sequence across text and phone until they respond or opt out | | Segmentation | One sequence for everyone | Different message per stage and per blocker | | Human handoff | Automation keeps firing mid-conversation | Automated touches pause the moment a person replies | | Compliance | Consent tracked informally, opt-outs missed | Consent and opt-out enforced across every channel, with an audit trail | ## Keep reading - [The Intake Gap (our research)](https://carelu.com/research/the-intake-gap): 185,054 family conversations across 120 ABA providers. The source for the numbers on this page. - [Where families disappear](https://carelu.com/resources/aba-intake-drop-off): The four leaks follow-up is meant to plug. - [Families without a diagnosis](https://carelu.com/resources/aba-evaluation-referrals): The cohort that needs the longest sequence. - [Waitlist management](https://carelu.com/resources/aba-waitlist-management): Keeping start-ready families warm for months. - [The full growth playbook](https://carelu.com/resources/how-to-grow-an-aba-practice): How follow-up multiplies every channel above it. Source: Carelu — https://carelu.com/resources/aba-follow-up-sequences. Free to cite with attribution. --- --- title: "ABA intake drop-off: why families disappear, and the fix." url: "https://carelu.com/resources/aba-intake-drop-off" description: "ABA providers lose 40–85% of families between first inquiry and first session. Where the drop-off happens, why, and the playbook for fixing each leak." updated: 2026-07-19 --- # ABA intake drop-off: why families disappear, and the fix. **Short answer:** ABA practices lose 40–85% of families between first inquiry and first session, at four points: the unanswered first contact, slow insurance verification, a stalled paperwork packet, and an unmanaged wait to start. The leaks multiply: answer 70%, verify 80%, complete 75% and start 80%, and you admit only about a third of the families who wanted you. Run the numbers on your own funnel and the result is usually a shock: of every ten families who reach out, somewhere between four and eight never make it to a first session. That's not a marketing problem — those families already found you, chose to contact you, and then fell out of a process you control. Drop-off clusters at four specific moments. Here's each one, why it happens, and what fixes it. ## Leak 1 — The unanswered first contact A large share of inquiries arrive after hours, on weekends, or while your coordinator is on another call. A parent who reaches voicemail doesn't leave a message and wait — they dial the next provider on their list. This is the single largest leak in most funnels, and the least visible: the families lost here never appear in your CRM at all. The fix: answer every channel, instantly, at every hour. Whether that's staffing or software, "first to respond" is the strongest predictor of who the family starts with. ## Leak 2 — The verification black hole The family had a great first call — then heard nothing for two weeks while someone got around to checking benefits. From the parent's side, the process simply stopped. The fix: run insurance verification within 24–48 hours of first contact, and tell the family exactly what's happening while they wait. Silence, not the wait itself, is what loses them. ## Leak 3 — The paperwork stall A 15-page packet lands in an inbox, gets half-finished on a Sunday night, and dies. No reminder ever comes. The fix: small digital steps a parent can finish on a phone, pre-filled with everything they've already told you, with automatic nudges on day 2 and day 5. Most stalled packets just need a tap on the shoulder. ## Leak 4 — The long wait to start Verified, documented families still evaporate when the gap to a first appointment stretches from days into months. Some wait is structural (staffing, auths) — but unmanaged wait is fatal. The fix is the waitlist playbook: rank by readiness, touch every family every 2–3 weeks, and fill every opening from a start-ready pool within days. ## The compounding math These leaks multiply. Answer 70% of inquiries, verify 80% of those, complete packets with 75%, and start 80% of the remainder — and you're admitting only a third of the families who wanted you. Fix each leak to 95% and the same inquiry volume yields more than double the admissions, with zero additional marketing spend. That's why intake, not lead generation, is usually an ABA practice's cheapest growth lever. ## What fixing it takes Every leak has the same shape: a rote, time-sensitive task that a busy human didn't get to in time. Which is why the durable fix is rarely "try harder" — it's making the first response, verification, document collection, reminders, and waitlist touches happen automatically, with your team focusing on the conversations that actually need a person. That's precisely what Carelu was built to do. [Download the free ABA intake checklist (PDF)](https://carelu.com/downloads/aba-intake-checklist.pdf): Map your own funnel against the full process and find where your families are leaking. ## Frequently asked questions ### What is a normal intake conversion rate for ABA? Many practices convert only 15–60% of inquiries into started clients. Well-run funnels — instant response, fast verification, digital paperwork, managed waitlists — reach 80%+. ### What's the single highest-impact fix? Answering every inquiry instantly, around the clock. It's the largest leak, the least visible, and the one fix that improves every downstream step. ### How do I measure my own drop-off? Count four numbers each month: inquiries, verified families, completed packets, and first sessions. The step with the biggest percentage fall is your leak — fix that one first. ## How Carelu closes each of the four leaks Every leak on this page is a rote, time-sensitive task that nobody got to in time. Carelu does those tasks as they come up, at any hour, so the families who found you don’t fall out of a process you control. Your team keeps the conversations that need a person: the family with a hard question, the scheduling decision, the call that says a spot is open. Carelu handles everything that only needed to happen on time. - **Leak 1: every first contact answered:** Phone, website chat, text and web forms are answered within seconds, 24/7, in English and Spanish. 48% of family contacts arrive after hours, and none of them reach voicemail. - **Leak 2: verification during intake:** Eligibility and ABA benefits are checked automatically while the family is still engaged, so there is no two-week silence while someone gets to it. - **Leak 3: paperwork that gets finished:** A phone-friendly intake prefilled from the conversation, with e-signed consents, uploads by text, and follow-up flows that chase what is missing until the family responds or opts out. - **Leak 4: a wait that is managed:** Families waiting to start get check-ins by text and email, and every family has a status in one live queue, so you can fill an opening from the ready pool. - **The leaks, measured:** Reporting shows answer rate, speed to contact, intake completion and conversion by channel and source, so you can see which leak is costing you most. ## Keep reading - [The full growth playbook](https://carelu.com/resources/how-to-grow-an-aba-practice): The five channels feeding the funnel that is leaking. - [After-hours coverage](https://carelu.com/resources/after-hours-intake-coverage): Leak 1, in detail: 48% of contacts arrive out of hours. - [Follow-up that reads human](https://carelu.com/resources/aba-follow-up-sequences): Leak 3, in detail: the packet that stalled. - [The numbers to watch](https://carelu.com/resources/aba-intake-metrics): Put a number on each of the four leaks. Source: Carelu — https://carelu.com/resources/aba-intake-drop-off. Free to cite with attribution. --- --- title: "ABA intake forms: what to include (+ free template)." url: "https://carelu.com/resources/aba-intake-forms" description: "Everything an ABA intake packet should cover — client and caregiver details, insurance, clinical history, availability, and consents — plus a free printable template." updated: 2026-07-19 --- # ABA intake forms: what to include (+ free template). **Short answer:** An ABA intake packet needs seven sections: client information, caregiver and contacts, insurance and funding, diagnosis and clinical history, goals and concerns, availability and logistics, and consents and policies. Keep it short enough to finish in 15–20 minutes on a phone, prefill anything the family already told you, and collect it with a HIPAA-compliant tool under a signed BAA. A good intake form collects everything your clinical and billing teams need to start services — without exhausting a family that is already stretched thin. Most packets fail in one of two directions: so short that staff spend a week chasing missing details, or so long that parents abandon them halfway. Here's what actually belongs in an ABA intake packet, section by section — and a free template you can adapt. ## The seven sections every packet needs - **1 · Client information:** Child's legal name, date of birth, address, primary language, school/daycare placement. - **2 · Caregiver & contacts:** Parent/guardian names, relationship, phone, email, preferred contact method and times, emergency contact. - **3 · Insurance & funding:** Payer, member and group IDs, subscriber details, secondary coverage, and a photo of the card — enough to run verification without a follow-up call. - **4 · Diagnosis & clinical history:** Diagnosis, date, diagnosing provider, and the report itself; current and past therapies (ABA, OT, speech); medications; medical conditions relevant to care. - **5 · Goals & concerns:** What the family most wants help with, in their own words — behaviors of concern, safety issues, skills to build. This is clinical gold for the assessment. - **6 · Availability & logistics:** Days and times the child is available, preferred setting (home, center, school), transportation constraints. - **7 · Consents & policies:** Consent to treat, HIPAA acknowledgment, release of information for records requests, financial policy, and cancellation policy — each a separate signature. ## The mistakes that kill completion - **One giant PDF:** A 15-page packet emailed as an attachment gets printed, half-finished, and lost. Break it into short digital steps a parent can finish on a phone. - **Asking twice:** If the family gave a detail on the first call, it should be pre-filled in the packet. Every repeated question erodes trust. - **No follow-up:** Most incomplete packets just need a nudge. Automatic reminders at day 2 and day 5 recover a large share of stalled families. - **Collecting everything before saying anything:** Don't gate a first conversation behind the full packet. Qualify with five questions, then collect the rest while verification runs in parallel. ## Paper, PDF, or digital? Digital, always — with paper as the exception for families who need it. Digital forms can be completed on a phone, validated as they're filled (no missing member IDs), fed straight into your systems without retyping, and chased automatically when they stall. Whatever tool you use, it must be HIPAA-compliant with a BAA — intake data is PHI from the first field. ## Beyond the form The form is one step of a larger funnel — what happens around it (response speed, verification, reminders, scheduling) decides whether the family ever reaches a first session. Carelu turns the whole packet into a conversation: families answer naturally by chat, phone, or text; the record fills itself; and nothing is ever asked twice. [Download the free ABA intake form template (PDF)](https://carelu.com/downloads/aba-intake-form-template.pdf): All seven sections, ready to print or rebuild in your forms tool. Free to adapt for your practice. ## Frequently asked questions ### How long should an ABA intake form be? Long enough to cover the seven core sections, short enough to finish in 15–20 minutes on a phone. Anything the family already told you should be pre-filled. ### Do intake forms need to be HIPAA-compliant? Yes. Intake responses are PHI, so the collection tool needs HIPAA compliance and a signed BAA — a standard web-form builder without one doesn't qualify. ### Can I use this template as-is? Yes — it's free to use and adapt. Have your compliance or legal reviewer confirm the consent language matches your state and payer requirements. ## How Carelu turns your packet into a form families finish The seven sections still have to be collected. The four mistakes on this page are what Carelu takes away: no giant PDF, nothing asked twice, no packet left without a reminder, and no first conversation held back until the paperwork is done. Your consent language stays yours, reviewed by your own compliance team, and your staff still review what comes in. The difference is that it arrives complete, signed, and filed. - **Prefilled from the conversation:** Whatever the family told you by phone, chat or text is already on the form. They confirm it instead of typing it again. - **Short steps on a phone, with resume:** A hosted intake built for a phone at 10pm. A family who stops halfway picks up where they left off, not at page one. - **Every signature becomes a document:** Consents, policies and releases are e-signed, and each signed document is generated as a PDF in the family’s packet the moment it is signed. - **Uploads without a scanner:** Families send the insurance card and diagnosis report by text or upload them on the form. - **Reminders, and a BAA:** Follow-up flows nudge unfinished forms and missing documents until the family responds or opts out. Carelu is HIPAA compliant, SOC 2 Type II, and signs a BAA. ## Keep reading - [Follow-up that reads human](https://carelu.com/resources/aba-follow-up-sequences): Chasing a half-finished packet without sounding like a robot. - [Records requests that come back](https://carelu.com/resources/aba-records-request): The release that belongs in the packet. - [The full growth playbook](https://carelu.com/resources/how-to-grow-an-aba-practice): Why paperwork is a growth constraint. - [After-hours coverage](https://carelu.com/resources/after-hours-intake-coverage): Most packets get opened at night. Source: Carelu — https://carelu.com/resources/aba-intake-forms. Free to cite with attribution. --- --- title: The eight numbers that explain why your ABA practice is not growing. url: "https://carelu.com/resources/aba-intake-metrics" description: "Speed to first contact, answer rate, qualified rate, packet completion, verification turnaround, inquiry-to-start and cost per started client — what to measure in an ABA practice, where each number hides, and how to review it weekly." updated: 2026-09-17 --- # The eight numbers that explain why your ABA practice is not growing. **Short answer:** Track eight: inquiries by channel, answer rate, speed to first contact, after-hours share, qualified rate with reasons, intake completion, verification turnaround, and inquiry to started with days to start, plus cost per started client. Start with answer rate and speed to contact; many practices convert only 15–60% of inquiries, while well-run funnels reach 80%+. "We get plenty of leads, they just do not convert" is the most common sentence in ABA growth conversations and the least useful, because it contains no number. Plenty compared with what? Do not convert at which step? Almost every practice that says this has a specific, findable leak, and almost none of them can point to it, because the funnel is measured at the ends — inquiries at the top, starts at the bottom — and not at the joints in between. Eight numbers will locate the leak. None require new software to start counting, and the first two usually end the argument by themselves. ## The eight Track these monthly at minimum, weekly if you are actively fixing something. Segment every one of them by channel, because averages hide the channel that is quietly failing. | Metric | What it actually means | Where it hides | | --- | --- | --- | | Inquiries by channel | Every first contact, on every channel, including calls that rang out | Calls that never became a record; the true denominator is always larger than the CRM says | | Answer rate | Share of inbound contacts that reached a human or a real response | Phone system reports, not the CRM. Missed calls leave no CRM trace at all | | Speed to first contact | Median and 90th percentile time to a real response, not an autoresponder | The median flatters you; the 90th percentile is where lost families live | | After-hours share | Contacts arriving outside business hours | Timestamps. In our cohort this ran at 48% of family contacts | | Qualified rate, and why not | Share that fit area, payer, age and diagnosis rules — with reasons recorded | Disqualification reasons are usually not captured, so nobody can see the pattern | | Intake completion | Share of started packets that get finished | Stalls partway through; the abandoned step tells you which question is killing it | | Verification turnaround | Hours from first contact to a benefits answer | Queues in another team’s inbox, invisible to intake | | Inquiry to started, and days to start | The number that pays the bills, plus how long it took | Requires connecting first contact to a scheduled first session — the link most systems break | Add one financial metric on top: cost per started client by channel. Cost per lead is the number that makes weak channels look strong. ## The two nobody tracks First: who picks up. Answer rate by person and by hour is uncomfortable to look at and enormously informative. It is rarely a performance problem and almost always a coverage problem — a single coordinator cannot answer a call while on another call, and the pattern shows up as a hole at the same hours every week. Second: what happened to the families you never reached. In most practices this is the largest cohort in the funnel and the least examined. They are not lost causes; they are people who were called once at a bad moment. Counting them is what makes the case for a real follow-up sequence. ## Telling a lead-quality problem from an intake problem Every practice with weak conversion eventually argues about this, and the argument is settled by two numbers rather than by opinion. Bad qualification — the wrong families arriving at all — is real, and it comes from the channel: geography set wider than you can serve, keywords that attract the curious rather than the ready, creative that speaks to no one in particular. But it is usually not the biggest thing wrong, and diagnosing it when the truth is a slow phone call sends a practice off to rebuild ad campaigns while the actual leak keeps running. It has a distinctive signature. You call within minutes of the inquiry, and still very few families respond at all — and of the ones who do, very few turn out to be in your service area, on a payer you take, or in your age band. Both halves have to be true. If families answer when you call promptly, the channel is doing its job. If they qualify once you reach them, the channel is doing its job. Either one on its own points back at operations. When the signature is genuinely there, the fix is in the channel and nowhere else: tighten geography to the area you can actually serve, cut the search terms that bring browsers, rebuild lookalikes from families who started care rather than from everyone who filled a form, and say the payers and ages you take out loud in the creative so families self-select before they ever contact you. ## Connect the ad channels or you are optimizing blind If your ad platforms only know about form submissions, they will optimize toward people who submit forms. Feeding the later outcomes back — qualified, intake completed, started care — retrains delivery toward families who become clients, and it is the highest-leverage change most ABA advertisers have never made. Three practical requirements. Keep the source on the record from first contact through to start, so a started client can be traced to a keyword or a campaign. Track calls, because in this category most paid conversions are phone calls and they are invisible by default. And account for lag: an ABA family sourced in March may start in May, so a 30-day window will tell you to switch off the channel that is working. ## Read the funnel as a multiplication Write your own numbers in a row and multiply them. Answer 70% of inquiries, qualify 80% of those, complete packets with 75%, and start 80% of the remainder, and you are admitting about a third of the families who wanted you. Now raise each of those to 95% and the same inquiry volume produces more than double the admissions, with no additional marketing spend. This is why intake, not lead generation, is usually the cheapest growth lever available — and why the multiplication is worth doing on a whiteboard in front of the whole team once a quarter. ## The systems being connected is itself a signal One finding from our own fleet is worth stating carefully, because it is the strongest association in the dataset and the easiest to over-read. Across 117 ABA providers over 13 months, those whose intake fed their CRM grew about 6.5% per month, against 0.9% for those whose intake did not — roughly a sevenfold difference. That is observational, and correlation is not causation: practices organized enough to connect their systems tend to do many other things well, and the connection is probably as much a symptom of discipline as a cause of growth. It is still the clearest line in the data, and the mechanism is not mysterious. When intake, phones and ads all write to the same record, every number on this page can actually be computed — and a practice that can see its funnel fixes it. ## The weekly twenty minutes A short standing review beats a beautiful dashboard nobody opens. Four questions: how many inquiries came in and from where; how many did we fail to answer; which families are stuck and on what; and what is the single biggest fall between two adjacent steps. Then fix one thing. Practices that review weekly and change one process a month outperform practices that commission a quarterly analysis, every time. ## Benchmarks, honestly Published drop-off between first inquiry and first appointment commonly runs 40–85%, and many practices convert only 15–60% of inquiries into started clients. Well-run funnels — instant response, fast verification, digital paperwork, managed waitlists — reach 80%+. Treat these as orientation, not as a target. Your own trend line month over month is worth more than any industry average, because it is the only comparison that controls for your market, your payers, and your capacity. [Download the free ABA intake checklist (PDF)](https://carelu.com/downloads/aba-intake-checklist.pdf): Walk your funnel stage by stage and write your own numbers next to each step. ## Frequently asked questions ### What is a good intake conversion rate for an ABA practice? Many practices convert 15–60% of inquiries into started clients, and drop-off between first inquiry and first session commonly runs 40–85%. Well-run funnels reach 80%+. Your own month-over-month trend matters more than any benchmark, because it controls for your market and capacity. ### What should we measure first? Answer rate and median time to first human contact, segmented by hour of day. They are the cheapest to fix, they multiply every other stage, and in most practices the first honest look at them settles the debate about where the problem is. ### Is our problem lead quality or our intake? Run one test: call within minutes for two weeks. If families answer and most of them qualify, the channel is fine and the problem is downstream. It is genuinely a lead-quality problem only when both halves fail — very few respond even to an immediate call, and very few of those who do are in your service area, on a payer you take, or in your age band. That is the less common case, and the fix for it lives in channel targeting rather than in intake. ### How do I track which ad channel produced a client? Keep the source attached to the lead record from first contact through to first session, use call tracking so phone conversions are attributable, and feed the downstream events back to the ad platforms. Allow for the lag between inquiry and start when judging a channel. ### Why do missed calls not show up in our CRM? Because a call that rang out never created a record. The CRM can only count families who reached someone, which is why answer rate has to come from the phone system and why most practices underestimate their true inquiry volume. ### Cost per lead or cost per started client? Cost per started client, always. Cost per lead rewards channels that produce volume regardless of whether those families can be served or ever start, and it is the main reason practices keep funding channels that lose money. ## How Carelu measures your intake funnel for you Most of the eight numbers on this page are hard to get for one reason: phones, forms, intake and the CRM were never connected, so the joints of the funnel go unmeasured. With Carelu, first contact, qualification, intake and verification all happen in one place, so the numbers come straight from the work. Reading the numbers, and choosing the one thing to fix this month, is still your team’s weekly twenty minutes. Carelu makes sure the numbers are there when you sit down. - **Answer rate and speed to contact:** Measured across phone, website chat, text and web forms, because Carelu is the first response on all of them. - **Qualification on the record:** Service area, payer, age and diagnosis status are captured in the first conversation, so qualification is written down, not remembered. - **Completion, conversion and cost:** Intake completion, conversion and cost per started client by channel and source, with Google Ads, Meta Ads and CallRail connected. - **A clean denominator:** Job seekers are separated from families on your website, and they make up 40% of captured website leads, so they don’t inflate your inquiry count. - **Your systems connected:** Leads and status flow into CentralReach, Rethink, Aloha, Salesforce, HubSpot or Zoho, or anywhere else by webhook. ## Knowing your numbers, by hand and with Carelu Most of these metrics are not hard to compute. They are hard to compute repeatedly, from systems that were never connected to each other. | Step | Doing it manually | With Carelu | | --- | --- | --- | | Counting inquiries | CRM records only; missed calls invisible | Every call, chat, form and fax counted, answered or not | | Speed to contact | Not measured | Median and 90th percentile, by channel and by hour | | Disqualification reasons | Rarely recorded | Captured in the conversation and reportable | | Attribution | Breaks between ad click and first session | Source carried from first contact to started client | | Reporting effort | A manual export and a spreadsheet each month | Live, and answerable in plain language | ## Keep reading - [The full growth playbook](https://carelu.com/resources/how-to-grow-an-aba-practice): The equation these numbers describe. - [Where families disappear](https://carelu.com/resources/aba-intake-drop-off): The four leaks behind a bad number. - [Google Ads for ABA](https://carelu.com/resources/google-ads-for-aba): Feeding these events back into the auction. - [After-hours coverage](https://carelu.com/resources/after-hours-intake-coverage): The hours behind your worst answer rate. Source: Carelu — https://carelu.com/resources/aba-intake-metrics. Free to cite with attribution. --- --- title: "How to get pediatricians to refer to your ABA practice — and keep referring." url: "https://carelu.com/resources/aba-pediatrician-referrals" description: Referred families are pre-qualified, usually diagnosed, and free. Here is who to approach, what to say, what to leave behind, and the follow-through loop that decides whether a first referral becomes a steady stream. updated: 2026-09-17 --- # How to get pediatricians to refer to your ABA practice — and keep referring. **Short answer:** Lead with what you take (ages, counties, payers and current wait), make referring one step by fax, email or phone with no portal, and build the relationship with the referral coordinator as well as the physician. Then close the loop: acknowledge every referral the same day, tell the office when you reach the family, and report the outcome and start date. A referred family is the best lead an ABA practice can get. They arrive with a diagnosis or a clear path to one, they have been told by someone they trust that you are the right place, and they cost nothing per lead. A practice with three or four reliably referring offices has a floor under its census that no ad account can provide. Referral relationships also fail in a specific, predictable way, and it is almost never because a competitor out-sold you. It is because an office referred three children, heard nothing back about any of them, and stopped. Referral growth is a follow-through discipline that looks like a sales activity. ## Know who you are actually talking to Practices spend months trying to get lunch with a physician when the person who decides where referrals go is the referral coordinator or the medical assistant who processes them. The physician chooses a category of care. The coordinator chooses the name on the form, usually from a short list of who is easiest to deal with. Build the relationship with both. The physician needs to trust your clinical quality. The coordinator needs to know you answer the phone, take their patient’s insurance, and will not send the family back to them confused. - **Pediatricians and family medicine:** The largest single source. Often the first professional a worried parent tells. - **Developmental pediatricians, psychologists, neurologists:** Fewer offices, much higher volume per office, and families arrive already diagnosed. - **Speech and occupational therapists:** Frequently the first to notice, they see the child weekly, and they refer both directions. Chronically underworked as a channel. - **Schools and early intervention:** Not a medical referral, but the strongest local signal a parent gets. Relationships here compound quietly for years. - **Payer care managers:** On some plans they hold a list of in-network providers and steer families directly. Ask how to get on it. ## The outreach that works Lead with what you take, not with who you are. An office does not need your philosophy of care; it needs to know, in one glance, whether you can help the patient sitting in front of them. Ages served. Counties and ZIPs. Payers accepted, named specifically. Current wait to evaluation and to start. Whether you do in-home, in-clinic, in-school. How to refer, in one step. That is a one-page leave-behind, and it should be updated when the facts change. A stale wait time on a sheet from last spring is worse than no sheet, because the first time you cannot take a patient you promised to take, you have spent the relationship. The visit itself is short and specific. Ask what happens today when they identify a child who might need ABA: who do they send to, what goes wrong, what do they never hear back about. Then solve exactly that. Most offices will describe the same two frustrations — nobody tells them what happened, and the family comes back weeks later still waiting. ## The loop that keeps the referrals coming This is the whole discipline, and it is four touches. - **When** A referral arrives **then** Acknowledge it the same day, back to the referring office, by name and by child. Even "received, we are contacting the family today" is more than most practices ever send. - **When** You reach the family **then** Tell the office you made contact, or tell them you could not. An office that learns its patient was never reached will forgive you once if you say so. - **When** The child is evaluated or admitted **then** Close the loop with the outcome and the start date. This is the touch that converts a one-off referral into a habit. - **When** You cannot serve the family **then** Say so immediately and say where else to go. Declining fast and helpfully earns more future referrals than accepting slowly. - **When** Quarterly **then** Send the office a short summary: how many children they sent, how many started, current wait, any change in payers or areas. Almost nobody does this, and it is remembered. ## Make it mechanically easy to refer Every step of friction loses referrals to whoever has fewer steps. Accept referrals the way the office already works — fax, secure email, a phone call, a simple web form — and never require a portal signup to send you a patient. Publish a single referral phone number that a human answers, and make sure the fax line is monitored like an inbox rather than a machine someone checks on Fridays. Give them a one-field referral form, not a clinical intake packet. The office’s job is to hand over the child; the intake is your job, and pushing your paperwork onto their staff is the fastest way to be removed from a list. ## Records: get them right the first time Most referral relationships fray over records requests rather than over care. You need the evaluation or diagnostic report to authorize services; the office needs a valid release before it can send anything; and the request that arrives is frequently missing the details their staff need to even locate the chart. Requests that come back fast name the child exactly as the office files them, name the parent or guardian and their relationship to the child, specify which document is wanted and over what date range, and carry a release that plainly identifies who may receive the information. This is worth getting right as an operational habit, and it has its own playbook. ## Track referrals like a channel If you cannot say how many children each office sent last quarter and how many started, you cannot tell a productive relationship from a polite one. Record the referral source on every lead, report on it monthly, and let it direct where the next visit goes. The pattern that shows up almost every time: a small number of offices produce most referrals, several produce one and then stopped, and the ones that stopped are usually recoverable with a single honest call about what went wrong. [Download the free ABA records request templates (PDF)](https://carelu.com/downloads/aba-records-request-templates.pdf): The request letters and release language that get diagnostic reports back from a referring office without a second round trip. ## Frequently asked questions ### How do I get pediatricians to refer patients to my ABA practice? Make it obvious what you take — ages, counties, payers, current wait — make referring a single step by fax, email or phone with no portal, and close the loop on every referral: acknowledge the same day, report contact with the family, and report the outcome. Offices refer to whoever they trust to follow through. ### Who actually decides where referrals go? Usually the referral coordinator or medical assistant, not the physician. The physician decides that a child needs ABA; the staff member processing the referral decides which practice to name, generally based on who is easiest to work with. ### What should be on an ABA referral one-pager? Ages served, counties and ZIPs, payers accepted by name, current wait to evaluation and to start, service settings (home, clinic, school), and exactly how to refer with a phone number and fax. Keep it current — an out-of-date wait time costs more credibility than no sheet at all. ### How fast should we respond to a referral? Acknowledge to the referring office the same day and contact the family within hours. Referred families are not exclusive either; many were given two or three names. ### What if we cannot take the referred family? Say so immediately and point them somewhere useful. A fast, helpful decline preserves the relationship; a slow one where the family drifts back to the office confused is what ends it. ## How Carelu follows through on every referral Referral relationships die from silence, and the silence is almost always operational: the family wasn’t reached quickly, the release wasn’t signed, nobody knew where the child stood. Carelu takes that follow-through off your coordinators’ plates. The relationship itself stays human. The visits, the one-page leave-behind, and the call to the office telling them their patient started all come from your team. Carelu makes sure you always have something good to tell them. - **The family reached fast:** A referred family who calls, texts or fills a form is answered within seconds, 24/7. Referrals that arrive through a connected form or webhook go straight into the same queue. - **Qualified and verified up front:** Area, payer, age and diagnosis status are confirmed in the first conversation, and eligibility and ABA benefits are checked during intake, so a family you can’t serve hears it right away. - **The release signed with intake:** The release of information is e-signed inside the hosted intake and saved as a PDF in the family’s packet, ready before your team needs it. - **Status per family, routed to the right person:** Each referral goes to the right coordinator by state or ZIP and has a status in one live queue, so you always know what to tell the referring office. - **Referrals as a channel:** Reporting shows conversion by source, so you can see which offices produce started clients. ## A referral, by hand and with Carelu Referral programs rarely fail at the visit. They fail in the weeks afterwards, in the follow-through nobody has time for. | Step | Doing it manually | With Carelu | | --- | --- | --- | | Referral arrives by fax | Sits on a machine until someone checks it | Faxes, emails and forms land in one queue and are worked immediately | | Acknowledgement to the office | Rarely sent | Same-day confirmation back to the referring office | | Contacting the family | Within a few days, if the queue allows | Contacted within minutes, on the channel they use | | Records and releases | Chased by phone, often incomplete and returned | Release captured with intake; requests go out complete the first time | | Closing the loop | The office never hears the outcome | Status tracked per referral and reportable per office | | Source reporting | Nobody knows which office produces starts | Referrals by source, with started-client counts | ## Keep reading - [Records requests that come back](https://carelu.com/resources/aba-records-request): Releases, recipients and the details that stop a second round trip. - [Pediatrician contact directory](https://carelu.com/resources/pediatrician-referral-contacts): Referral contacts by state, ready to work through. - [The full growth playbook](https://carelu.com/resources/how-to-grow-an-aba-practice): How referrals sit alongside paid and organic demand. - [Families without a diagnosis](https://carelu.com/resources/aba-evaluation-referrals): The referrals that arrive one step too early. Source: Carelu — https://carelu.com/resources/aba-pediatrician-referrals. Free to cite with attribution. --- --- title: "Records requests that actually come back: releases, recipients, and the details that decide." url: "https://carelu.com/resources/aba-records-request" description: Why diagnostic reports stall an ABA start, what makes a release valid under HIPAA, when one general ROI can cover a class of recipients, and the details that get a request fulfilled on the first attempt. updated: 2026-09-17 --- # Records requests that actually come back: releases, recipients, and the details that decide. **Short answer:** Send a complete request to the right desk, with a HIPAA release that states the information, discloser, recipient, purpose, expiration, signature and right to revoke. The recipient can be a clearly identified class, so one release signed at intake can cover the pediatrician, psychologist and school. Chase at day three and day seven, and ask the family to check their patient portal. A surprising share of ABA starts are not waiting on clinical capacity or on an authorization. They are waiting on a PDF sitting in another organization’s chart — an evaluation report, a diagnostic letter, a school assessment — that nobody has successfully asked for. Records work looks like administrative trivia and behaves like a growth constraint. A request that is missing one detail gets set aside by a records clerk with a hundred others, and nobody tells you it was set aside. Two weeks later a family who was ready to start is still waiting, and has begun to wonder whether you are competent. The fix is unglamorous and highly learnable: send complete requests, to the right desk, with a release that plainly authorizes the disclosure — and then chase them on a schedule rather than when someone remembers. ## Why records stall a start Most payers will not authorize ABA without documentation of the diagnosis, and many have rules about how recent it must be and what tool produced it. The family rarely has that report. They remember an appointment eighteen months ago at a hospital clinic, they may have been handed a summary they have since lost, and the actual document lives with the evaluating provider. So the sequence is: get a release signed, identify who holds the record, ask correctly, and follow up until it arrives. Each of those steps is where practices lose days. ## What makes a release valid A HIPAA-compliant authorization has required elements, and missing one is the most common reason a records department refuses to act. Whatever form you use, it must contain each of these in a way a stranger can read without interpretation. | Element | What it means in practice | Status | | --- | --- | --- | | Description of the information | Specific, not "all records" — e.g. "psychological evaluation and diagnostic report, 2024–present" | Required | | Who is disclosing | The organization that holds the record, named as they are known | Required | | Who may receive it | The name, or other specific identification, of the person(s) or class of persons receiving the information | Required | | Purpose | "At the request of the individual" is acceptable; treatment coordination is clearer | Required | | Expiration | A date or an event — an open-ended release is not valid | Required | | Signature and date | The individual, or a personal representative with authority to sign | Required | | Right to revoke | A statement of the right to revoke in writing, and any exceptions | Required | | Authority of the signer | If not the patient, the basis of authority — parent, guardian, custodial documentation | Conditional | This is a working summary, not legal advice. Confirm your forms with your own compliance reviewer, and note that some states and some record types — psychotherapy notes, substance use, HIV status — carry stricter rules than HIPAA alone. ## The recipient can be a class of people, not one named provider This is the single most useful and least known point in records work, and it removes a chase that most intake teams run every week. HIPAA does not require that every individual recipient be named. It requires that the authorization identify the name, or other specific identification, of the person or persons — or the class of persons — who may receive the information. A general release is therefore acceptable as long as the class of recipients is clearly identified. In practice that means categories such as "Primary Care Physicians," "School Personnel," or "Treating Providers involved in the client’s care" are generally appropriate. Written that way, one release signed at intake can cover the pediatrician, the diagnosing psychologist, the school, and the speech therapist — instead of a new signature, a new email, and a new three-day delay for each one. Two cautions. Keep the class genuinely identifiable: "anyone" is not a class. And remember that the receiving organization gets to decide whether it is satisfied, so a small number of hospital systems will insist on a named recipient on their own form regardless. Build for the general release and keep the specific one ready. ## Identify the child the way the other office files them A records clerk is matching your request against a chart in a system you cannot see. Anything that makes matching ambiguous turns your request into a callback, and a callback becomes a pile. Send more identifying detail than feels necessary, not less. - **When** Naming the child **then** Full legal name as the other office would have registered it, plus any name the family commonly uses, plus date of birth. A child enrolled under a hyphenated or maternal surname is the classic stall. - **When** Naming the requester **then** The parent or guardian’s full name and their relationship to the child — and, where custody is not straightforward, the documentation that establishes authority to sign. - **When** Naming the document **then** Exactly what you want, in their vocabulary: "the diagnostic evaluation report," not "records." Include the approximate date or date range of service, and the evaluating clinician if known. - **When** Naming yourself **then** Practice name, NPI, a direct fax and phone, and a named person who can answer questions. A request from an anonymous fax number is easy to deprioritize. - **When** Stating the purpose **then** Continuity of care and insurance authorization for ABA services, so the urgency is visible rather than implied. - [Records request templates (PDF)](https://carelu.com/downloads/aba-records-request-templates.pdf): Request letters and release language covering the elements above, with bracketed placeholders to fill in. - [Consent authority templates (PDF)](https://carelu.com/downloads/aba-consent-authority-templates.pdf): Who may sign for a child, and the documentation to collect when custody is shared or contested. ## Send it to the right desk Large organizations have a health information management department, and a request faxed to the clinic front desk may never reach it. Small practices are the opposite: the front desk is the records department, and a formal request addressed to HIM will confuse them. Two minutes on the phone before sending saves a week. Ask where releases should go, whether they have their own form they prefer, what fax or portal they use, and roughly how long fulfilment takes. Record the answer against that organization so nobody has to ask again — a referral-source record that carries the right fax number and the right form is worth more than any template. ## Chase on a schedule, not on a memory Assume nothing arrives on its own. A workable rhythm is a confirmation call two to three days after sending to verify receipt and legibility, a follow-up at day seven, and an escalation in the second week to a supervisor or, where appropriate, a reminder that individuals have a right of access to their own records within defined timeframes. Keep the family informed while this happens, and give them a parallel path: many parents can pull the report themselves from a patient portal in a few minutes, which is frequently faster than any institutional route. Asking them to look is not an admission of failure; it is often the fastest single move available. And log everything — when it was sent, to whom, by what channel, what came back. Records chases that live in one coordinator’s memory stop the day that coordinator is out. ## Collect the release at the right moment The easiest release to obtain is the one signed while the parent is already filling out intake and motivated to move. The hardest is the one you go back for three days later, when you have discovered you need it and their enthusiasm has cooled. Put a properly drafted general release in the intake packet itself, written to cover the classes of recipients you predictably need, and capture it electronically so it can be attached to an outgoing request the same minute a gap is identified. ## Frequently asked questions ### Does a HIPAA release have to name each individual provider? No. HIPAA requires the authorization to identify the name or other specific identification of the person or persons, or the class of persons, who may receive the information. A general release is acceptable where the class of recipients is clearly identified — for example "Primary Care Physicians," "School Personnel," or "Treating Providers involved in the client’s care." Some organizations will still insist on their own form with a named recipient. ### Why do records requests come back unfulfilled? Most often the child could not be matched to a chart, the signer’s authority was unclear, the release was missing a required element such as an expiration date, the requested document was described too vaguely, or it went to the wrong desk. Every one of those is preventable on the first attempt. ### How long should a records request take? Fulfilment timeframes vary by organization and by state, and access rules give individuals a right to their own records within defined limits. Practically, plan on days rather than hours, chase at day three and day seven, and give the family a parallel route through their patient portal. ### Who can sign a release for a child? Generally a parent or legal guardian acting as the personal representative. Shared custody, foster placement, grandparent caregivers and court orders all change the answer, so collect documentation of authority at intake rather than discovering the problem when a request is refused. ### Can we ask the family to get the report instead? Yes, and it is frequently the fastest route. Many evaluation reports are downloadable from a patient portal in minutes. Ask in parallel with your own request rather than instead of it. ## How Carelu handles releases and missing reports Records work has two sides. One is the family: the release, the authority to sign, and the report they may be able to pull from a portal in minutes. The other is the organization holding the chart. Carelu runs the family side from the first day of intake, so your team never has to go back for a signature. The request to the other organization, the call to find the right desk, and the escalation in week two stay with your coordinators. They start that work with a signed release on file and a clear list of what is still missing. - **The release, signed at the right moment:** The release of information is e-signed inside the hosted intake, while the parent is motivated, and generated as a PDF in the family’s packet the moment it is signed. - **Knowing what the payer will need:** Diagnosis requirements and prior-auth rules for each state and payer are built in from Carelu’s payer directory, so your team knows what to ask for before an authorization is refused. - **The family’s parallel path:** Families can upload the evaluation report by text or on the intake form, often the fastest route when the report is in a patient portal. - **Chased on a schedule:** Follow-up flows by text and email ask for missing documents until they arrive or the family opts out, and every family’s status sits in one live queue. ## Records work, by hand and with Carelu Nothing here is difficult. All of it is a rote, time-sensitive task that a busy coordinator does not get to — which is exactly the category of work that should not depend on someone remembering. | Step | Doing it manually | With Carelu | | --- | --- | --- | | Getting the release signed | Chased days later, by email, once a gap is found | Signed as part of intake, electronically, before it is needed | | Knowing what is missing | Discovered when authorization is refused | Required documents tracked per family and per payer rule | | Sending the request | Retyped each time; details missed | Complete request assembled from the record, sent by fax or email | | Following up | When someone remembers | Scheduled chases at day three and day seven, escalated automatically | | Keeping the family posted | Silence while they wait | Family updated at each step, with a portal path offered in parallel | | Institutional memory | Lives in one coordinator’s head | Right fax, right form, right desk stored against each organization | ## Keep reading - [Pediatrician referrals](https://carelu.com/resources/aba-pediatrician-referrals): The relationships these requests run through. - [The full intake process](https://carelu.com/resources/aba-client-intake-process): Every document an ABA start requires, and when to ask for it. - [Families without a diagnosis](https://carelu.com/resources/aba-evaluation-referrals): When there is no report to request yet. - [Intake forms that get finished](https://carelu.com/resources/aba-intake-forms): Where the release belongs in the packet. Source: Carelu — https://carelu.com/resources/aba-records-request. Free to cite with attribution. --- --- title: "ABA waitlist management: keep families engaged, not waiting." url: "https://carelu.com/resources/aba-waitlist-management" description: "How ABA providers keep waitlisted families engaged, verified, and ready to start — instead of losing them to the first competitor with an opening. Free checklist included." updated: 2026-07-19 --- # ABA waitlist management: keep families engaged, not waiting. **Short answer:** Treat the waitlist as a pipeline, not a queue: verify insurance and collect documents the week a family joins, check in every two to three weeks, and rank by readiness rather than arrival date. A healthy list is more than 60% start-ready (verified and documented), with no family untouched for more than a month. Most ABA waitlists are where families go to disappear. A parent calls, gets told "we'll reach out when a spot opens," and then hears nothing for weeks. By the time you call back, they've started with another provider — because every family on your waitlist is on three other waitlists too. Waitlist management isn't a spreadsheet problem. It's a communication and readiness problem: the providers who convert their waitlist treat it as a pipeline of families being actively prepared to start, not a queue of names waiting their turn. ## Why ABA waitlists leak Between diagnosis and first session, a family is at their most motivated — and their most impatient. Industry drop-off between first inquiry and first appointment commonly runs 40–85%. Three leaks account for almost all of it: - **Silence:** No touchpoint between "you're on the list" and "a spot opened." Families read silence as rejection and keep shopping. - **Unreadiness:** A spot opens, but the family's insurance was never verified and documents were never collected — so the opening sits empty for weeks while paperwork catches up. - **Stale data:** By the time you call, the phone number changed, availability changed, or the child already started elsewhere. Nobody knew, because nobody asked. ## What good waitlist management looks like The goal is simple to state: when a spot opens, the next family should be able to start within days, not weeks. That takes four habits: - **Verify eligibility at intake, not at opening:** Run insurance verification the day a family joins the waitlist. Families who won't clear benefits shouldn't age on your list for months first. - **Collect documents up front:** Diagnosis report, insurance card, consents, availability — gather them while motivation is highest, the week the family first reaches out. - **Touch every family on a cadence:** A short check-in every 2–3 weeks: position update, document nudges, availability confirmation. It keeps data fresh and tells families you haven't forgotten them. - **Rank by readiness, not just date:** The next spot should go to the family who is verified, documented, and schedulable — order of arrival matters, but readiness decides who can actually start. ## The metrics that matter If you track nothing else, track these four: waitlist-to-start conversion rate (what share of waitlisted families ever begin services), time from opening to first session, share of the list that is "start-ready" (verified + documented), and contact freshness (when each family was last touched). A healthy list is above 60% start-ready with no family untouched for more than a month. ## Where automation fits Everything above is rote, repetitive, and time-sensitive — which is exactly what front-office staff don't have hours for, and exactly what software does well. An AI intake platform like Carelu answers every new inquiry instantly, verifies insurance up front, collects documents while the family is motivated, and keeps every waitlisted family warm with automatic check-ins — so when a spot opens, the next family is ready to start, not ready to be chased. [Download the free ABA intake checklist (PDF)](https://carelu.com/downloads/aba-intake-checklist.pdf): Every step from first contact to first session — printable, and free to adapt for your practice. ## Frequently asked questions ### How long is a typical ABA waitlist? Anywhere from weeks to over a year depending on region and staffing. Length matters less than leakage: a six-month list that stays engaged converts better than a six-week list that goes silent. ### How often should we contact waitlisted families? Every two to three weeks, briefly. Confirm availability, nudge missing documents, and share their status. Less than monthly and families assume they've been forgotten. ### Should we verify insurance before or after a spot opens? Before — the day they join the list. Verification at opening adds weeks of delay to every start and lets ineligible families age on the list. ## How Carelu keeps your waitlist start-ready The four habits on this page are simple. What makes them hard is keeping them going for months, for every family, while your coordinators handle today’s calls. Carelu does that part. Each family is verified and documented the week they reach out, then kept warm on a schedule until a spot opens. The decisions stay with your team: who gets the next opening, and the call that tells a family their spot is ready. Carelu makes sure that when you make that call, the family is still there and ready to start. - **Verified the day they join:** Insurance eligibility and ABA benefits, including coverage, in-network status and referral requirements, are checked automatically during intake. A family who will not clear benefits never sits on your list for months first. - **Documents while motivation is high:** A hosted intake families can finish on a phone, prefilled from their first conversation. Consents and releases are e-signed, and each signed document lands in the family’s packet as a PDF. Insurance cards and diagnosis reports come in by text or on the form. - **Check-ins that happen without anyone remembering:** Follow-up flows by text and email, per family and per stage, nudge missing documents and unfinished intake until the family responds or opts out. - **Readiness you can see:** Every family sits in one live queue with a status. When a spot opens, you can see at a glance who is verified, documented and ready. ## Keep reading - [The full growth playbook](https://carelu.com/resources/how-to-grow-an-aba-practice): Five channels, and the operational layer they all depend on. - [Follow-up that reads human](https://carelu.com/resources/aba-follow-up-sequences): What to say to a family who has been waiting for months. - [Families without a diagnosis](https://carelu.com/resources/aba-evaluation-referrals): The longest wait of all, and how to own it. - [The numbers to watch](https://carelu.com/resources/aba-intake-metrics): Measuring readiness, speed and conversion. Source: Carelu — https://carelu.com/resources/aba-waitlist-management. Free to cite with attribution. --- --- title: Half the families who contact you are not doing it during business hours. url: "https://carelu.com/resources/after-hours-intake-coverage" description: "In a cohort of 120 providers and 185,000 family conversations, 48% of contacts arrived outside business hours. What parents do when they reach voicemail, the real options for covering those hours, and what coverage has to do beyond taking a message." updated: 2026-09-17 --- # Half the families who contact you are not doing it during business hours. **Short answer:** About half: in a cohort of 120 providers and roughly 185,000 family conversations, 48% of contacts arrived outside business hours. Parents who reach voicemail usually call the next practice, so real coverage has to tell them whether you serve their area and take their plan and start intake on the spot, not just take a message. Across 120 ABA and behavioral-health providers and roughly 185,000 family conversations, 48% of family contacts arrived outside business hours. Not a rounding error, and not an edge case. Half the demand. That number has an obvious explanation. A parent of a child who needs ABA is not free at eleven on a Tuesday morning. They are free after bedtime, on a lunch break, on Sunday afternoon — and that is when they finally do the thing they have been putting off for weeks. Which means the most consequential question in ABA intake is not what your team says on a call. It is what happens when nobody is there — and the answer matters more each year, because in the same research the median provider in a same-store cohort saw demand grow 35% year over year. A fixed-size gap in coverage loses a growing number of families. ## What a parent actually does at 8pm They do not leave a voicemail. They hang up and try the next practice on the list they are working through, and the one after that, until somebody answers. If nobody answers, a good share of them do not try again the next day — the moment of resolve passes, and calling strangers about your child is hard enough once. This is why after-hours loss is invisible. These families never enter your CRM, never appear in a report, and never show up in the conversation about why growth is flat. The only evidence is a gap in the timestamps. ## What voicemail communicates Put yourself on the other end. A parent has spent months working up to this call. They get a recorded greeting and an invitation to leave a message. What they learn, fairly or not, is that reaching this organization is going to be difficult — and they are about to hand that organization their child for twenty hours a week. The same applies to a web form that promises a response within one business day. It is honest and it is a competitive liability, because "one business day" on a Friday night means Monday, and Monday is three practices too late. ## The four ways to cover the hours Every practice picks one of these, including the ones that have never discussed it. | Option | What it really costs | What a parent gets | | --- | --- | --- | | Voicemail and a web form | Nothing up front; roughly half your inquiry demand | A recording, and a reason to call the next practice | | Staff rotation or on-call | Real money and real goodwill; hard to sustain, worse to recruit for | A person — on the nights the rotation holds | | Answering service | Modest and predictable | A courteous message-taker who cannot answer whether you take their plan | | Coverage that can actually transact | More than a message service, less than headcount | Answers about area and coverage, and intake started on the spot | The distinction that matters is not human versus automated. It is whether the family gets an answer or gets a promise of one. ## Taking a message is not coverage This is where most after-hours projects fail. A service that collects a name and number and emails it to the office has moved the delay, not removed it. The parent still does not know the three things they called to find out — whether you serve their area, whether you take their insurance, and how long the wait is — and they will keep calling other practices until someone tells them. Real coverage answers those questions at the moment they are asked, and then advances the family: confirm the area, confirm the payer, start the intake while intent is at its peak, book the next step, and route a family with no diagnosis toward evaluation instead of a dead end. Everything a good coordinator would do at 2pm needs to happen at 9pm, or the coverage is theatre. ## Weekends, holidays, and the lunch hour After-hours is usually discussed as nights, but the pattern is wider. Weekends are heavy, because that is when two parents can talk it through together. Holidays and school breaks produce spikes, as does the week after a pediatrician visit. And the daily lunch hour is a hole in most practices: it is precisely when working parents make personal calls, and precisely when the front desk is down to one person or none. Whatever coverage you build, check it against your own timestamps rather than against assumptions. The specific holes vary by market more than people expect. ## The internal objection, answered Someone will say that families who are serious will call back. Some will. The question is what share, and whether you are willing to concede the rest to whichever competitor picked up — and in a market where several practices bid on the same search terms, "we will get them tomorrow" is a bet against arithmetic. The related objection is that after-hours contacts are lower quality. They are not; they are the same families, contacting you at the only time they are free. What is true is that they are less patient, because they are making the call in a narrow window they had to carve out. ## How to measure whether it is working Three numbers. The share of contacts arriving outside business hours, which tells you the size of the prize. The answer rate inside those hours specifically. And the conversion rate of after-hours contacts compared with business-hours contacts — if the first is materially worse, your coverage is taking messages rather than doing the work. Watch the third one over a full quarter. When after-hours conversion approaches business-hours conversion, the coverage is real. ## Frequently asked questions ### What share of ABA inquiries arrive after hours? In our published cohort of 120 providers and roughly 185,000 family conversations, 48% of family contacts arrived outside business hours. The pattern is driven by when parents of young children are actually free — evenings, weekends and lunch breaks. ### Do parents leave a voicemail? Mostly not. They hang up and call the next provider. Families lost this way never create a record, which is why after-hours loss is usually absent from the conversation about why growth is flat. ### Is an answering service enough? It is better than voicemail and short of coverage. A message service cannot tell a parent whether you serve their county or take their plan, so the family keeps calling other practices while your message sits in an inbox until morning. ### Should we just restrict our ads to business hours? It is a legitimate choice if you genuinely cannot cover the hours — better to spend the budget where you can respond. Understand the trade: you are conceding the busiest window in the category, including most weekend demand, to competitors who can answer. ### Are after-hours leads lower quality? No. They are the same families contacting you at the only time they are free. They are less patient, because the window they carved out is narrow, which makes response speed matter more rather than less. ## How Carelu covers nine at night This page draws the line between taking a message and coverage that does the work. Carelu is the second kind. At 9pm it does what a good coordinator would do at 2pm: answer the parent’s three questions, move the family forward, and route a family with no diagnosis toward evaluation. Your team still owns the morning: the scheduling call, the harder questions, and the families who asked for a person. The difference is that they start with qualified families who have already begun intake, not a stack of voicemails. - **Answered live, any hour:** An AI voice agent answers every call, and website chat, text and web forms are answered within seconds, in English and Spanish. That covers the 48% of contacts that arrive after hours. - **The three questions, answered:** Service area by ZIP or drive time and payer accepted are confirmed in the conversation, with insurance eligibility and ABA benefits checked automatically during intake. - **Intake started on the spot:** A phone-friendly intake prefilled from the conversation, with e-signed consents and uploads by text, that the family can resume later. - **Monday is a queue, not a stack:** Each family is routed to the right coordinator by state or ZIP and shows up in one live queue with its status. - **Proof it is working:** Answer rate, speed to contact and conversion by channel show whether after-hours families are converting, not just being logged. ## Nine at night, by hand and with Carelu The test of a coverage plan is not whether something happens when a family calls at nine at night. It is whether the family gets what they would have gotten at two in the afternoon. | Step | Doing it manually | With Carelu | | --- | --- | --- | | The call at 9pm | Voicemail; most parents hang up | Answered live | | "Do you take my insurance?" | Unanswerable until morning | Answered in the conversation, with eligibility checked | | "Do you serve my area?" | Unanswerable until morning | Resolved by county and ZIP on the spot | | Starting intake | Waits for a callback that may not connect | Started while the parent is still on the line | | Sunday web form | Read Monday, answered Monday afternoon | Answered in seconds | | Monday morning | A stack of messages, hours of callbacks, many unreachable | A queue of qualified families with intake already underway | ## Keep reading - [The full growth playbook](https://carelu.com/resources/how-to-grow-an-aba-practice): Why coverage multiplies every channel you run. - [Google Ads for ABA](https://carelu.com/resources/google-ads-for-aba): You are buying these hours whether or not you meant to. - [The numbers to watch](https://carelu.com/resources/aba-intake-metrics): Measuring the hours you are losing. - [Where families disappear](https://carelu.com/resources/aba-intake-drop-off): The unanswered first contact, and the three leaks after it. Source: Carelu — https://carelu.com/resources/after-hours-intake-coverage. Free to cite with attribution. --- --- title: "How AI can help an ABA practice grow, and where it shouldn’t be used." url: "https://carelu.com/resources/ai-for-aba-practices" description: "A practical guide to AI in ABA practices: AI receptionists and intake, insurance verification, document collection, follow-up, marketing and admin, plus the clinical decisions AI should stay out of, and the HIPAA guardrails every tool must meet." updated: 2026-09-23 --- # How AI can help an ABA practice grow, and where it shouldn’t be used. **Short answer:** AI helps most in the front office: answering every inquiry 24/7, qualifying families, completing intake, verifying benefits and following up on missing documents, where 48% of contacts arrive after hours and only 2% of providers run automated re-engagement. It shouldn’t make clinical decisions like medical necessity, hours or treatment plans, and any tool touching family data needs a signed BAA. Most of the work that decides whether an ABA practice grows isn’t clinical. It’s answering the phone at 8:40pm, checking whether a plan covers ABA, chasing a diagnostic report, and reminding a family for the third time that one signature is missing. That is repetitive, rule-bound and time-sensitive, which is exactly what current AI does well. The clinical work is different: assessment, programming, supervision and the relationship with the family. AI can help around it, but it shouldn’t make those decisions. This guide covers where AI earns its place in an ABA practice, where it doesn’t, and how to adopt it without putting families or compliance at risk. ## Where AI helps most: the front office The front office is where ABA practices lose the most families and have the least slack. In our research across 120 ABA providers, 48% of family contacts arrived outside business hours, and only 2% of providers ran any automated re-engagement at all. Both of those are problems AI can solve today. - **Answering every inquiry:** An AI voice agent, chat and text that respond in seconds, at any hour, in English and Spanish. It answers the parent’s actual question (do you take my plan, do you serve my town, do I need a diagnosis) instead of taking a message. - **Qualifying:** Checking service area, payer, age and diagnosis status in the first conversation, so coordinators spend time on families you can actually serve and families you can’t get a clear, kind answer right away. - **Completing intake:** Guiding a parent through the intake packet on their phone, prefilled from what they already said, with e-signed consents and document uploads, so the coordinator reviews a finished packet instead of assembling one. - **Verifying benefits:** Running eligibility and ABA benefit checks automatically during intake, and applying each state’s and payer’s diagnosis and referral rules. - **Following up:** Sending the right next message to each family based on what is actually missing, whether that’s the diagnosis report, the insurance card back or a signature, until they respond or opt out. ## Should you use an AI receptionist or an answering service? An answering service puts a human on the line after hours, which is better than voicemail. But most answering services take a message, cover only the phone, and hand you a callback list in the morning. By then the parent has usually contacted two other practices. An AI receptionist built for ABA intake does the intake itself on every channel: it qualifies, starts the packet and verifies benefits, then passes the family to your coordinator the next morning. The question to ask is not "human or AI" but "does the family finish the call closer to a first session?" Test both on your after-hours traffic and measure how many families reach the documents step. One rule applies either way: be honest with families. The AI should say what it is, hand off to a person whenever the family asks or the situation calls for it, and never pretend to be a named staff member. ## Other good uses: marketing and admin - **Measuring marketing by started clients:** Tying each started client back to the ad, referral source or page that brought them in, so you cut spend on channels that bring leads but not starts. - **Writing and updating content:** Drafting location pages, payer FAQs and referral-partner one-pagers, with a person checking every clinical and payer claim before it goes live. - **Recruiting:** Screening RBT and BCBA applicants and scheduling interviews quickly, and keeping job seekers out of the family pipeline (40% of captured website leads in our research were job seekers). - **Summaries and admin:** Summarizing long calls and email threads, drafting routine letters and flagging expiring authorizations and credentials. ## Where AI should not be used Some decisions have to stay with licensed people. Whether a child needs ABA and how many hours, what goes into the treatment plan, how a program changes, and whether a family is clinically appropriate for your services are all clinical judgments. AI can prepare the information, but a BCBA makes the call. The same applies to telling families things that sound like clinical or coverage promises. An AI can say what a plan’s published rules are and that benefits verified as active. It should not promise a family a number of hours, a start date or that a claim will be paid. ## The guardrails every AI tool must meet - **A signed BAA:** Any tool that sees a child’s name, diagnosis or insurance is handling PHI. No BAA, no family data. This includes general-purpose AI chat tools your staff might paste notes into. - **Security you can verify:** Ask for a SOC 2 Type II report, not a badge on a website. - **Consent for texts and calls:** Automated texts need documented consent and a working opt-out. Follow-up must stop when a family says stop. - **A person behind the bot:** Clear handoff to a human, on request and for anything sensitive, with the full conversation attached so the family never has to repeat themselves. - **A record of everything:** Every conversation, answer and signed document saved to the family’s record, so you can audit what was said. ## How to start Start where the loss is biggest and the risk is lowest, which for most practices is after-hours response. Put AI on nights and weekends for two weeks, keep your team on business hours, and compare how many families reach the documents step in each group. If after-hours families now convert close to daytime families, extend it to overflow during the day, then to follow-up and verification. Adding one step at a time keeps each change measurable. ## Frequently asked questions ### How can AI help an ABA practice grow? Mostly in the front office: answering every inquiry 24/7 on phone, chat and text, qualifying families by area, payer and diagnosis, completing intake and consents on a phone, verifying insurance benefits and following up on missing documents. These are the steps where ABA practices lose most families, and they are repetitive and rule-bound, which is where AI works well. ### Is it safe to use AI with ABA families’ information? Only with a vendor that signs a BAA and can show a SOC 2 Type II report. Never paste family information into general-purpose AI tools that don’t have a BAA with your practice. ### Will an AI receptionist replace my intake coordinator? It shouldn’t. The AI does the repetitive work (answering, qualifying, collecting, verifying, reminding), and your coordinator handles the conversations that need a person and builds the relationship. Most practices use it to let the same team admit more families. ### Do parents mind talking to AI? Parents mostly mind waiting. An assistant that answers at 10pm, knows whether you take their plan and lets them start intake right away beats voicemail. Be transparent that it’s AI, and hand off to a person whenever they ask. ### Can AI make clinical decisions in ABA? No. Medical necessity, hours, treatment plans and program changes are decisions for a BCBA or other qualified professional. AI can gather and organize the information that goes into those decisions. ## How Carelu puts AI to work in your front office Carelu is AI built for one job: getting ABA families from first contact to a verified, documented, schedulable case, on every channel and at any hour. It covers the front-office work described on this page and stays out of the clinical work. Your coordinators keep the conversations that need a person. Carelu hands them families who are already qualified and verified, with the full conversation attached. - **An AI receptionist on every channel:** Phone, website chat, text and forms, answered in seconds, 24/7, in English and Spanish, with a clear handoff to your team whenever a family asks. - **Intake, qualification and verification:** Area, payer, age and diagnosis checked in the first conversation. Intake completed on a phone with e-signed consents. Benefits verified with each state’s payer rules applied. - **Follow-up that knows what’s missing:** Text and email flows per family and per missing item, with consent handling and opt-outs, until the packet is complete. - **Measured by started clients:** Answer rate, speed to contact, completion and cost per started client by channel, so you can see the lift for yourself. - **The guardrails, included:** HIPAA compliant, SOC 2 Type II, and a BAA with every provider. Every conversation and signed document is saved to the family’s record. ## The front office, by hand and with Carelu | Step | Doing it manually | With Carelu | | --- | --- | --- | | After-hours inquiry | Voicemail or a message for the morning | Answered in seconds; intake started that night | | Qualification | Coordinator checks area and payer lists by hand | Checked in the first conversation | | Intake packet | Emailed PDF; finished or abandoned | Completed on a phone, prefilled, e-signed | | Benefits | Verification call, days later | Verified automatically during intake | | Follow-up | Whoever remembers | Per family, per missing item, until done or opted out | ## Keep reading - [Choosing intake software](https://carelu.com/resources/best-aba-intake-software): The four kinds of tools, twelve questions and a two-week test. - [After-hours coverage](https://carelu.com/resources/after-hours-intake-coverage): Why taking a message is not coverage. - [Follow-up sequences](https://carelu.com/resources/aba-follow-up-sequences): What to send, when, and what never to automate. - [How to grow an ABA practice](https://carelu.com/resources/how-to-grow-an-aba-practice): The five channels and the operations layer they all depend on. - [The Intake Gap (our research)](https://carelu.com/research/the-intake-gap): 185,054 family conversations across 120 ABA providers. Source: Carelu — https://carelu.com/resources/ai-for-aba-practices. Free to cite with attribution. --- --- title: "Best ABA intake software in 2026: how to choose, and what to test before you buy." url: "https://carelu.com/resources/best-aba-intake-software" description: The four kinds of tools ABA practices use for intake (practice-management intake modules, general CRMs, answering services and AI intake platforms), what each is good at, the twelve questions to ask any vendor, and a two-week test that shows whether a tool actually moves families to first session. updated: 2026-09-23 --- # Best ABA intake software in 2026: how to choose, and what to test before you buy. **Short answer:** The best one fixes the step where your families get lost, so pull 60 days of inquiries and mark where each family stopped. Families who never reach a person need 24/7 answering on every channel; families who stall on documents need guided digital intake with follow-up. Test any tool on a slice of real traffic for two weeks before you buy. When an ABA owner asks for "the best intake software," they usually mean one of four different kinds of product, and the best choice depends on where families are getting lost. A practice that loses families at the first phone call needs something different from one that loses them waiting on the diagnostic report. So this guide doesn’t rank vendors. It explains the four categories, what each one actually does, the questions that separate a demo from a working system, and a two-week test to run before you sign. Carelu is one of these tools, and its pitch is at the end. The method works whatever you buy. ## Start with where families get lost, not with features ABA intake has six steps: the family reaches out, someone answers, you qualify them (area, payer, age, diagnosis status), they complete documents, benefits are verified, and a first session is scheduled. Industry drop-off between first inquiry and first appointment commonly runs 40–85%, and almost every practice has one or two steps that cause most of it. Before any demo, pull the last 60 days of inquiries and mark where each family stopped. If most never reached a person, you have an answering problem. If most qualified but never sent documents, you have a completion problem. If most were verified and still didn’t start, you have a scheduling or staffing problem that no intake software will fix. Buy for the step that is losing the most families. ## The four kinds of ABA intake software - **Intake modules inside practice-management / EHR systems:** The intake or "lead" feature built into the system you already use for scheduling, clinical data and billing. Strong: one record from inquiry to claim, no integration. Weak: it’s a form and a status list. It stores families but doesn’t answer them, chase them or verify them, and families have to come to it. - **General CRMs:** Sales CRMs adapted for intake. Strong: pipelines, task queues, email and text sequences, reporting. Weak: they are built for sales, not care. HIPAA coverage depends on the plan and the BAA, payer and diagnosis rules must be built by hand, and someone still has to have every conversation. - **Answering services and call centers:** People who answer the phone when you can’t. Strong: a human voice at 10pm. Weak: most take a message rather than doing intake, cover only the phone and not chat, text or forms, and hand you a list to call back in the morning, when the family may already have booked elsewhere. - **AI intake platforms:** Software that has the intake conversation itself on phone, chat, text and forms, qualifies, collects documents and verifies benefits, then hands the case to your team. Strong: covers all channels, 24/7, and finishes the work instead of logging it. Weak: quality varies widely, and a bad one frustrates families. Test it hard (see the two-week test below). ## Twelve questions to ask every vendor A demo shows the happy path. These questions show what happens to a real family on a real Tuesday night. - **1. What happens to a call, chat or text at 9pm on a Saturday?:** In our research, 48% of family contacts arrive outside business hours. "It goes to voicemail" and "we send an email" are not coverage. - **2. Which channels are covered: phone, website chat, text, web forms, fax referrals?:** Families use whichever is closest. A tool that covers only one channel leaves the others to your staff. - **3. How does it qualify: service area, payer, age, diagnosis?:** Ask to see it turn away a family outside your area politely, and route a family with no diagnosis to an evaluation path. 22% of families reach out before a diagnosis. - **4. Are payer rules built in per state, or do we configure them?:** Diagnosis requirements, referral orders and prior-auth rules differ by state and plan. Someone has to maintain them. - **5. Does it verify benefits, and when?:** During intake, or as a task for staff later? What does it check: eligibility only, or ABA coverage and network status too? - **6. How do families send documents?:** Portal login, email attachment, text photo, on-form upload? Every login you add costs you completions. - **7. Can a family finish intake on a phone, and pick up where they left off?:** Most parents will do this in a pediatrician’s waiting room, not at a desk. - **8. Are consents e-signed, and where do the signed documents end up?:** You want each signed document as a PDF in the family’s record, not a checkbox in a database. - **9. What does follow-up look like for a family that stalls?:** Only 2% of providers in our research run any automated re-engagement. Ask what message a family gets on day 1, 3 and 7 when their diagnosis report is missing. - **10. Does it separate job applicants from families?:** In our research, 40% of captured website leads were job seekers. They distort every metric unless they’re filtered. - **11. Does it integrate with our practice-management system and CRM?:** Ask for the exact fields that sync, in which direction, and how often. - **12. HIPAA, BAA, SOC 2?:** A signed BAA is the minimum. Ask for the SOC 2 report, not a badge. ## The two-week test Don’t decide from a demo. Run the tool on a slice of real traffic, such as one location, one channel or after-hours only, for two weeks, and compare it against the same slice from the previous two weeks. Measure four things: the share of inquiries answered within five minutes, the share that complete qualification, the share that submit documents, and the median time from first contact to verified. If the tool doesn’t move the step you bought it for, it doesn’t matter how good the demo was. Also call it yourself, pretending to be a stressed parent with a vague question and the wrong insurance card. That tells you more than any feature list. ## What it costs you to keep doing it by hand The alternative to intake software is usually a coordinator and a shared inbox, and that setup has a cost that doesn’t show up on an invoice: every family who reached voicemail, waited overnight for a callback, or never sent the diagnosis report. Our free intake leak calculator (linked below) turns your monthly inquiry count into a dollar figure for that. ## Frequently asked questions ### What is the best intake software for an ABA clinic? It depends on where your families get lost. If they never reach a person, you need something that answers every channel 24/7. If they qualify but never finish documents, you need guided digital intake and follow-up. If you only need a record from inquiry to claim, the intake module in your practice-management system may be enough. Pull 60 days of inquiries, find the step losing the most families, and buy for that step. ### Is a CRM enough for ABA intake? A CRM tracks families and can send sequences, but it doesn’t have the conversation, qualify against payer rules, collect documents or verify benefits. Someone still does that work by hand. Check the HIPAA coverage and BAA on the specific plan before storing family data. ### Should an ABA practice use an answering service or AI intake? An answering service puts a person on the phone after hours but usually takes a message. AI intake completes the intake across phone, chat, text and forms and verifies benefits, then hands your team a finished case. Test either on after-hours traffic for two weeks and compare the share of families who reach the documents step. ### What should ABA intake software cost? Compare the price to the value of the families it recovers, not to the cost of a coordinator. One additional started client a month usually covers most intake tools many times over. Our intake leak calculator estimates that figure from your own volume. ### Does ABA intake software need to be HIPAA compliant? Yes. Intake collects protected health information: diagnosis, insurance and the child’s details. The vendor must sign a BAA, and you should ask for their SOC 2 report. ## Where Carelu fits: the AI intake platform built for ABA Carelu is the fourth kind of tool on this list, built only for ABA and behavioral-health intake. It has the intake conversation itself, on every channel and at any hour, and hands your coordinators families who are qualified, documented and verified. It works alongside your practice-management system and CRM rather than replacing them. Your team still decides who to admit, schedules the assessment and builds the trust only people can build. Carelu does the repetitive work before that. - **Every channel, 24/7, in English and Spanish:** Phone (an AI voice agent), website chat, text and web forms are answered in seconds, including the 48% of contacts that arrive outside business hours. - **Qualified in the first conversation:** Service area, payer, age and diagnosis status are checked on the spot. Families outside your area are turned away kindly, and families without a diagnosis get your evaluation path. - **Intake that gets finished:** A phone-friendly intake prefilled from the conversation, e-signed consents with a PDF for every signed document, uploads by text, resume where they left off, and follow-up until the packet is complete. - **Benefits verified up front:** Eligibility, ABA coverage, network status and referral requirements are checked during intake, with each state’s payer rules built in. - **One queue, your systems:** Routing by location or state, job seekers separated from families, and integrations with CentralReach, Rethink, Aloha, Salesforce, HubSpot and more. HIPAA compliant, SOC 2 Type II, BAA signed. ## The four kinds of intake software, side by side How each category handles the six steps, and where Carelu sits. | Step | Doing it manually | With Carelu | | --- | --- | --- | | Answers the family | PM module and CRM: no. Answering service: phone only, takes a message | Phone, chat, text and forms, 24/7, in seconds | | Qualifies | Staff, by hand, from a payer and ZIP list | Area, payer, age and diagnosis checked in the conversation | | Collects documents | Form or portal; families finish or they don’t | Guided intake, uploads by text, follow-up until complete | | Verifies benefits | Staff task, often days later | Automatically, during intake | | Follows up | CRM sequences if someone builds them | Per family, per missing item, until they respond or opt out | | Record of truth | PM module: yes. Others: another system to reconcile | Syncs to your practice-management system and CRM | ## Keep reading - [AI for ABA practices](https://carelu.com/resources/ai-for-aba-practices): Where AI helps an ABA practice grow, and where it shouldn’t be used. - [Where families disappear](https://carelu.com/resources/aba-intake-drop-off): The four leaks between first inquiry and first session. - [After-hours coverage](https://carelu.com/resources/after-hours-intake-coverage): The four coverage options compared, and how to measure them. - [The numbers to watch](https://carelu.com/resources/aba-intake-metrics): The scoreboard for your two-week test. - [Carelu vs. a CRM](https://carelu.com/carelu-vs-crm): What a CRM does for intake, and what it leaves to your staff. - [Intake leak calculator](https://carelu.com/tools/intake-leak-calculator): What the families you lose today are worth per year. Source: Carelu — https://carelu.com/resources/best-aba-intake-software. Free to cite with attribution. --- --- title: "Google Ads for ABA: everyone bids on the same parent. The winner answers first." url: "https://carelu.com/resources/google-ads-for-aba" description: "Campaign structure, negative keywords, landing pages and call tracking for ABA practices on Google Ads — plus the response discipline that decides which of the five providers that parent contacted actually gets the child." updated: 2026-09-17 --- # Google Ads for ABA: everyone bids on the same parent. The winner answers first. **Short answer:** Google Ads bring the highest-intent ABA families, but the click isn’t exclusive: the same parent contacts several practices in one sitting, and whoever answers first with a real answer usually wins. Run a few tightly themed campaigns, add negatives for job and training searches, use call tracking, and cover nights and weekends, when 48% of family contacts arrive. Search is the highest-intent channel in ABA and the most expensive. A parent typing "aba therapy near me" or "autism services accepting medicaid" has already decided to act. You are not persuading anyone; you are being present at the moment of action, and every competent competitor in your market is trying to be present too. Which produces the defining feature of this channel: the click is not exclusive. The same parent will contact several practices in one sitting, frequently in the same ten minutes. The auction decides who gets seen. Something else entirely decides who gets the child. ## What you are actually buying You are buying a place in a comparison, not a customer. That reframing changes what you optimize. Ad copy and bid strategy determine how many parents reach you. Response speed, coverage and intake quality determine what share of those you convert — and the second set of levers is usually further from optimal than the first. It also changes how you read your own numbers. A campaign producing plenty of calls and few clients is rarely a targeting problem. It is usually a phone problem. ## Campaign structure that does not waste money Keep it boring. A small number of tightly themed campaigns, separated by the thing that changes your economics: location, service line, and payer language. - **Core service terms:** "aba therapy near me," "autism therapy [city]," "applied behavior analysis [county]." Phrase and exact match. This is the money, and it deserves its own budget rather than sharing with experiments. - **Payer-qualified terms:** "aba therapy that takes medicaid," "[plan name] autism coverage." Lower volume, far higher conversion, and it pre-filters the objection that kills most ABA inquiries. Worth more budget than most accounts give it: in our research, 46% of families reported Medicaid as their payer, so this is the median family rather than a niche. - **Diagnosis-stage terms:** "autism evaluation near me," "how to get my child tested." High volume, no diagnosis yet. Only run these if you have a real evaluation path or in-house testing — otherwise you are paying to say no. - **Branded:** Cheap, high-converting, and worth owning so a competitor does not sit above your own name. Keep it in a separate campaign or it will flatter every other metric you look at. - **Location separation:** One campaign per clinic or service radius when the economics differ by site. Averaged geography hides the location that is quietly losing money. ## Negative keywords are half the job ABA search is polluted with traffic that will never become a client, and an unmanaged account spends a serious share of budget on it. Build the negative list before you launch and revisit search terms weekly for the first two months. The recurring offenders: employment and training searches ("rbt certification," "bcba salary," "aba jobs," "rbt training"), academic and definitional searches ("what is applied behavior analysis," "aba vs speech therapy," "aba criticism"), searches for other meanings of the acronym entirely, insurance-only searches with no service intent, and out-of-area cities that share a name with somewhere you serve. Employment traffic is the big one, and it is bigger than most teams believe — in many practices a large share of what arrives through the website is not a family at all, but an RBT or behavior tech looking for work. A practice that is also hiring should run recruitment as a separate campaign with its own budget and its own queue, not let applicants eat a clinical acquisition budget and clinical intake hours. ## The landing page rules Match the promise in the ad, exactly. A click on "ABA therapy in [county] accepting Medicaid" should land on a page that names the county and the plan in the first screen, not a generic homepage that makes the parent hunt. Then remove every step between interest and contact. A tracked phone number at the top, tappable on mobile, where most of this traffic lives. An intake that begins on the page itself rather than a "contact us" form that promises a callback. Clear statements of service area, ages served, and payers accepted, because those three facts are what the parent is comparing across their open tabs. No PDF packet download. No portal registration. One more thing most practices miss: say what happens next and when. "Someone will call you within the hour, including evenings" converts better than any testimonial on the page. ## Call tracking, or you are flying blind Most ABA search conversions are phone calls, which means the important half of your performance data lives outside the ad platform by default. Without call tracking you cannot tell which keywords produce calls that become clients, and you certainly cannot tell how many of those calls rang out. Dynamic numbers per campaign or per source, recordings and transcripts where consent rules allow, and one number that matters more than the rest: the share of paid calls that were actually answered. In most first audits, that number is the finding. ## You are buying nights and weekends whether you meant to or not Ads serve around the clock, and families search when they finally have a free moment — after dinner, after bedtime, on Sunday. In our published cohort of 120 providers and 185,000 conversations, 48% of family contacts arrived outside business hours. There are two honest responses. Restrict ad scheduling to the hours you can genuinely answer, and accept that you have conceded the busiest window in the category to competitors. Or cover the hours the ads run. Dayparting is the cheaper fix and the smaller business. What does not work is running 24/7 ads into a voicemail box and calling the leads low quality. ## Qualify without interrogating The first conversation has four jobs: confirm the service area, confirm the payer, confirm the child’s age, and find out whether there is a diagnosis yet. Done well, it takes ninety seconds and feels like help. Done badly, it feels like a screening call and the parent hangs up and calls the next tab. Lead with what you can do. "We serve that county and we do take that plan — let me get the first piece of this started for you while we talk" is qualification. "What insurance do you have?" as the opening line is an obstacle course. ## What to measure Three numbers per campaign: cost per started client, share of calls answered, and median time to first human contact. Conversion tracking should fire on outcomes further down the funnel than a form submission — import the later events so smart bidding optimizes toward families who actually start. Expect lag and plan for it. ABA acquisition-to-start commonly runs weeks, so judging a campaign on a 14-day window will make you cancel the thing that works. ## Frequently asked questions ### How much do Google Ads cost for an ABA practice? Clicks in this category are expensive because intent is high and several practices compete for the same local searches; costs vary widely by market and by how many providers bid locally. Rather than benchmarking cost per click, track cost per started client — a market with costly clicks and fast response can be cheaper per admitted child than a market with cheap clicks and slow follow-up. ### What negative keywords should an ABA practice add? Start with employment and training terms (rbt certification, bcba salary, aba jobs, rbt training), academic and definitional terms (what is aba, aba vs speech therapy), unrelated meanings of the acronym, and out-of-area place names. Employment traffic is usually the single largest source of wasted spend for clinics that are also hiring. ### Should ABA ads run 24/7? Only if someone or something can answer 24/7. Roughly half of family contacts arrive outside business hours, so around-the-clock ads into a voicemail box pay to send families to competitors. If you cannot cover those hours, restrict ad scheduling to the hours you can answer. ### Do I need call tracking? Yes. Most conversions in this category are phone calls, so without call tracking you cannot attribute clients to keywords or campaigns, and you cannot see your unanswered-call rate — which is frequently the biggest problem in the account. ### Should I bid on autism evaluation searches? Only if you can do something with those families — in-house testing, or a real referral path to diagnosticians with known waits and payers. Otherwise you are paying premium prices to tell parents to come back in nine months, and most of them will not. ## How Carelu answers the search call you paid for On this page, the auction decides who gets seen and something else decides who gets the child: who answers first, with a real answer. Carelu is that answer, on the first ring and in the first ninety seconds, at every hour the ads are running. Campaign structure, negatives, landing pages and bids stay with you and your agency. Carelu covers the other half of the account: the calls and forms those clicks produce, and the numbers that show which of them become clients. - **Every call answered:** An AI voice agent picks up every paid call, 24/7, in English and Spanish. The 48% of contacts that arrive after hours don’t reach voicemail. - **Qualification that feels like help:** Service area, payer, age and diagnosis status are resolved in the first conversation, leading with what you can do. Families without a diagnosis are routed to an evaluation path. - **Intake at the peak of intent:** Web forms and chats are answered within seconds, and intake starts during that first contact, with insurance eligibility and ABA benefits checked automatically. - **Job seekers kept out of the family queue:** Carelu separates applicants from families on your website. 40% of captured website leads are job seekers, and they shouldn’t use up clinical intake hours. - **Cost per started client, by source:** With Google Ads and CallRail connected, reporting shows answer rate, speed to contact and cost per started client by channel and source. ## A search call, by hand and with Carelu Two practices in the same market can run near-identical campaigns and admit very different numbers of children. The difference shows up after the click. | Step | Doing it manually | With Carelu | | --- | --- | --- | | Call arrives | Rings the front desk; goes to voicemail if busy or after hours | Answered on the first ring, every hour of the week | | Web form arrives | Email to a shared inbox, answered when someone gets to it | Answered in seconds, conversation continues by text | | Qualifying | Interrogation, or no qualification until much later | Area, payer, age and diagnosis status resolved in the first ninety seconds | | Intake | Packet promised, emailed later that day | Intake begins during the first contact, while intent is at its peak | | Attribution | Calls unattributed; keyword performance unknown | Calls tracked to source with answer rate and cost per started client | | Follow-up | One voicemail, then the lead goes cold | Multi-touch sequence across text and phone until they respond or opt out | ## Keep reading - [The Intake Gap (our research)](https://carelu.com/research/the-intake-gap): 185,054 family conversations across 120 ABA providers. The source for the numbers on this page. - [The full growth playbook](https://carelu.com/resources/how-to-grow-an-aba-practice): Where paid search fits among the five channels. - [Meta ads for ABA](https://carelu.com/resources/meta-ads-for-aba): The volume channel, and why it needs a different response plan. - [After-hours coverage](https://carelu.com/resources/after-hours-intake-coverage): Half your paid traffic arrives when the office is closed. - [The numbers to watch](https://carelu.com/resources/aba-intake-metrics): Answer rate and speed to contact, the two metrics that explain a bad account. Source: Carelu — https://carelu.com/resources/google-ads-for-aba. Free to cite with attribution. --- --- title: "How to grow an ABA practice: five channels, and the one thing they all depend on." url: "https://carelu.com/resources/how-to-grow-an-aba-practice" description: "How to grow and scale an ABA practice: the five channels that bring families in (Google Ads, Meta, SEO, physician referrals, and the families you already have), where each one leaks, and the operational work that decides whether any of it converts." updated: 2026-09-23 --- # How to grow an ABA practice: five channels, and the one thing they all depend on. **Short answer:** Fix operations before buying demand: answer every inquiry fast on every channel, qualify instantly and get documents finished, then grow through Google Ads, Meta, SEO, referrals and the families you already have. Demand isn’t the constraint (the median provider’s inquiries grew 35% year over year), but 48% of family contacts arrive outside business hours, when most practices are a voicemail. Growing an ABA practice is two separate problems that get talked about as one. The first is getting families to raise their hand. The second is not losing them between the hand-raise and the first session. Almost everything written about ABA growth is about the first problem, and almost all the lost revenue is in the second. That matters because the two problems have wildly different costs. Doubling your inquiry volume means doubling ad spend, or years of referral relationship-building. Doubling the share of inquiries that turn into started clients usually means fixing four or five specific operational failures — and it costs nothing in media. The market is not the constraint. In our published research, the median provider in a 37-provider same-store cohort saw family demand grow 35% year over year across 13 months of monthly counts. Families are finding ABA providers. What happens after they do is where practices diverge. This is the whole playbook: the five channels that actually produce ABA families, what each is good at, the structural catch inside each one, and the shared operational layer that decides whether any of them pay off. ## The growth equation Every ABA practice runs the same multiplication, whether or not anyone writes it down: Inquiries × answered × qualified × documents completed × verified × started. Miss on any term and the whole product shrinks, which is why practices with identical marketing budgets in the same city admit wildly different numbers of children. Work the terms in the order they cost you money. Answering is free and multiplies everything downstream. Qualification is cheap. Documents are a process problem. Only when those are solid does buying more inquiries make sense — before that, more spend just means more families falling through the same holes, at a higher price per hole. - **Inquiries:** Volume from all five channels. The only term most practices actively manage, and the most expensive one to move. - **Answered:** The share of inquiries that reach a human, or something that behaves like one, before the family moves on. Almost half of contacts arrive outside business hours. - **Qualified:** Right service area, workable payer, age in band, diagnosis status known. Getting this wrong wastes staff hours on families you can never serve — and, worse, turns away families you could. - **Documents completed:** Intake packet, consents, insurance card, diagnostic report, releases. The quiet killer: a family that says yes and then never finishes the paperwork. - **Verified:** Benefits checked early enough that nobody discovers a coverage problem after the family has emotionally committed. - **Started:** A first session on the calendar. Everything before this is unpaid work. ## What 185,054 family conversations say about ABA demand Before choosing channels, it helps to know what demand actually looks like. These figures come from our published research: 185,054 family conversations and 29,021 captured leads across 120 ABA provider organizations in 48 states, aggregated and de-identified. Demand is growing. The median provider in a 37-provider same-store cohort saw inquiry volume rise 35% year over year. It is concentrated: Georgia and North Carolina alone account for 27% of it. It is mostly Medicaid: 46% of families who named a payer were on Medicaid. And it arrives when offices are closed: 48% of conversations start outside business hours. The typical provider captures a median of about 24 leads a month, with the busiest tenth above 127. One pattern stands out for growth. Providers whose intake feeds their CRM grew about 6.5% a month, against 0.9% for those whose intake didn’t, roughly seven times faster. That is a correlation, not proof, but it points the same way as everything else on this page: growth follows the operational layer. | State | Share of national demand | Most-named payers | | --- | --- | --- | | Georgia | 13.6% | Medicaid 33% · Peach State 14% · CareSource 13% | | North Carolina | 13.3% | Medicaid 43% · BCBS 11% · Trillium 8% | | Indiana | 9.1% | Medicaid 39% · Anthem 26% · CareSource 10% | | Virginia | 6.4% | Medicaid 31% · Anthem 24% · Aetna 9% | | Tennessee | 6.4% | TennCare 26% · BlueCare 19% · Wellpoint 16% | | Ohio | 5.0% | CareSource 37% · Medicaid 12% · UnitedHealthcare 10% | | Arizona | 4.9% | Mercy Care / AHCCCS 39% · UnitedHealthcare 27% · BCBS 12% | | Utah | 4.7% | Medicaid 40% · Select Health 21% · BCBS 10% | | New Jersey | 4.2% | UnitedHealthcare 25% · Medicaid 20% · Aetna 19% | | Colorado | 3.7% | Medicaid 67% · Cigna 6% · UnitedHealthcare 6% | | New York | 3.2% | Medicaid 46% · Fidelis 20% · BCBS 9% | | Florida | 3.1% | Sunshine / Ambetter 25% · Medicaid 20% · Aetna 14% | Source: Carelu Research, "The Intake Gap" (2026). Payer shares are of families in that state who named a payer; "Medicaid" means Medicaid named without a specific plan. ## Channel 1 — Google Ads: the highest intent, the least exclusivity A parent typing "aba therapy near me" is the most valuable lead in the category. They have decided to act, they are looking right now, and they are within a few taps of contacting someone. You are buying that moment, and you are paying a premium for it. The catch is that the click is not exclusive. That parent opens four or five tabs and contacts several practices in the same sitting. You are not really competing on ad copy or landing-page design; you are competing on who calls back first with a real answer. A perfectly optimized campaign feeding a phone that rings out is a machine for funding your competitors. ## Channel 2 — Meta: reach far beyond search, intent far below it Meta reaches the parent who has not typed anything yet — the one who has been quietly worried for six months and has never once searched for "ABA." That audience is many times larger than the in-market search audience, and it is cheaper to reach. For a growing practice, it is often the only way to add real volume quickly. The catch is the mirror image of Google’s. The intent is borrowed, not owned. A parent who fills a form in eight seconds because a video caught them at a traffic light has not decided anything. That interest decays in minutes. Meta rewards practices that can convert attention immediately and punishes practices that treat a lead form as something to work through tomorrow morning. ## Channel 3 — SEO and AI answers: slow, compounding, increasingly conversational Search is where families go when they are ready to compare, and it keeps producing after you stop paying. The work is unglamorous: a genuinely useful page per location, per payer, and per stage of the journey, plus a Google Business Profile that is actually maintained. Reviews belong in this channel and deserve more attention than they get. They move the map results, they are what a parent actually reads when comparing you with two other clinics, and they are one of the few quality signals an AI assistant can read about you. The practice in your market with sixty reviews is rarely better than you; it asked. What has changed is that a growing share of these questions never reach a results page at all. Parents ask an assistant "who does ABA in my county and takes my plan," and get a synthesized answer. Pages that answer one question completely, in plain language, with the specifics an assistant can quote, are the ones that get surfaced. Pages written to hit a keyword density are not. ## Channel 4 — Physician, school and diagnostician referrals Referred families are the best families you will ever get: pre-qualified, usually diagnosed, and arriving with trust already transferred from someone they believe. They also cost nothing per lead. The catch is that referral relationships die from silence, not from competition. A referral coordinator sends three children to you, hears nothing back about any of them, and quietly starts sending to the practice that confirms receipt the same day. Referral growth is a follow-through discipline dressed up as a sales activity. ## Channel 5 — The families you already have The cheapest growth in most practices is sitting in a spreadsheet. Families who inquired and were never reached. Families told to call back when they have a diagnosis. Families who stalled halfway through a packet. Families on a waitlist who assume they have been forgotten. Discharged clients whose needs changed. Siblings. This list is usually worth more than a quarter of ad spend, and almost nobody works it, because nobody owns it. It is also the fastest thing on this page to act on — a structured pass over the last twelve months of dead leads reliably surfaces families who are still looking, at no media cost whatsoever. ## What every channel converges on: speed and coverage Across a cohort of 120 ABA and behavioral-health providers and 185,000 family conversations, 48% of family contacts arrived outside business hours. Whatever channel a family came from, roughly half of them are reaching out at night, on a weekend, or during a lunch break — the exact moments when most practices are a voicemail greeting. The widely cited lead-response research says the same thing in a different way: the odds of ever connecting with an inbound lead fall off a cliff between five minutes and thirty, and the provider who responds first wins a disproportionate share. In ABA, where a family is frequently contacting several practices in one sitting, that effect is stronger, not weaker. This is why speed is not a nice-to-have layered on top of a channel strategy. It is the multiplier that determines what every channel is worth. Buying more inquiries before fixing response is the single most common and most expensive mistake in ABA growth. ## The order of operations If you do these in order, each step makes the next one cheaper. - **When** Before you spend another dollar on ads **then** Measure your answer rate and median time to first human contact — including nights and weekends. If the number embarrasses you, fix that first; it costs nothing in media and lifts every channel at once. - **When** Once every inquiry gets answered **then** Fix qualification. Know instantly whether a family is in your service area, on a payer you take, and in your age band — and know what you do with the ones who are not, instead of turning them away. - **When** Once qualification is instant **then** Fix documents. Short digital steps, prefilled with what the family already told you, finishable on a phone, with automatic nudges. Paperwork stalls are the largest silent leak after the unanswered first call. - **When** Once families complete intake **then** Turn on demand. Start with the channel closest to intent — search — then add Meta once you can convert a cold lead within minutes. - **When** Once demand is running **then** Build referrals in parallel. They are slow to start and compound for years, and they make you resilient to rising ad costs. - **When** Always **then** Work the families you already have. Every month, every stalled and disqualified and waitlisted family gets a touch until they tell you to stop. ## The scoreboard Growth conversations go in circles when nobody has numbers. Four numbers, reviewed monthly, will end most of the arguing: inquiries by channel, share answered within five minutes, share that completed intake, and share that started care — plus cost per started client, not cost per lead, for anything you pay for. Cost per lead is the metric that makes bad channels look good. A channel producing cheap leads that never start is more expensive than a channel producing costly leads that do. [Download the free ABA intake checklist (PDF)](https://carelu.com/downloads/aba-intake-checklist.pdf): Map your own funnel end to end and find the term in the growth equation that is costing you the most. ## Frequently asked questions ### What is the fastest way to grow an ABA practice? Fix response before buying demand. Most practices already receive more inquiries than they convert, and roughly half of those inquiries arrive outside business hours. Answering every inquiry quickly, on every channel, lifts the yield of every marketing dollar you are already spending and costs nothing in media. ### Should I start with Google Ads or Meta ads? Google, if you can only do one. Search captures families who have already decided to act, so it converts at a far higher rate per click. Add Meta once you can reliably respond to a cold lead within minutes — Meta produces volume, but that volume decays fast and punishes slow follow-up. ### How much should an ABA practice spend on marketing? Budget against cost per started client and payback period, not a percentage of revenue. Work out what one admitted child is worth over their expected course of care, then spend up to a fraction of that to acquire one. Practices with weak intake conversion should spend less and fix intake first, because every leak multiplies the true acquisition cost. ### How do I get more ABA referrals from pediatricians? Make referring easy and make the loop visible. Accept referrals by fax, email, and phone without a portal signup; acknowledge every referral the same day; and report back when the child is evaluated and when they start. Offices refer to whoever they trust to follow through, and silence is what ends the relationship. ### Why do we get plenty of leads but few new clients? Almost always one of four leaks: inquiries that were never answered (especially after hours), families who waited days for insurance verification, packets that were started and abandoned, or a wait to start that no one managed. Measure the drop between each stage and fix the largest fall first. There is a fifth cause — the wrong families arriving in the first place — but it is usually not the biggest one, and it has a specific signature: you call within minutes and still hear back from very few of them, and very few of the ones who do respond are in your area, on a payer you take, or in your age band. That pattern points at channel targeting, not at intake. Without it, assume the leak is operational. ## How Carelu runs the operational layer under every channel The order of operations on this page starts with the terms that cost nothing in media: answering, qualifying, documents, verification, and working the families you already have. Those are the terms Carelu runs, the same way for a search call, a Meta form, or a pediatrician referral. Channel strategy, referral relationships and clinical care are still yours. Carelu makes sure the families those efforts produce are answered, qualified and moved forward, so buying more inquiries adds starts and not just leaks. - **Answered, on every channel:** Phone, website chat, text and web forms answered within seconds, 24/7, in English and Spanish. That covers the 48% of contacts that arrive outside business hours. - **Qualified in the first conversation:** Service area by ZIP or drive time, payer, age and diagnosis status. Out-of-area families and payers you don’t take are turned away politely, and families without a diagnosis are routed to an evaluation path. - **Documents and verification, up front:** A hosted intake finishable on a phone, e-signed consents, and automatic insurance eligibility and ABA benefits checks before staff time is spent. - **The families you already have:** Follow-up flows by text and email for every stalled, waiting or unfinished family, until they respond or opt out. Only 2% of providers run any automated re-engagement. - **The scoreboard:** Answer rate, speed to contact, intake completion, conversion and cost per started client by channel and source, with Google Ads, Meta Ads, CallRail and your CRM connected. ## The operational layer, by hand and with Carelu Every channel on this page ends at the same place: a family reaching out, and someone needing to respond well, immediately, at any hour. That work is identical whether the family came from a search ad, a Facebook video, or a pediatrician. | Step | Doing it manually | With Carelu | | --- | --- | --- | | First response | Business hours only; voicemail nights and weekends, when ~48% of contacts arrive | Answered in seconds on phone, chat, text and forms, 24/7 | | Qualification | Coordinator checks the service-area list and payer list by hand | Area, payer, age and diagnosis status confirmed during the first conversation | | Intake | Packet emailed; family finishes it or does not | Guided digital intake, prefilled from the conversation, finishable on a phone | | Insurance | Verification queued, often days later | Eligibility checked up front, before staff time is spent | | Follow-up | Whoever remembers, whenever they remember | Contextual sequences per family, per stage, until they respond or opt out | | Measurement | Lead counts in a spreadsheet, no channel truth | Answer rate, speed, conversion and cost per started client by channel | ## Keep reading - [The Intake Gap (our research)](https://carelu.com/research/the-intake-gap): 185,054 family conversations across 120 ABA providers. The source for the numbers on this page. - [Google Ads for ABA](https://carelu.com/resources/google-ads-for-aba): The highest-intent lead in the category, and why the auction is not where you win it. - [Meta ads for ABA](https://carelu.com/resources/meta-ads-for-aba): Reaching parents before they search, and converting borrowed intent before it cools. - [SEO and AI search](https://carelu.com/resources/seo-for-aba-practices): The pages that rank, and what changes when a parent asks an assistant instead. - [Pediatrician referrals](https://carelu.com/resources/aba-pediatrician-referrals): How to earn a referral stream, and the follow-through that keeps it. - [The numbers to watch](https://carelu.com/resources/aba-intake-metrics): Eight metrics that explain why a practice is not growing. - [Where families disappear](https://carelu.com/resources/aba-intake-drop-off): The four leaks between first inquiry and first session. Source: Carelu — https://carelu.com/resources/how-to-grow-an-aba-practice. Free to cite with attribution. --- --- title: "Meta ads for ABA: buying attention the family never went looking for." url: "https://carelu.com/resources/meta-ads-for-aba" description: "How ABA practices use Meta ads to reach parents before they ever search — what to run, why lead quality looks worse than it is, and the five-minute follow-up discipline that decides whether any of it converts." updated: 2026-09-17 --- # Meta ads for ABA: buying attention the family never went looking for. **Short answer:** Meta ads work for ABA when you respond within minutes: they reach parents before they ever search, but that borrowed intent decays fast. Text within a minute, call within five, qualify area, payer, age and diagnosis in the first exchange, give undiagnosed families an evaluation path, and judge the channel on cost per started client, not cost per lead. Meta is the best tool in the category for one specific job: reaching the parent who has not searched for anything yet. A mother who has been worried about her two-year-old for months, who has googled "speech delay" twice at midnight and never once typed the word "ABA," is unreachable on search. She is very reachable on Instagram. That is an enormous audience, and it is cheap relative to search. It is also the reason Meta has a reputation for junk leads in ABA. Both things are true, and they have the same cause: you are interrupting someone rather than answering them. Everything below follows from that one fact. ## What Meta is actually good at Meta does three things no other ABA channel does well. It creates demand instead of harvesting it, reaching families before they know a service category exists. It scales in days rather than quarters, which makes it the practical answer when a new location opens with empty schedules. And it targets geography precisely, which matters enormously when your service area is four counties and not a state. It is also the channel where the message does the most work. On search, the parent brings the intent and your ad just has to be there. On Meta, your creative has to produce the intent from scratch. ## The structural catch: borrowed intent decays A search lead decided to contact you. A Meta lead was persuaded to, in about eight seconds, while doing something else. That difference does not make the lead worthless, but it does mean the interest is on loan and it is already evaporating when the form submits. Practically, this shows up in three ways. Meta leads answer the phone at a lower rate than search leads. A larger share are outside your service area or on a payer you do not take, because they were not filtering for you the way a searcher was. And a much larger share have no diagnosis yet, because you reached them earlier in the journey — which is an opportunity, not a defect, as long as you have somewhere to send them. The failure mode is a practice that runs Meta, judges it on the same yardstick as search, concludes the leads are garbage, and turns it off. Usually the leads were fine and the follow-up was six hours late. There is a test that separates the two, and it is worth running before touching the ad account. Call within minutes for a couple of weeks. If families answer and most of them qualify, the targeting is fine and the old follow-up was the problem. Only when both halves fail — almost nobody responds to a five-minute call, and almost none of the few who do are in your area, on your payers, or in your age band — is the channel genuinely bringing the wrong families, and then the fix is geography, creative and audience rather than anything downstream. ## Targeting: less clever than you want it to be Health-related interest targeting is restricted on Meta, and you should not plan around reaching "parents interested in autism." Nor should you want to: audiences built on sensitive inferences are both unreliable and a bad look for a healthcare provider. What works is unglamorous. Tight geography around each clinic or service radius, not the whole state. Broad parent-aged demographics, and let the delivery system find responders. Lookalikes built from families who actually started care, not from everyone who filled a form. And exclusions for current clients and recent converters so you stop paying to reach people you already serve. - **Geography first:** Radius or county targeting that matches the area you can genuinely serve, including drive time. Paying to reach families you will have to turn away is the most common Meta waste in ABA. - **Broad over narrow:** Give the delivery system room. Over-layered targeting on a small local audience raises costs and starves learning. - **Lookalikes from starts:** Seed from admitted families, not raw leads. Optimizing toward form-fillers optimizes toward people who fill forms. - **Creative as targeting:** A video that opens with the specific worry — an 18-month-old who stopped babbling, a four-year-old who melts down at every transition — self-selects the right audience better than any interest setting. ## Creative that works for ABA Speak to the worry, not the modality. Parents at this stage do not know what ABA is, and "evidence-based applied behavior analysis" means nothing to them. "Is my child just a late talker?" means everything. Show real people and real rooms. Stock photography of smiling children reads as an ad; a therapist in your actual clinic reads as a place. Name the geography out loud, because a parent scrolling has no idea you are local until you tell them. State the payer situation plainly if you take Medicaid or the dominant commercial plan in your market, since that single fact removes the biggest objection before it forms. And be careful with tone. Content that implies something is wrong with a child performs badly and, more importantly, is the wrong thing to put in front of a frightened parent. The best-performing ABA creative is reassuring and concrete: here is what the first step looks like, here is how long it takes, here is who you would talk to. ## Instant forms versus landing pages — and the middle path Instant forms produce the most leads and the weakest ones, because friction is near zero and so is commitment. Landing pages produce fewer, better leads, because a parent who clicks through and reads has spent something. Both are defensible, and the choice depends entirely on what happens next. The middle path is better than either: an instant form with two or three qualifying questions — ZIP or county, insurance, child’s age — followed immediately by a thank-you step that offers the real next action. Not "we will be in touch." A link that starts actual intake, or a button that calls you now. The moment of highest intent is the second after they submit, and almost every practice wastes it on a confirmation message. Whatever you choose, do not send a cold Meta lead a fifteen-page PDF packet. It will not come back. ## The first five minutes decide everything This is the whole channel. A Meta lead contacted an hour later behaves like a stranger; contacted in two minutes, they behave like someone who just raised their hand, because they did. The discipline that works: a text within sixty seconds that names the child and the practice, a call within five minutes from a local number, and a fallback sequence of several attempts across text and phone over the following week rather than one voicemail and a shrug. Ads run at 10pm and on Sundays — 48% of family contacts in our published cohort arrive outside business hours — so any coverage plan that stops at 5pm is throwing away roughly half of what you paid for. Speed alone is not enough, though. The first contact has to advance the family, not just greet them: confirm you serve their area, confirm the payer, get the intake started while you have their attention, and if there is no diagnosis yet, hand them the evaluation path instead of a dead end. ## Measure the channel correctly or you will kill it by accident Meta looks bad on cost per lead compared with nothing, and great compared with search. It looks bad on lead-to-contact rate. It can look excellent on cost per started client — which is the only number that matters. Judge the channel on admitted children and be honest about the lag: an ABA family sourced in March may not start until May, and a 30-day reporting window will tell you to turn off the thing that is working. Feed conversions back. Meta optimizes toward whatever you tell it success looks like, so if the only signal it receives is "form submitted," it will find you excellent form submitters. Sending back the later events — qualified, intake completed, started care — retrains delivery toward families who become clients. This is the single highest-leverage account change most ABA advertisers have never made. ## Compliance sanity checks You are a healthcare provider advertising to families about a child’s development, which means the ordinary rules deserve real attention. Do not upload client lists as custom audiences without a defensible legal basis. Keep protected health information out of ad platforms entirely. Make sure any form that collects a phone number carries clear consent language for calls and texts, with an opt-out honored everywhere. And if a third-party pixel sits on a page where families enter health information, know exactly what it is collecting. ## Frequently asked questions ### Do Facebook and Instagram ads work for ABA therapy? Yes, for reach and for reaching families earlier in the journey than search can. They work poorly as a lead-collection exercise judged on cost per lead. The practices that succeed on Meta respond within minutes, qualify during the first conversation, and have a defined path for families who do not yet have a diagnosis. ### Why are Meta leads for ABA lower quality than Google leads? Because you interrupted them rather than answering them. A Meta lead never searched for ABA, so more of them are outside your service area, on a payer you do not take, or without a diagnosis yet. That is inherent to the channel, and it is manageable with instant qualification and an evaluation referral path — not by blaming the leads. ### Instant forms or a landing page? Instant forms with two or three qualifying questions, followed by an immediate next step on the thank-you screen, outperform both plain instant forms and most landing pages — provided you respond within minutes. If you cannot respond fast, a landing page with more friction will produce fewer and slightly better leads. ### How fast do I have to respond to a Meta lead? Minutes, not hours. Text within a minute and call within five. Because ads run around the clock and roughly half of family contacts arrive outside business hours, the response plan has to cover nights and weekends or it only works for half the leads you buy. ### What should a Meta ad for an ABA clinic actually say? Name the worry in a parent’s own words, name the place, and name the next step. Avoid clinical jargon and avoid implying something is wrong with the child. Stating that you take the dominant local plan or Medicaid removes the largest objection before the parent forms it. ## How Carelu works a Meta lead in the first five minutes This page comes down to one discipline: reach the parent while the borrowed intent is still there, and make that first contact move them forward. Carelu does both the moment the form submits, including at 10pm and on Sundays when your ads are still running. The account is still yours: creative, geography, audiences and budget. Carelu makes sure the leads those choices produce are judged on how they actually convert, not on how late someone called them. - **Worked the moment it lands:** Meta Ads connects to Carelu, so a lead form is answered by text within seconds and the conversation continues on phone, text or chat, whichever the parent prefers. - **Qualified without a screening call:** Service area by ZIP or drive time, payer, age and diagnosis status confirmed in the first exchange. Families you can’t serve are turned away politely instead of left waiting. - **A path for families without a diagnosis:** Meta reaches parents early, and 22% of families reach out before a diagnosis. They are routed to an evaluation path and kept in touch, not dead-ended. - **Intake started while intent is high:** The family gets a link to a phone-friendly intake prefilled from the conversation, and follow-up flows by text and email keep going until they respond or opt out. - **Judged on starts, not leads:** Reporting shows speed to contact, intake completion, conversion and cost per started client by source, so you can see what each campaign actually produces. ## A Meta lead, by hand and with Carelu The ad account is the easy half. What decides whether Meta is profitable for an ABA practice is what happens in the twenty minutes after a form submits — including at 9pm on a Saturday. | Step | Doing it manually | With Carelu | | --- | --- | --- | | Lead arrives | Email notification into a shared inbox; seen next business morning | Meta Lead Ads flow straight in and are worked the moment they land | | First touch | A call attempt hours later; voicemail; no text | Text in seconds, conversation continues on the channel the parent prefers | | Qualifying | Coordinator checks area and payer manually, later | County, payer, age and diagnosis status confirmed in the first exchange | | No diagnosis yet | "Call us back when you have one" — lead lost | Routed to the evaluation path for that state and plan, then kept warm | | After hours | Roughly half of leads wait until morning | Answered at the moment they arrive, any hour | | Reporting | Cost per lead only | Cost per started client by campaign, with later events fed back to Meta | ## Keep reading - [The Intake Gap (our research)](https://carelu.com/research/the-intake-gap): 185,054 family conversations across 120 ABA providers. The source for the numbers on this page. - [The full growth playbook](https://carelu.com/resources/how-to-grow-an-aba-practice): All five channels and the operational layer they share. - [Google Ads for ABA](https://carelu.com/resources/google-ads-for-aba): The other paid channel, and why it behaves nothing like this one. - [Families without a diagnosis](https://carelu.com/resources/aba-evaluation-referrals): What to do with the largest segment Meta will send you. - [After-hours coverage](https://carelu.com/resources/after-hours-intake-coverage): Ads run at night. Decide what happens when they do. Source: Carelu — https://carelu.com/resources/meta-ads-for-aba. Free to cite with attribution. --- --- title: "SEO for ABA practices — and what changes when parents ask an AI instead." url: "https://carelu.com/resources/seo-for-aba-practices" description: "The pages that actually rank for ABA searches, why Google Business Profile outranks your website for \"near me,\" and how to be the practice an AI assistant names when a parent asks who takes their plan." updated: 2026-09-17 --- # SEO for ABA practices — and what changes when parents ask an AI instead. **Short answer:** Maintain a Google Business Profile per location, build real location and payer pages, and make asking for reviews a habit, since local signals decide "near me" searches. To be named by AI assistants, answer one question per page in plain sentences, state the specifics (counties, payers, ages, waits) as facts, and keep your name, address and phone consistent everywhere. Search is the only ABA channel that keeps producing after you stop paying, and the only one where the asset compounds. It is also the slowest, which is why most practices start it, get impatient at month three, and quietly abandon a half-built site. Two things make ABA search unusual. Almost all of it is local, so a maintained Google Business Profile often matters more than the website it links to. And a growing share of these questions are now answered without a results page at all, by an assistant that reads a handful of sources and writes a paragraph. Optimizing for that reader is different work than optimizing for a ranking. ## The three kinds of ABA search Every query a parent types falls into one of three buckets, and they want completely different pages. - **Ready to act:** "aba therapy near me," "autism services [city]." Highest intent, most competitive, and largely decided by local signals — profile, reviews, proximity — rather than by article quality. - **Qualifying:** "does medicaid cover aba in [state]," "[plan] autism coverage," "aba therapy that takes [payer]." Lower volume, extremely high conversion. The parent has decided on the service and is now filtering for who can serve them. - **Worried but early:** "is my 2 year old speech delayed," "signs of autism in toddlers," "how do I get my child evaluated." Enormous volume, no service intent yet. The parent does not know ABA exists. This is where you earn trust months before the decision. ## The pages worth building A small number of genuinely useful pages beats a large number of thin ones, and thin location pages are the most common self-inflicted wound in this category. A page per city that differs only by a find-and-replace does not rank and does not convert. Build a real page per location: the actual address, the counties and ZIPs you serve, the ages you take, the payers accepted there, the current wait, the people who work there, and directions a parent would actually use. Build a page per payer for the plans that dominate your market — in our research 46% of families reported Medicaid, so these are not niche pages — stating plainly what that plan requires: diagnosis, referral, prior authorization. That is what the parent is trying to find out. And build a handful of stage-of-journey explainers for the worried-but-early searches, written to help rather than to convert. The test for any page: would a parent who found this by accident be glad they did? If not, no amount of structure will save it. ## Google Business Profile is the highest-return hour in local ABA SEO For "near me" searches, the map results sit above everything and are driven by the profile, not the site. An hour spent on the profile routinely outperforms a month spent on blog posts. Get the category right, list service areas honestly, add real photos of the actual space, keep hours accurate — and treat "open" as a promise that someone answers, because a parent who calls during listed hours and reaches voicemail has learned something about you. Answer the Q&A section yourself with the questions families actually ask: which insurance, what ages, how long is the wait. Every location gets its own profile, and the name, address and phone must match your website and every directory exactly. ## Reviews are the ranking factor you can actually influence Of everything on this page, reviews are where a practice can move fastest and where most leave the most on the table. Everything else here is a project. Reviews are a habit, and the habit pays three times over. They move local rankings, which decides whether you appear in the map results at all. They move parents, who read reviews more carefully in this category than in almost any other — they are choosing who will spend twenty hours a week with their child, and they cannot evaluate your clinical model, so they read what other parents said instead. And they increasingly move the AI answers, because public review volume, recency and substance are close to the only third-party quality signal an assistant can actually read about a local provider. Three properties matter, roughly in this order. Recency, because a wall of five-star reviews from three years ago reads as a practice that used to be good. Volume relative to the other practices in your city, because parents compare. And specificity — a review that names a therapist and describes a change in a child is worth ten that say "great place." The gap in ABA is enormous, and it is not a quality gap. Most clinics have a handful of reviews. The practice in your market with sixty is not sixty times better than you. They asked, and you did not. ## The only reason you do not have more reviews is that nobody asks Every practice knows it should collect reviews. The reason it does not happen is always the same: asking feels awkward, no one owns it, and the moment passes. The fix is to stop treating it as a favor someone remembers and make it a step in a process, with a trigger, an owner, and a script. - **When** Choosing the moment **then** Ask after a visible win — a first progress report, a goal met, a parent who says something warm in a session. Never at intake, when the family has received nothing yet, and never in the same breath as a billing conversation. - **When** Choosing who asks **then** The person with the relationship: the BCBA or the coordinator the family already trusts. An ask from a name they recognize converts several times better than one from the practice in the abstract. - **When** Making it one tap **then** A text with a direct link straight to the review form. An email telling a parent to search for you on Google loses most of them between the intent and the typing. - **When** Following up **then** Ask once, then send one reminder a few days later. The reminder collects roughly as many reviews as the original ask, and almost nobody sends it. - **When** Who to ask **then** Everyone. Do not screen families first, route happy ones to the public profile and unhappy ones to a private form — review gating violates platform policies, risks the profile, and the negative reviews you avoid are worth reading anyway. - **When** What never to offer **then** Anything of value in exchange. In healthcare an incentive for a review is not merely a platform violation, and a gift card is not worth the exposure. - **When** Responding **then** Reply to every review, including the difficult ones, in language that never confirms or denies that someone is a client. A public reply acknowledging a specific child’s care is a privacy problem however kindly it is meant. Thank, offer a private channel, and stop. ## Make the ask automatic A timed, repeatable, slightly awkward message is exactly the kind of work that should not depend on anyone remembering, which is why this is worth putting into a system rather than onto a person. Carelu can run the ask for you: a review request sent by text at the moment you choose in the family’s journey, from the same place that runs the rest of your follow-ups, with the link in the message and one reminder if there is no response. The same conversation history that makes those follow-ups sound human is what lets the ask reference the child by name and land as a message from your practice rather than a broadcast. The practices that end up with sixty reviews are not the ones that tried harder. They are the ones for whom asking stopped being a decision. ## What changes when an assistant answers instead of a results page A parent who asks an assistant "who does ABA therapy in my county and takes my insurance" gets a synthesized answer drawn from a few sources. There is no blue-link list to climb. You are either in the answer or invisible. What gets a practice into those answers is not mysterious, but it is different from classic SEO. Assistants favor pages that answer one question completely and unambiguously, in plain sentences, with the specifics stated as facts rather than implied — the counties, the payers, the ages, the waits. They favor consistency across the web, because contradictory hours or addresses across directories make a source unreliable. They lean on the aggregators and directories they already trust, so your presence in payer directories and local listings matters more, not less. And they reward structure: clear headings that mirror real questions, FAQ markup, organization and location data that machines can read without guessing. The practical instruction is almost old-fashioned. Write the page as an answer to a question a parent asked out loud, put the facts in sentences instead of in a graphic, and make every page state plainly who it is for and where it applies. ## Write for the question, not the keyword Keyword-density writing produces pages that read like they were written for a machine, and the machines now prefer pages written for people. Title a page with the question. Answer it in the first two sentences. Then earn the rest of the page. This also happens to be the format a parent scanning four tabs at 11pm can actually use, which is why it converts as well as it ranks. ## The catch nobody mentions SEO does not deliver clients. It delivers a phone call, usually at an inconvenient hour, from a parent who is also calling three other practices they found the same way. Everything you invested in ranking is settled in the next ten minutes by whether someone picks up and can answer whether you take their plan. Practices that rank well and answer badly have built an expensive referral service for their competitors. ## Frequently asked questions ### How long does SEO take for an ABA practice? Local profile work can move within weeks. Site and content work usually takes several months to compound, and payer-specific pages often produce their first inquiries faster than broad service pages because competition for them is thinner. ### What is the single highest-impact SEO task for a clinic? The Google Business Profile for each location: correct category, honest service areas, real photos, accurate hours, answered Q&A, and a steady flow of reviews. For "near me" searches it sits above the organic results and is the main thing a parent sees. ### How do I get my ABA practice mentioned by AI assistants? Answer real questions completely and plainly on pages dedicated to them, state the specifics as facts (counties served, payers accepted, ages, waits), keep your name, address and phone consistent everywhere, use FAQ and organization structured data, and make sure you appear in the payer directories and local listings assistants already treat as reliable. ### How do I get more Google reviews for my ABA clinic? Make the ask a step in a process rather than a favor someone remembers: trigger it after a visible win such as a first progress report or a goal met, have the person the family already trusts send it, put a direct link in a text rather than asking them to search, and send one reminder a few days later. Ask every family, not just the happy ones, and automate the trigger so it stops depending on anyone remembering. ### Should we only ask happy families for reviews? No. Screening families and routing only the happy ones to your public profile is review gating — it violates platform policies and puts the profile at risk. Ask everyone at the same point in the journey. Steady, recent reviews from real families outperform a curated handful, and the critical ones tell you something worth knowing. ### How should we respond to a negative review? Reply publicly, promptly, and without confirming or denying that the person is a client — acknowledging a specific child's care in a public reply is a privacy problem however kindly meant. Thank them, state generally how you handle concerns, and offer a direct phone number or email to continue privately. ### Do reviews affect whether AI assistants recommend us? They help. Public review volume, recency and substance are among the few third-party quality signals an assistant can read about a local provider, so they feed the answer alongside your own pages, your listings and the directories you appear in. ### Are location pages worth building? Real ones, yes. Templated pages that differ only by city name tend not to rank and do not convert. A location page should carry the address, service area, payers, ages, wait time and staff for that site — facts a parent could not get from any other page. ### Should we blog? Only with a purpose. A handful of thorough, genuinely useful explainers aimed at worried-but-early searches outperform a weekly post written for volume, and they are far more likely to be cited by an assistant answering a parent’s question. ## How Carelu answers the families your rankings send Everything on this page earns you one thing: a parent contacting you, often in the evening, while they check three other practices they found the same way. Carelu makes sure that contact gets the answer the parent was looking for: whether you serve their town, whether you take their plan, and what happens next. The ranking work is still yours: the location and payer pages, the Business Profile, and the habit of asking for reviews. Carelu makes sure what that work earns doesn’t end in a voicemail box. - **The evening "near me" call:** Answered live by an AI voice agent at any hour, in English or Spanish, along with website chat, text and web forms. - **"Do you serve my town?":** Service area is resolved by ZIP or drive time the same way every time, and out-of-area families are turned away politely. - **"Do you take my plan?":** Payer rules for each state are built in, and insurance eligibility and ABA benefits are checked automatically during intake. - **The weekend web form:** Answered within seconds, with a phone-friendly intake started before the parent opens the next tab. ## The call that SEO earns you, by hand and with Carelu Organic search sends families at the hours they are free, which is rarely between nine and five. What happens on that call is the return on every hour spent ranking. | Step | Doing it manually | With Carelu | | --- | --- | --- | | Evening "near me" call | Voicemail; the parent calls the next result | Answered live, at any hour | | "Do you take my plan?" | Callback promised after someone checks | Answered in the conversation, with eligibility verified up front | | "Do you serve my town?" | Depends who answers and what they remember | Service area resolved by county and ZIP, consistently | | Weekend web form | Read Monday morning | Answered in seconds and intake started | | Review requests | Asked occasionally, by whoever remembers, if at all | Sent by text at the moment you choose, with a reminder — and a reply to every review | ## Keep reading - [The full growth playbook](https://carelu.com/resources/how-to-grow-an-aba-practice): Where organic search fits among the five channels. - [Google Ads for ABA](https://carelu.com/resources/google-ads-for-aba): Buying the same intent while the organic asset is still compounding. - [After-hours coverage](https://carelu.com/resources/after-hours-intake-coverage): Organic search sends families at night. Decide what happens then. - [Pediatrician referrals](https://carelu.com/resources/aba-pediatrician-referrals): The other channel that compounds, and costs nothing per lead. Source: Carelu — https://carelu.com/resources/seo-for-aba-practices. Free to cite with attribution. --- --- title: "Who should answer your ABA intake line: a coordinator, a BCBA, or the owner?" url: "https://carelu.com/resources/who-should-answer-aba-intake-calls" description: Speed is table stakes in ABA intake, but trust is what wins the family. Who should take the first call (an intake coordinator, a BCBA, the owner or an answering service), what each one is good at, and how the fastest-growing practices split the job so every family is answered instantly and talks to a clinician early. updated: 2026-09-23 --- # Who should answer your ABA intake line: a coordinator, a BCBA, or the owner? **Short answer:** Split the job. A stable intake layer (a system plus a coordinator) should answer every inquiry instantly at any hour, qualify the family and start paperwork, and a BCBA or the owner should then have a real conversation with every qualified family, ideally the same day. Speed gets you into the conversation; trust wins the family. Most ABA practices decide who answers the phone by default. Whoever sits at the front desk takes the calls, the calls go to voicemail when that person is busy, and the BCBAs stay in sessions. That setup treats the first call as admin work. It isn’t: it is the first time a worried parent decides whether to trust you with their child. ABA intake has two jobs, and they need different people. The first is speed and stability: answer every family immediately, qualify them and get the paperwork moving. That part is table stakes. Every practice needs it, and it has to work at 9pm on a Saturday. The second is trust: a real conversation with someone who understands the child. That part is how you win, because families contact several providers at once and usually start with whoever made them feel understood first. Among the providers we work with, the ones that grow fastest share a pattern. A BCBA or the owner talks to the family early, often on the first day, while the intake layer underneath answers every inquiry instantly and handles everything else. This playbook explains why that works and how to set it up without burning out your clinicians. ## What the first contact really looks like Before deciding who answers, look at who is calling and when. These numbers come from our published research across 185,054 family conversations with 120 ABA providers in 48 states, aggregated and de-identified. - **48% arrive outside business hours:** Nearly half of families reach out in the evening, overnight or on weekends, when neither your front desk nor your BCBAs are at work. Whoever "answers the phone" has to include something that works at those hours. - **22% have no diagnosis yet:** More than one family in five is still at the "is something wrong with my child?" stage. They need guidance on the path to evaluation, and that is a clinical conversation, not a form. - **The median child is 6, and 27% are 10 or older:** Many parents have already been through early intervention, school evaluations or another provider. They ask specific, experienced questions, and they can tell quickly whether the person on the line understands their child. - **40% of website leads are job seekers:** A large share of what arrives is RBT and BCBA applicants, not families. If a clinician is the first line, they spend a lot of their time on the wrong calls. - **Only about a quarter of website chats become a lead:** At the median provider, roughly one website conversation in four ends with contact details captured. The rest leave without anyone knowing who they were. ## Speed is table stakes. Trust is the game. Families shop in parallel. A parent who gets a diagnosis on Tuesday afternoon typically contacts three or four providers that evening. Whoever answers first gets the first conversation, which is why speed matters so much: a practice that calls back the next morning often isn’t in the running anymore. But answering first only gets you into the conversation. It doesn’t win it. What the parent is really deciding is whether this practice will be good for their child, and whether they trust the people there. Waitlists, payer rules and paperwork are similar across practices. The feeling of "these people get my kid" is not. So the goal isn’t to choose between speed and trust. It’s to make speed automatic so the people who build trust can spend their time building it. ## The four options, honestly compared - **Intake coordinator:** Strong: consistent process, knows the payer list, keeps paperwork moving, cheaper than a clinician. Weak: can’t answer clinical questions with authority ("will ABA help with his meltdowns?"), is one person with lunch breaks and sick days, and works business hours. Coordinators are essential, but on their own they make the first call feel like registration. - **BCBA:** Strong: instant credibility. A BCBA can explain what the assessment involves, what the first month looks like and what progress might mean for this child. Weak: every hour on the phone is an hour not supervising or billing, calls interrupt sessions, and nobody wants a BCBA spending the morning on job applicants and out-of-area families. - **The owner:** Strong: the most trust and urgency in the building. Owners care about every family, know every exception and can make decisions on the spot. Weak: doesn’t scale past a few dozen families a month, and the practice becomes dependent on one person’s phone. Great at the beginning, and a bottleneck later. - **Answering service:** Strong: a human voice outside business hours. Weak: usually takes a message, knows nothing about your payers or service area, and builds no relationship. The parent still waits until morning for a real answer. ## What the fastest-growing practices do: split the job The practices that grow fastest don’t pick one of the four. They separate the stable layer from the relationship layer and staff each one differently. The stable layer answers every inquiry within seconds, on every channel and at every hour. It qualifies the family (service area, payer, age, diagnosis status), starts intake and checks benefits. It should behave the same way on a Saturday night as on a Tuesday morning. This is work for a system plus a coordinator, and it should never depend on whether a clinician is free. The relationship layer is a real conversation with a BCBA or the owner, as early as possible, for every family who qualifies. It is not a registration call. It is fifteen minutes about the child. Because the stable layer has already filtered out job seekers, out-of-area families and unaccepted plans, the clinician’s time goes only to families you can actually serve. ## How to run the trust call - **Call the same day:** Set a rule: every qualified family hears from a BCBA or the owner the same business day, or by the next morning for after-hours inquiries. The first practice to have a real conversation usually wins. - **Come prepared:** The clinician should read the intake summary first and never ask a question the family already answered. "I saw that Liam just turned four and his pediatrician mentioned speech" beats "So, how old is your child?" - **Talk about the child, not the paperwork:** Ask what a hard day looks like at home. Explain what the assessment involves and what the first month of services looks like. Leave insurance and forms to the intake layer, which is already handling them. - **Be honest about timing:** If there is a waitlist or a pending authorization, say so and explain what happens meanwhile. Families forgive a wait they understand, not one they discover. - **End with one concrete next step:** An assessment date, a document still needed, or a call-back time. Never end with "we’ll be in touch." - **Protect clinical time:** Give BCBAs two short call blocks a day instead of taking calls between sessions. With the stable layer running, those blocks are enough. ## Pre-diagnosis families need the relationship most The 22% of families who reach out before a diagnosis are the easiest to lose and among the most loyal once you help them. They are confused, often scared, and have been told to "get an evaluation" without anyone explaining how. A ten-minute conversation with a BCBA about what an evaluation involves, who does them locally, and what the family can do while they wait is often the moment that family decides to stay with you through the months ahead. Our guide to pre-diagnosis families covers the evaluation path in detail. ## What to measure - **Time to first response:** From inquiry to first reply, on every channel, including nights and weekends. This is the stable layer’s number. It should be measured in seconds or minutes, not hours. - **Time to first clinical conversation:** From inquiry to the BCBA or owner call. This is the relationship layer’s number. Aim for the same day. - **Share of qualified families who talk to a clinician before the assessment:** If this is low, your clinicians are only meeting families at the assessment, and many families never get that far. - **Inquiry to first session, by who made the first call:** Compare families whose first real conversation was with a clinician to those who only spoke with admin. That comparison shows whether the trust call is worth the time. ## Frequently asked questions ### Who should answer the phone at an ABA clinic? Split the job. A stable intake layer (a system plus an intake coordinator) should answer every inquiry instantly at any hour, qualify the family and start paperwork. Then a BCBA or the owner should have a real conversation with every qualified family, ideally the same day. Speed gets you into the conversation; trust wins the family. ### Should BCBAs answer intake calls? BCBAs shouldn’t answer every call. Many are job seekers, out-of-area families or plans you don’t accept. They should call every qualified family early, in scheduled call blocks, with the intake summary in front of them. That makes the best use of their credibility without cutting into billable time. ### Should the owner of an ABA practice answer the phone? In the early stage, often yes. Owners build trust faster than anyone and can make decisions on the spot. As volume grows, the owner should move from answering every call to calling qualified families, then hand that role to BCBAs, while an intake layer handles speed and qualification. ### How fast should an ABA practice respond to a new inquiry? Within minutes, at any hour. Families contact several providers at once, and 48% of contacts in our research arrive outside business hours. The first real conversation with a clinician should follow the same day. ### Is an answering service enough for ABA intake? Usually not. Most answering services take a message without qualifying the family, checking coverage or starting intake, and build no relationship. The parent still waits until morning, often after contacting other providers. ## How Carelu runs the stable layer so your clinicians can build trust Carelu is the stable layer from this playbook. It answers every family in seconds on every channel, qualifies them and starts intake, at any hour. Your BCBAs and owner only talk to families you can serve, and they start that call already knowing the child. The trust call stays human, and it should. Carelu makes sure it happens with the right families, early, and with nothing left for the clinician to ask twice. - **Every family answered instantly:** An AI voice agent, website chat, text and web forms respond within seconds, 24/7, in English and Spanish, including the 48% of contacts that arrive after hours. - **Only qualified families reach your clinicians:** Service area, payer, age and diagnosis status are checked in the first conversation. Job seekers are separated from families, and out-of-area families get a kind, clear answer. - **Routed to the right person:** Each qualified family is routed to the BCBA, owner or coordinator you choose by location or state, and appears in one live queue with its status. - **A summary before the call:** The clinician sees the full conversation and intake answers before dialing, so the trust call is about the child, not about re-asking questions. - **Paperwork kept out of the conversation:** Intake, e-signed consents, document uploads and benefits verification run in the background, with follow-up until the packet is complete. ## The first 24 hours, by hand and with Carelu | Step | Doing it manually | With Carelu | | --- | --- | --- | | 9pm inquiry | Voicemail; callback next morning | Answered in seconds, qualified and intake started | | Filtering | Coordinator sorts families, job seekers and out-of-area calls by hand | Done in the first conversation | | Clinician’s first call | Often only at the assessment, if the family gets that far | Same day, with qualified families only | | Call preparation | Clinician re-asks the basics | Full conversation and intake summary attached | | Paperwork | Discussed on the call, finished later or never | Running in the background, with follow-up until complete | ## Keep reading - [After-hours coverage](https://carelu.com/resources/after-hours-intake-coverage): Why taking a message is not coverage. - [Families without a diagnosis](https://carelu.com/resources/aba-evaluation-referrals): The 22% who reach out first, and how to keep them. - [The numbers to watch](https://carelu.com/resources/aba-intake-metrics): Speed to contact and inquiry-to-start, measured weekly. - [How to grow an ABA practice](https://carelu.com/resources/how-to-grow-an-aba-practice): The five channels, and the operations layer they all depend on. - [The Intake Gap (our research)](https://carelu.com/research/the-intake-gap): 185,054 family conversations across 120 ABA providers. Source: Carelu — https://carelu.com/resources/who-should-answer-aba-intake-calls. Free to cite with attribution. --- # ABA payer directory --- --- title: ABA Payer Directory url: "https://carelu.com/payers" description: "ABA therapy coverage and prior-authorization guides per payer, with whether the assessment and treatment need prior auth: state Medicaid programs, Medicaid managed care plans, and commercial insurers, sourced from primary documents." last_reviewed: October 2026 guides: 484 --- # ABA Payer Directory ABA coverage and prior-authorization guides for 484 payers, grouped by state. Each guide has an HTML page and a clean Markdown twin (append `.md` to the URL). Last reviewed October 2026. ## National - [Aetna](https://carelu.com/payers/aetna) ([Markdown](https://carelu.com/payers/aetna.md)) — Commercial insurance. CPB 0554 — ASD-only coverage, precert form GR-69017-4, telehealth codes. Prior auth: assessment Required; treatment Required. - [ASR Health Benefits](https://carelu.com/payers/asr-health-benefits) ([Markdown](https://carelu.com/payers/asr-health-benefits.md)) — Commercial insurance. Administrator of employer-funded health plans; verify ABA benefits for the employer group. - [Carelon Behavioral Health](https://carelu.com/payers/carelon-behavioral-health) ([Markdown](https://carelu.com/payers/carelon-behavioral-health.md)) — Commercial insurance. The BH carve-out behind Empire Plan, EmblemHealth and several Anthem/Wellpoint books — one national ABA auth form. Prior auth: assessment Required; treatment Required. - [CHAMPVA](https://carelu.com/payers/champva) ([Markdown](https://carelu.com/payers/champva.md)) — Commercial insurance. A VA program, not TRICARE. ABA is covered, treatment needs pre-authorization, and the family pays 25% after deductible. Prior auth: assessment Not required; treatment Required. - [Cigna / Evernorth](https://carelu.com/payers/cigna) ([Markdown](https://carelu.com/payers/cigna.md)) — Commercial insurance. No PA on assessment codes; EN0499 treatment authorization; full telehealth. Prior auth: assessment Not required for assessment codes 97151, 97152, 0362T (with ASD dx + licensed/BCBA provider); treatment Required. - [ComPsych](https://carelu.com/payers/compsych) ([Markdown](https://carelu.com/payers/compsych.md)) — Commercial insurance. Usually EAP, sometimes the whole BH network — establish which before you promise a start date. - [Humana](https://carelu.com/payers/humana) ([Markdown](https://carelu.com/payers/humana.md)) — Commercial insurance. Humana finished leaving employer group medical in 2025 — route a bare "Humana" card to Medicaid, Medicare Advantage or TRICARE East first. - [Magellan Health / Magellan Healthcare](https://carelu.com/payers/magellan-health) ([Markdown](https://carelu.com/payers/magellan-health.md)) — Commercial insurance. Publishes dated, public ABA criteria — fax-in auth forms, 1–2 hrs supervision per 10 direct, 97152 not covered. Prior auth: assessment Required; treatment Required. - [Meritain Health](https://carelu.com/payers/meritain-health) ([Markdown](https://carelu.com/payers/meritain-health.md)) — Commercial insurance. Aetna-owned TPA for self-funded employer plans — the employer's plan document, not Meritain, sets the ABA benefit. - [TRICARE East (Humana Military)](https://carelu.com/payers/tricare-east-humana-military) ([Markdown](https://carelu.com/payers/tricare-east-humana-military.md)) — Commercial insurance. ABA runs through the Autism Care Demonstration — referral chain, four outcome measures, six-month authorizations. Prior auth: assessment Required; treatment Required. - [TRICARE West (TriWest)](https://carelu.com/payers/tricare-west-triwest) ([Markdown](https://carelu.com/payers/tricare-west-triwest.md)) — Commercial insurance. TriWest took the West Region on Jan. 1, 2025 — ACD rules, a published place-of-service map, and the 97155 monthly penalty. Prior auth: assessment Required; treatment Required. - [UnitedHealthcare / Optum](https://carelu.com/payers/unitedhealthcare-optum) ([Markdown](https://carelu.com/payers/unitedhealthcare-optum.md)) — Commercial insurance. Two-step auth via Provider Express, 4–6 month reviews, code clusters. Prior auth: assessment Required; treatment Required. ## Alabama (AL) State autism mandate: Riley Ward Act (Ala. Code § 27-54A-2; large group, 18 and under, ABA caps $40K/$30K/$20K by age) - [Alabama Medicaid](https://carelu.com/payers/alabama-medicaid) ([Markdown](https://carelu.com/payers/alabama-medicaid.md)) — State Medicaid program. Fee-for-service EPSDT benefit (under 21) with no MCOs; PA on every ABA code except 97151; published rates (97153 $10.00); licensed BCBA must bill. Prior auth: assessment No for the initial 97151 assessment, according to both the Chapter 37 code table and the February 2026 fee…; treatment Required. - [Aetna in Alabama](https://carelu.com/payers/aetna-alabama) ([Markdown](https://carelu.com/payers/aetna-alabama.md)) — Commercial insurance. Aetna’s national ABA guide and BH precertification list, plus Alabama’s Riley Ward Act mandate (large group, 18 and under, age-banded caps). Prior auth: assessment Required: all ten ABA codes, 97151 included, are on Aetna’s behavioral health precertification list; treatment see guide. - [Blue Cross and Blue Shield of Alabama](https://carelu.com/payers/blue-cross-blue-shield-of-alabama) ([Markdown](https://carelu.com/payers/blue-cross-blue-shield-of-alabama.md)) — Commercial insurance. Alabama’s Blue plan: ABA run by Lucet under policy 20.5.005; PA on every ABA session, assessment included; physical Alabama location required; Riley Ward Act mandate. Prior auth: assessment Required; treatment Required, through Lucet WebPass. - [Cigna / Evernorth in Alabama](https://carelu.com/payers/cigna-alabama) ([Markdown](https://carelu.com/payers/cigna-alabama.md)) — Commercial insurance. Evernorth EN0499 + autism resource guide (no PA on assessment codes) + Alabama’s Riley Ward Act; Evernorth’s Alabama Regulatory Addendum applies. Prior auth: assessment Not required for 97151, 97152 and 0362T with an autism diagnosis when the provider is independently licensed…; treatment Required: completed assessment and treatment plan submitted with the ABA prior authorization request. - [UnitedHealthcare / Optum in Alabama](https://carelu.com/payers/unitedhealthcare-alabama) ([Markdown](https://carelu.com/payers/unitedhealthcare-alabama.md)) — Commercial insurance. Optum ABA criteria + Alabama’s Riley Ward Act; Alabama is not in Optum’s state-mandate supplement; telehealth limited to 97155–97157. Prior auth: assessment Required: Optum’s ABA Supplemental Clinical Criteria say "prior authorization is required for ABA (unless…; treatment see guide. ## Alaska (AK) State autism mandate: AS 21.42.397 autism coverage (under 21; no visit or dollar caps; small groups of 20 or fewer exempt) - [Alaska Medicaid](https://carelu.com/payers/alaska-medicaid) ([Markdown](https://carelu.com/payers/alaska-medicaid.md)) — State Medicaid program. Fee-for-service only (no MCOs, ASO ended 2024); autism services under 21 per 7 AAC 135.350, no prior auth since 7/1/2025, FY2027 rates up sharply. Prior auth: assessment No; treatment No, since July 1, 2025: regulation project 2024200550 set out to "remove certain prior authorization…. - [Aetna in Alaska](https://carelu.com/payers/aetna-alaska) ([Markdown](https://carelu.com/payers/aetna-alaska.md)) — Commercial insurance. Aetna’s national ABA policies + Alaska’s AS 21.42.397 mandate (under 21, small-group exemption); BCBA needs an Alaska license. Prior auth: assessment Required: all ten ABA codes, 97151 included, are on Aetna’s behavioral health precertification list; treatment see guide. - [Cigna / Evernorth in Alaska](https://carelu.com/payers/cigna-alaska) ([Markdown](https://carelu.com/payers/cigna-alaska.md)) — Commercial insurance. EN0499 + autism resource guide + Alaska’s AS 21.42.397 mandate; no PA on assessment codes; Evernorth has an Alaska regulatory addendum. Prior auth: assessment Not required for 97151, 97152 and 0362T with an autism diagnosis when the provider is independently licensed…; treatment Required: completed assessment and treatment plan attached to the ABA Prior Authorization Form. - [Premera Blue Cross Blue Shield of Alaska](https://carelu.com/payers/premera-blue-cross-blue-shield-alaska) ([Markdown](https://carelu.com/payers/premera-blue-cross-blue-shield-alaska.md)) — Commercial insurance. Alaska’s largest insurer: Premera policy 3.01.510, ABA on the PA list (individual and group), 365-day filing, AS 21.42.397 mandate. Prior auth: assessment Required on individual plans: 97151 and 0362T are "Prior Authorization Required" on Premera Alaska’s October…; treatment Required: 97153, 97154, 97155, 97156, 97158 and 0373T are "Prior Authorization Required" on the individual…. - [UnitedHealthcare / Optum in Alaska](https://carelu.com/payers/unitedhealthcare-alaska) ([Markdown](https://carelu.com/payers/unitedhealthcare-alaska.md)) — Commercial insurance. Optum criteria (BH803ABASCC) + Alaska’s AS 21.42.397 mandate; no Alaska state supplement; three-code telehealth list. Prior auth: assessment Required: the ABA Supplemental Clinical Criteria require prior authorization for ABA "unless otherwise…; treatment see guide. ## Arizona (AZ) State autism mandate: Steven’s Law (A.R.S. § 20-826.04; dollar caps repealed by SB 1590, 2025) - [AHCCCS (Arizona Medicaid)](https://carelu.com/payers/arizona-ahcccs) ([Markdown](https://carelu.com/payers/arizona-ahcccs.md)) — State Medicaid program. Dual path: six ACC plans or DDD Health Plans; no autism dx required; tiered rates. - [Arizona Complete Health - Complete Care Plan](https://carelu.com/payers/arizona-complete-health) ([Markdown](https://carelu.com/payers/arizona-complete-health.md)) — Medicaid managed care plan (MCO). Centene's CP.BH.104 overlay: dx confirmation, 5-year eval recency, hour bands; every county. Prior auth: assessment see guide; treatment Required per CP.BH.104. - [Banner-University Family Care](https://carelu.com/payers/banner-university-family-care) ([Markdown](https://carelu.com/payers/banner-university-family-care.md)) — Medicaid managed care plan (MCO). AMPM 320-S baseline; PA on 97155–97158 (assessment and 97153/97154 PA-free in network); 120-day filing limit. Prior auth: assessment Not for in-network providers; treatment Required for 97155, 97156, 97157 and 97158 before services start, on Banner’s ABA Prior Authorization Form…. - [Blue Cross Blue Shield of Arizona Health Choice](https://carelu.com/payers/health-choice-arizona) ([Markdown](https://carelu.com/payers/health-choice-arizona.md)) — Medicaid managed care plan (MCO). Now officially "Blue Cross Blue Shield of Arizona Health Choice"; grid-driven PA, no published ABA policy. - [DES/DDD (Arizona Division of Developmental Disabilities)](https://carelu.com/payers/arizona-ddd) ([Markdown](https://carelu.com/payers/arizona-ddd.md)) — Medicaid managed care plan (MCO). The second funnel: ALTCS-DD members get ABA via Mercy Care DD or UHCCP DD, statewide. Prior auth: assessment Follows the member's DDD Health Plan; treatment Through the member's DDD Health Plan (Mercy Care DD or UHCCP DD), on the same ABA PA machinery as their ACC…. - [Mercy Care (AZ)](https://carelu.com/payers/mercy-care-arizona) ([Markdown](https://carelu.com/payers/mercy-care-arizona.md)) — Medicaid managed care plan (MCO). No PA on 97151/97152; 6-month auths on its own ABA form; serves ACC + DDD + DCS books. Prior auth: assessment Not required for 97151 and 97152; treatment Required for 97153–97158. - [Molina Healthcare of Arizona](https://carelu.com/payers/molina-healthcare-arizona) ([Markdown](https://carelu.com/payers/molina-healthcare-arizona.md)) — Medicaid managed care plan (MCO). Smallest ACC footprint (3 Phoenix-metro counties); no published ABA policy — verify by phone. Prior auth: assessment see guide; treatment Required. - [UnitedHealthcare Community Plan of Arizona](https://carelu.com/payers/unitedhealthcare-community-plan-arizona) ([Markdown](https://carelu.com/payers/unitedhealthcare-community-plan-arizona.md)) — Medicaid managed care plan (MCO). Optum-run; PA on everything except 97151/97152; explicit "no ASD dx required" rule. Prior auth: assessment Not required; treatment Required for all treatment codes. - [Aetna in Arizona](https://carelu.com/payers/aetna-arizona) ([Markdown](https://carelu.com/payers/aetna-arizona.md)) — Commercial insurance. CPB 0554 (ABA) + CPB 0648 (ASD) + Steven's Law with its caps repealed by SB 1590 (2025). Prior auth: assessment Required; treatment Required. - [Cigna / Evernorth in Arizona](https://carelu.com/payers/cigna-arizona) ([Markdown](https://carelu.com/payers/cigna-arizona.md)) — Commercial insurance. EN0499 (no AZ carve-out) + Steven's Law with its caps repealed by SB 1590 (2025). Prior auth: assessment Not required for assessment codes 97151, 97152, 0362T; treatment Required. - [UnitedHealthcare / Optum in Arizona](https://carelu.com/payers/unitedhealthcare-arizona) ([Markdown](https://carelu.com/payers/unitedhealthcare-arizona.md)) — Commercial insurance. BH803ABASCC + Optum's AZ state-mandate entry reflecting SB 1590's cap repeal. Prior auth: assessment Required; treatment Required. ## Arkansas (AR) State autism mandate: Ark. Code § 23-99-418 (Act 196 of 2011; ABA under 18 and $50,000/yr as enacted) - [Arkansas Medicaid](https://carelu.com/payers/arkansas-medicaid) ([Markdown](https://carelu.com/payers/arkansas-medicaid.md)) — State Medicaid program. EPSDT ABA for ages 18 months–21: Acentra prior-authorizes fee-for-service; PASSE members go through their PASSE. Rates $15–$22.50. Prior auth: assessment Required; treatment Yes, for every ABA service (97153, 97155, 97156): “Prior authorization is required for an applied behavior…. - [Arkansas Total Care](https://carelu.com/payers/arkansas-total-care) ([Markdown](https://carelu.com/payers/arkansas-total-care.md)) — Medicaid managed care plan (MCO). Centene PASSE with its own Arkansas ABA policy (AR.CP.BH.104): PCP prescription, 6 hrs/day–30 hrs/week ceiling without extra justification, 2-business-day decisions. Prior auth: assessment Not for network providers; treatment Only for non-participating providers, per the Pre-Auth Check (queried October 18, 2026): 97153, 97154, 97155,…. - [CareSource PASSE](https://carelu.com/payers/caresource-passe-arkansas) ([Markdown](https://carelu.com/payers/caresource-passe-arkansas.md)) — Medicaid managed care plan (MCO). CareSource PASSE: ABA policy MM-1227 + payment policy PY-1616 follow the state manual; review before every ABA service; 2-business-day decisions. Prior auth: assessment Yes: “All covered services must be reviewed for medical necessity prior to the service,” and the covered…; treatment Yes: “A review of medical necessity is required prior to any ABA service provision” (PY-1616). - [Empower Healthcare Solutions](https://carelu.com/payers/empower-healthcare-solutions-arkansas) ([Markdown](https://carelu.com/payers/empower-healthcare-solutions-arkansas.md)) — Medicaid managed care plan (MCO). Empower PASSE: PA required on 97151, 97153, 97155 and 97156 (BH/IDD form or portal); otherwise the state ABA manual applies. Prior auth: assessment Yes: 97151 is on Empower’s PA list; treatment Yes: 97153, 97155 and 97156 are on the PA list (PA required). - [Summit Community Care](https://carelu.com/payers/summit-community-care-arkansas) ([Markdown](https://carelu.com/payers/summit-community-care-arkansas.md)) — Medicaid managed care plan (MCO). Summit Community Care PASSE: PA on 97151–97156 and 97158 (list updated 2/11/2026); otherwise the state ABA manual applies. Prior auth: assessment Yes: 97151 and 97152 are on Summit’s list of services requiring prior authorization (updated 2/11/2026); treatment Yes: 97153, 97154, 97155, 97156 and 97158 are on the PA list (only 97153, 97155 and 97156 are payable under…. - [Aetna in Arkansas](https://carelu.com/payers/aetna-arkansas) ([Markdown](https://carelu.com/payers/aetna-arkansas.md)) — Commercial insurance. Aetna ABA medical necessity guide + precertification of all ten ABA codes + Arkansas’s § 23-99-418 mandate layer. Prior auth: assessment Required: all ten ABA codes, 97151 included, are on Aetna’s behavioral health precertification list; treatment see guide. - [Arkansas Blue Cross and Blue Shield](https://carelu.com/payers/arkansas-blue-cross-blue-shield) ([Markdown](https://carelu.com/payers/arkansas-blue-cross-blue-shield.md)) — Commercial insurance. Policy 2011053 (Lucet manages ABA): no PA for metallic, group, individual or governmental plans; PA for ERISA self-insured and FEP; $50K cap only on grandfathered plans. - [Cigna / Evernorth in Arkansas](https://carelu.com/payers/cigna-arkansas) ([Markdown](https://carelu.com/payers/cigna-arkansas.md)) — Commercial insurance. Evernorth EN0499 + autism resource guide + Arkansas’s § 23-99-418 mandate; no PA on assessment codes; Arkansas regulatory addendum on recoupment. Prior auth: assessment Not required for 97151, 97152 and 0362T with an autism diagnosis when the provider is independently licensed…; treatment Required: complete the assessment and treatment plan, then the Applied Behavior Analysis Prior Authorization…. - [UnitedHealthcare / Optum in Arkansas](https://carelu.com/payers/unitedhealthcare-arkansas) ([Markdown](https://carelu.com/payers/unitedhealthcare-arkansas.md)) — Commercial insurance. Optum ABA criteria (BH803ABASCC) + Arkansas’s § 23-99-418 mandate; no Arkansas state supplement; telehealth limited to 97155–97157. Prior auth: assessment Required: “Prior authorization is required for ABA *(unless otherwise specified or mandated by contract or…; treatment see guide. ## California (CA) State autism mandate: SB 946 autism mandate (H&S § 1374.73, Ins. Code § 10144.51; no age or dollar caps) - [Medi-Cal (California Medicaid)](https://carelu.com/payers/medi-cal-california-medicaid) ([Markdown](https://carelu.com/payers/medi-cal-california-medicaid.md)) — State Medicaid program. BHT for under-21s regardless of diagnosis, via the county Medi-Cal plan; no hour caps; Regional Center pays last. Prior auth: assessment see guide; treatment Required. - [Anthem Blue Cross Partnership Plan (Medi-Cal)](https://carelu.com/payers/anthem-blue-cross-partnership-plan-california) ([Markdown](https://carelu.com/payers/anthem-blue-cross-partnership-plan-california.md)) — Medicaid managed care plan (MCO). Anthem Medi-Cal in 15 counties + L.A. Care subcontract; ABA precert via Availity or fax; recommendation, not dx. Prior auth: assessment Required through the authorization request; treatment Required. - [CalOptima Health (Medi-Cal)](https://carelu.com/payers/caloptima-health-california) ([Markdown](https://carelu.com/payers/caloptima-health-california.md)) — Medicaid managed care plan (MCO). Orange County COHS; strict recommendation rules (no LMFT/LCSW/NP alone), Vineland-3 required, PAVE enrollment. Prior auth: assessment Required; treatment Required. - [Health Net Community Solutions (Medi-Cal) / CalViva Health](https://carelu.com/payers/health-net-community-solutions-california) ([Markdown](https://carelu.com/payers/health-net-community-solutions-california.md)) — Medicaid managed care plan (MCO). Health Net + CalViva Medi-Cal; new policy CA.CP.BH.104 (4/20/2026): 6 h/day–30 h/wk cap, 12-month dx eval, 6-month auths. Prior auth: assessment Required; treatment Required. - [Inland Empire Health Plan (IEHP, Medi-Cal)](https://carelu.com/payers/inland-empire-health-plan-california) ([Markdown](https://carelu.com/payers/inland-empire-health-plan-california.md)) — Medicaid managed care plan (MCO). Riverside/San Bernardino LI (1.37M); BHT in-house via portal, 6-month units, 2:10 supervision, H0031 = FBA. Prior auth: assessment Required; treatment Required. - [Kaiser Permanente (Medi-Cal)](https://carelu.com/payers/kaiser-permanente-medi-cal-california) ([Markdown](https://carelu.com/payers/kaiser-permanente-medi-cal-california.md)) — Medicaid managed care plan (MCO). Direct DHCS contract since 2024; entry only through a Kaiser physician referral; KP authorization even when secondary. Prior auth: assessment Required; treatment Required. - [L.A. Care Health Plan (Medi-Cal)](https://carelu.com/payers/la-care-health-plan-california) ([Markdown](https://carelu.com/payers/la-care-health-plan-california.md)) — Medicaid managed care plan (MCO). Largest Medi-Cal plan (2.08M); BHT in-house via the ASD Program, H-codes on form LA5480, no autism dx required. Prior auth: assessment Required; treatment Required. - [Molina Healthcare of California (Medi-Cal)](https://carelu.com/payers/molina-healthcare-california) ([Markdown](https://carelu.com/payers/molina-healthcare-california.md)) — Medicaid managed care plan (MCO). Own ABA department + case managers; PA on 97153–97158/0373T; clinical policy stricter than the state APL. Prior auth: assessment see guide; treatment Required. - [Partnership HealthPlan of California (Medi-Cal)](https://carelu.com/payers/partnership-healthplan-of-california) ([Markdown](https://carelu.com/payers/partnership-healthplan-of-california.md)) — Medicaid managed care plan (MCO). COHS for 24 northern counties; BHT reviewed in-house (not Carelon); TAR for assessment and treatment; ROI with every request. Prior auth: assessment Required; treatment Required. - [Aetna in California](https://carelu.com/payers/aetna-california) ([Markdown](https://carelu.com/payers/aetna-california.md)) — Commercial insurance. CPB 0554 + ABA MN guide; CA state supplement drops outpatient BH PA on fully insured plans — confirm for ABA. - [Anthem Blue Cross (California commercial)](https://carelu.com/payers/anthem-blue-cross-california) ([Markdown](https://carelu.com/payers/anthem-blue-cross-california.md)) — Commercial insurance. PA on every ABA code; fully insured reviewed on AACAP criteria (SB 855), self-funded on licensed MCG B-806-T. Prior auth: assessment Required; treatment Required. - [Blue Shield of California](https://carelu.com/payers/blue-shield-of-california) ([Markdown](https://carelu.com/payers/blue-shield-of-california.md)) — Commercial insurance. Magellan out 1/1/2026 — Blue Shield manages ABA itself; PA on assessment + treatment; BSC3.01; 2:10 supervision ceiling. Prior auth: assessment Required; treatment see guide. - [Cigna in California](https://carelu.com/payers/cigna-california) ([Markdown](https://carelu.com/payers/cigna-california.md)) — Commercial insurance. EN0499 (no CA carve-out) + autism resource guide + the H&S § 1374.73 mandate; no PA on in-network assessment. Prior auth: assessment Not required for standard in-network requests; treatment Required. - [Health Net of California (commercial)](https://carelu.com/payers/health-net-california) ([Markdown](https://carelu.com/payers/health-net-california.md)) — Commercial insurance. Leaving CA group market (plans end ~2/28/2027); in-house BH Autism Center; CASP criteria; PA via ABA@healthnet.com. Prior auth: assessment Required; treatment Required. - [Kaiser Permanente (California commercial)](https://carelu.com/payers/kaiser-permanente-california) ([Markdown](https://carelu.com/payers/kaiser-permanente-california.md)) — Commercial insurance. Closed HMO: BHT only by Kaiser physician referral (NCAL via PDCP/Catalight); 12-month auths; H&S 1374.73 mandate. Prior auth: assessment Required as a Kaiser referral, not a provider-filed PA; treatment Required as a Kaiser authorization. - [UnitedHealthcare in California](https://carelu.com/payers/unitedhealthcare-california) ([Markdown](https://carelu.com/payers/unitedhealthcare-california.md)) — Commercial insurance. Optum BH; CASP guidelines posted as CA commercial ABA criteria; State Mandates entry bars IEP/Medicaid offsets. Prior auth: assessment Required; treatment Required. ## Colorado (CO) State autism mandate: Colorado autism insurance mandate (C.R.S. § 10-16-104(1.4)) - [Health First Colorado (Colorado Medicaid)](https://carelu.com/payers/colorado-medicaid) ([Markdown](https://carelu.com/payers/colorado-medicaid.md)) — State Medicaid program. No autism-dx gate; FFS carve-out (RAEs don't run ABA); PAR on everything; no 97156. Prior auth: assessment Required; treatment Required. - [Aetna in Colorado](https://carelu.com/payers/aetna-colorado) ([Markdown](https://carelu.com/payers/aetna-colorado.md)) — Commercial insurance. CPB 0554 (ABA) + CPB 0648 (ASD) + the C.R.S. § 10-16-104(1.4) mandate layer. Prior auth: assessment Required; treatment Required. - [Anthem BCBS Colorado](https://carelu.com/payers/anthem-bcbs-colorado) ([Markdown](https://carelu.com/payers/anthem-bcbs-colorado.md)) — Commercial insurance. Anthem reviews ABA in-house (not Carelon); weekly approved units since 3/1/2026; no mandate caps. Prior auth: assessment Required; treatment Required. - [Cigna / Evernorth in Colorado](https://carelu.com/payers/cigna-colorado) ([Markdown](https://carelu.com/payers/cigna-colorado.md)) — Commercial insurance. EN0499 + autism resource guide + the C.R.S. § 10-16-104(1.4) mandate layer. Prior auth: assessment Not required for assessment codes 97151, 97152, 0362T; treatment Required. - [UnitedHealthcare / Optum in Colorado](https://carelu.com/payers/unitedhealthcare-colorado) ([Markdown](https://carelu.com/payers/unitedhealthcare-colorado.md)) — Commercial insurance. Optum Supplemental Clinical Criteria (BH803ABASCC) + the C.R.S. § 10-16-104(1.4) mandate layer. Prior auth: assessment Required; treatment Required. ## Connecticut (CT) State autism mandate: Conn. Gen. Stat. §§ 38a-514b / 38a-488b (behavioral therapy under 21, under 26 from 1/1/2027; no dollar cap) - [Connecticut Medicaid (HUSKY Health)](https://carelu.com/payers/connecticut-medicaid) ([Markdown](https://carelu.com/payers/connecticut-medicaid.md)) — State Medicaid program. HUSKY Health has no MCOs: ABA (ASD services) is fee-for-service, authorized by Carelon BH CT, with published rates. Prior auth: assessment Required; treatment Required. - [Carelon Behavioral Health of Connecticut (CT BHP)](https://carelu.com/payers/carelon-behavioral-health-connecticut) ([Markdown](https://carelu.com/payers/carelon-behavioral-health-connecticut.md)) — Medicaid managed care plan (MCO). Not an MCO: the HUSKY behavioral health ASO that qualifies ASD providers and authorizes every ASD service; Gainwell pays. Prior auth: assessment Required; treatment Yes, through ProviderConnect: initial treatment authorizations up to 90 days, then up to 6 months, with…. - [Aetna in Connecticut](https://carelu.com/payers/aetna-connecticut) ([Markdown](https://carelu.com/payers/aetna-connecticut.md)) — Commercial insurance. Aetna’s national ABA guide and precertification list + Connecticut’s § 38a-514b mandate (licensed supervision, under 21). Prior auth: assessment Required: all ten ABA codes, including 97151, are on Aetna’s behavioral health precertification list; treatment see guide. - [Anthem Blue Cross and Blue Shield (Connecticut)](https://carelu.com/payers/anthem-bcbs-connecticut) ([Markdown](https://carelu.com/payers/anthem-bcbs-connecticut.md)) — Commercial insurance. Connecticut’s Blue plan: ABA is on Anthem’s CT precertification list (BH 800-934-0331) under the § 38a-514b mandate. Prior auth: assessment see guide; treatment Required. - [Cigna / Evernorth in Connecticut](https://carelu.com/payers/cigna-connecticut) ([Markdown](https://carelu.com/payers/cigna-connecticut.md)) — Commercial insurance. EN0499 + autism resource guide (no PA on assessments) + Connecticut’s § 38a-514b mandate and Evernorth’s CT addendum. Prior auth: assessment Not required for 97151, 97152 and 0362T with an autism diagnosis when the provider is independently licensed…; treatment Required: request treatment authorization up to 30 days before or two weeks after the start date. - [ConnectiCare (Connecticut)](https://carelu.com/payers/connecticare-connecticut) ([Markdown](https://carelu.com/payers/connecticare-connecticut.md)) — Commercial insurance. Connecticut’s local carrier, now owned by Molina: Optum Behavioral Health manages ABA; 2026 PA lists put ABA codes through Optum. Prior auth: assessment see guide; treatment Required. - [UnitedHealthcare / Optum in Connecticut](https://carelu.com/payers/unitedhealthcare-connecticut) ([Markdown](https://carelu.com/payers/unitedhealthcare-connecticut.md)) — Commercial insurance. Optum ABA criteria + Optum’s Connecticut state-mandate entry (1 hr face-to-face per 10) + § 38a-514b; telehealth limited to 3 codes. Prior auth: assessment Required: Optum’s ABA Supplemental Clinical Criteria say “Prior authorization is required for ABA *(unless…; treatment see guide. ## Delaware (DE) State autism mandate: Delaware autism mandate (18 Del. C. §§ 3366, 3570A; under 21, CPI-adjusted ABA cap $38,601.65 for 2026) - [Delaware Medicaid (DMAP / Diamond State Health Plan)](https://carelu.com/payers/delaware-medicaid) ([Markdown](https://carelu.com/payers/delaware-medicaid.md)) — State Medicaid program. ABA is an EPSDT benefit under 21 (SPA 16-010), delivered almost entirely through three MCOs; DMAP pays ABA by degree-level modifier. - [AmeriHealth Caritas Delaware](https://carelu.com/payers/amerihealth-caritas-delaware) ([Markdown](https://carelu.com/payers/amerihealth-caritas-delaware.md)) — Medicaid managed care plan (MCO). DSHP MCO that lists ABA among autism services; its pages disagree on the under-18 30-unit cap (DDDS vs DSCYF). Prior auth: assessment Required; treatment Required for every ABA code. - [Delaware First Health](https://carelu.com/payers/delaware-first-health) ([Markdown](https://carelu.com/payers/delaware-first-health.md)) — Medicaid managed care plan (MCO). Centene’s DSHP plan: all ABA codes PA-required, ASD services under 21 outside the 30-visit limit, 7-day standard decisions. Prior auth: assessment Required; treatment Required. - [Highmark Health Options](https://carelu.com/payers/highmark-health-options-delaware) ([Markdown](https://carelu.com/payers/highmark-health-options-delaware.md)) — Medicaid managed care plan (MCO). Highmark BCBSD’s Medicaid MCO: ABA needs precertification, is covered outside the under-18 30-unit cap, and follows Medical Policy MP-1045. Prior auth: assessment Required; treatment Yes: precertification for all outpatient behavioral health, faxed on the Request for Authorization form or…. - [Aetna in Delaware](https://carelu.com/payers/aetna-delaware) ([Markdown](https://carelu.com/payers/aetna-delaware.md)) — Commercial insurance. Aetna’s national ABA guide + BH precert list + Delaware’s under-21 mandate with its CPI-adjusted ABA cap. Prior auth: assessment Required: all ten ABA codes, 97151 included, are on Aetna’s behavioral health precertification list; treatment Required: precertification through Availity or the number on the card. - [Cigna / Evernorth in Delaware](https://carelu.com/payers/cigna-delaware) ([Markdown](https://carelu.com/payers/cigna-delaware.md)) — Commercial insurance. EN0499 + autism resource guide + Delaware’s under-21 mandate; no PA on assessment codes; Evernorth’s DE addendum sets 180-day filing. Prior auth: assessment Not required for 97151, 97152 and 0362T with an autism diagnosis when the provider is independently licensed…; treatment Required: completed assessment and treatment plan with the ABA Prior Authorization Form. - [Highmark Blue Cross Blue Shield Delaware](https://carelu.com/payers/highmark-bcbs-delaware) ([Markdown](https://carelu.com/payers/highmark-bcbs-delaware.md)) — Commercial insurance. Delaware’s Blue plan: every ABA code on Highmark’s auth list (Highmark Behavioral Health), 97153 PPO rate $15.73 from 10/16/2026. Prior auth: assessment Yes: 97151, 97152 and 0362T are on Highmark’s authorization list (effective 10/01/2026, "For PA, WV, DE & NY…; treatment Yes: 97153–97158 and 0373T (plus H0032 and H2019 under the same ABA category) are on the list, managed by…. - [UnitedHealthcare / Optum in Delaware](https://carelu.com/payers/unitedhealthcare-delaware) ([Markdown](https://carelu.com/payers/unitedhealthcare-delaware.md)) — Commercial insurance. Optum ABA criteria + Delaware’s under-21 mandate; no Delaware state supplement, no Delaware Medicaid plan. Prior auth: assessment Required: Optum’s ABA criteria require prior authorization for ABA "unless otherwise specified or mandated by…; treatment Required. ## District of Columbia (DC) State autism mandate: D.C. Code §§ 31-3271–31-3272 (habilitative services incl. autism, under 21; ABA named in DC EHB benchmark) - [District of Columbia Medicaid](https://carelu.com/payers/district-of-columbia-medicaid) ([Markdown](https://carelu.com/payers/district-of-columbia-medicaid.md)) — State Medicaid program. ABA is an EPSDT benefit under SPA 23-0009 (since 10/1/2023); most children are in AmeriHealth Caritas DC, MedStar Family Choice DC or HSCSN. Prior auth: assessment see guide; treatment Required. - [AmeriHealth Caritas District of Columbia](https://carelu.com/payers/amerihealth-caritas-district-of-columbia) ([Markdown](https://carelu.com/payers/amerihealth-caritas-district-of-columbia.md)) — Medicaid managed care plan (MCO). The larger DC Healthy Families plan (took Wellpoint DC’s members 8/1/2026): PA on 97151, 97153 and 97155 per its lookup tool. Prior auth: assessment Required; treatment Yes for 97153 and 97155 (and 0373T, flagged not on the DC Medicaid fee schedule). - [Health Services for Children with Special Needs (HSCSN)](https://carelu.com/payers/hscsn-district-of-columbia) ([Markdown](https://carelu.com/payers/hscsn-district-of-columbia.md)) — Medicaid managed care plan (MCO). DC’s CASSIP plan for children with SSI (birth to 26): 12 ABA evaluation units a year with no PA; treatment authorized in 14 days. Prior auth: assessment No, within limits; treatment Required. - [MedStar Family Choice District of Columbia](https://carelu.com/payers/medstar-family-choice-district-of-columbia) ([Markdown](https://carelu.com/payers/medstar-family-choice-district-of-columbia.md)) — Medicaid managed care plan (MCO). DC Healthy Families plan whose Quick Authorization Guide lists "ABA Services" as prior authorization required. Prior auth: assessment see guide; treatment Required. - [Aetna in the District of Columbia](https://carelu.com/payers/aetna-district-of-columbia) ([Markdown](https://carelu.com/payers/aetna-district-of-columbia.md)) — Commercial insurance. Aetna’s national ABA guide + precert on all ten codes + D.C. Code § 31-3272 habilitative mandate (under 21). Prior auth: assessment Required: all ten ABA codes, 97151 included, are on Aetna’s behavioral health precertification list; treatment see guide. - [CareFirst BlueCross BlueShield (District of Columbia)](https://carelu.com/payers/carefirst-district-of-columbia) ([Markdown](https://carelu.com/payers/carefirst-district-of-columbia.md)) — Commercial insurance. The District’s Blue plan (GHMSI/BlueChoice): ABA on the HMO prior-auth list (3.01.015), habilitative pre-service review on PPO; MCG for behavioral health. Prior auth: assessment see guide; treatment Required. - [Cigna / Evernorth in the District of Columbia](https://carelu.com/payers/cigna-district-of-columbia) ([Markdown](https://carelu.com/payers/cigna-district-of-columbia.md)) — Commercial insurance. EN0499 + autism resource guide + D.C. Code § 31-3272 habilitative mandate; no PA on assessment codes. Prior auth: assessment Not required for 97151, 97152 and 0362T with an autism diagnosis when the provider is independently licensed…; treatment Required: after the assessment, submit the treatment plan on the Applied Behavior Analysis Prior…. - [UnitedHealthcare / Optum in the District of Columbia](https://carelu.com/payers/unitedhealthcare-district-of-columbia) ([Markdown](https://carelu.com/payers/unitedhealthcare-district-of-columbia.md)) — Commercial insurance. Optum criteria (BH803ABASCC) + D.C. Code § 31-3272 habilitative mandate; no DC entry in Optum’s state mandates supplement. Prior auth: assessment Required: Optum’s ABA Supplemental Clinical Criteria say "Prior authorization is required for ABA" unless…; treatment see guide. ## Florida (FL) State autism mandate: Steven A. Geller Autism Coverage Act (§ 627.6686, Fla. Stat.) - [Florida Medicaid — Behavior Analysis Services (AHCA)](https://carelu.com/payers/florida-medicaid) ([Markdown](https://carelu.com/payers/florida-medicaid.md)) — State Medicaid program. No autism dx required; BA carved INTO nine MMA plans 2/1/2025; 97153 at $12.26/unit. Prior auth: assessment Required; treatment Required. - [Aetna Better Health of Florida](https://carelu.com/payers/aetna-better-health-florida) ([Markdown](https://carelu.com/payers/aetna-better-health-florida.md)) — Medicaid managed care plan (MCO). BA contracting runs through third-party BSN; universal PA from 7/1/2025 (per plan notices). Prior auth: assessment Required; treatment Required. - [Children's Medical Services (CMS) Health Plan (FL)](https://carelu.com/payers/cms-health-plan-florida) ([Markdown](https://carelu.com/payers/cms-health-plan-florida.md)) — Medicaid managed care plan (MCO). Specialty plan for children with chronic conditions; run by Molina from 10/1/2026 (Sunshine before), 3-day contract clock. Prior auth: assessment From 10/1/2026 (Molina): not for 97151; treatment Required. - [Community Care Plan (FL)](https://carelu.com/payers/community-care-plan-florida) ([Markdown](https://carelu.com/payers/community-care-plan-florida.md)) — Medicaid managed care plan (MCO). BA fully delegated to Therapy Network of FL — auths AND claims; 5-day standard / 2-day expedited decisions. Prior auth: assessment Required; treatment Required. - [Florida Community Care](https://carelu.com/payers/florida-community-care) ([Markdown](https://carelu.com/payers/florida-community-care.md)) — Medicaid managed care plan (MCO). CIDD-focused specialty plan; in-house UM, PA by fax, email, or portal; 120-day continuity honored. Prior auth: assessment Required; treatment Required. - [Humana Healthy Horizons in Florida](https://carelu.com/payers/humana-healthy-horizons-florida) ([Markdown](https://carelu.com/payers/humana-healthy-horizons-florida.md)) — Medicaid managed care plan (MCO). Widest channels of the nine (Availity, 24/7 IVR, fax), named BA reps, non-par paid at 80% of the state fee schedule. Prior auth: assessment Required; treatment Required. - [Molina Healthcare of Florida](https://carelu.com/payers/molina-healthcare-florida) ([Markdown](https://carelu.com/payers/molina-healthcare-florida.md)) — Medicaid managed care plan (MCO). In-house BA on state criteria; detailed July 2026 BA guide, weekly-hour auths, 97151 without PA. Prior auth: assessment Not for 97151; treatment Required. - [Simply Healthcare Plans (FL)](https://carelu.com/payers/simply-healthcare-florida) ([Markdown](https://carelu.com/payers/simply-healthcare-florida.md)) — Medicaid managed care plan (MCO). BA fully delegated to Carelon — auths AND claims; 30-day data-freshness rule on PAs. Prior auth: assessment Required; treatment Required. - [Sunshine Health (FL)](https://carelu.com/payers/sunshine-health-florida) ([Markdown](https://carelu.com/payers/sunshine-health-florida.md)) — Medicaid managed care plan (MCO). Largest SMMC plan; in-house UM, dedicated BA fax/form, 5-day determinations, BA VBP. Prior auth: assessment Required; treatment Required. - [UnitedHealthcare Community Plan of Florida](https://carelu.com/payers/unitedhealthcare-community-plan-florida) ([Markdown](https://carelu.com/payers/unitedhealthcare-community-plan-florida.md)) — Medicaid managed care plan (MCO). Optum-run since 2/2025: portal-only PA on Provider Express, 2-step auth, 120-day continuity. Prior auth: assessment Required; treatment Required. - [Aetna in Florida](https://carelu.com/payers/aetna-florida) ([Markdown](https://carelu.com/payers/aetna-florida.md)) — Commercial insurance. CPB 0554 (ABA) + CPB 0648 (ASD) + the § 627.6686 Geller Act mandate layer. Prior auth: assessment Required; treatment Required. - [Cigna / Evernorth in Florida](https://carelu.com/payers/cigna-florida) ([Markdown](https://carelu.com/payers/cigna-florida.md)) — Commercial insurance. EN0499 + autism resource guide + the § 627.6686 Geller Act mandate layer. Prior auth: assessment Not required for assessment codes 97151, 97152, 0362T; treatment Required. - [Florida Blue (Blue Cross and Blue Shield of Florida)](https://carelu.com/payers/florida-blue) ([Markdown](https://carelu.com/payers/florida-blue.md)) — Commercial insurance. Florida's local Blue; ABA authorized by Lucet under policy 20.5.005, covered without plan limits per Florida Blue, plus the § 627.6686 mandate layer. Prior auth: assessment Required; treatment Required. - [UnitedHealthcare / Optum in Florida](https://carelu.com/payers/unitedhealthcare-florida) ([Markdown](https://carelu.com/payers/unitedhealthcare-florida.md)) — Commercial insurance. Optum criteria (BH803ABASCC) + a real FL State Mandates entry: Down syndrome ABA covered. Prior auth: assessment Required; treatment Required. ## Georgia (GA) State autism mandate: Ava’s Law (O.C.G.A. § 33-24-59.10) - [Georgia Medicaid](https://carelu.com/payers/georgia-medicaid) ([Markdown](https://carelu.com/payers/georgia-medicaid.md)) — State Medicaid program. EPSDT under 21, Katie Beckett path, CMO landscape, PA packages. Prior auth: assessment Required; treatment Required. - [Amerigroup (GA Medicaid CMO)](https://carelu.com/payers/amerigroup-georgia) ([Markdown](https://carelu.com/payers/amerigroup-georgia.md)) — Medicaid managed care plan (MCO). PA through the GAMMIS portal under DCH ASD rules; 2017 CG-BEH-02 is off the adopted list. Prior auth: assessment Required; treatment Required. - [CareSource (Georgia Medicaid CMO)](https://carelu.com/payers/caresource-georgia) ([Markdown](https://carelu.com/payers/caresource-georgia.md)) — Medicaid managed care plan (MCO). MCD-MM-0212 (7/2026) defers to the DCH manual; in-house PA; reported 2026 rate cut. Prior auth: assessment Required; treatment Required. - [Peach State Health Plan (GA Medicaid CMO)](https://carelu.com/payers/peach-state-georgia) ([Markdown](https://carelu.com/payers/peach-state-georgia.md)) — Medicaid managed care plan (MCO). GA.CP.BH.504; hour parameters + 80%-attendance rule; 0373T rules. Prior auth: assessment Required; treatment Required. - [Aetna in Georgia](https://carelu.com/payers/aetna-georgia) ([Markdown](https://carelu.com/payers/aetna-georgia.md)) — Commercial insurance. CPB 0554 (ABA) + CPB 0648 (ASD) + the O.C.G.A. § 33-24-59.10 (Ava’s Law) mandate layer. Prior auth: assessment Required; treatment Required. - [Anthem BCBS Georgia](https://carelu.com/payers/anthem-bcbs-georgia) ([Markdown](https://carelu.com/payers/anthem-bcbs-georgia.md)) — Commercial insurance. MCG B-806-T reviews (since 6/2024) + Ava’s Law mandate; weekly-unit claims, parity, billing rules. Prior auth: assessment Required; treatment Required. - [Cigna / Evernorth in Georgia](https://carelu.com/payers/cigna-georgia) ([Markdown](https://carelu.com/payers/cigna-georgia.md)) — Commercial insurance. EN0499 + autism resource guide + the O.C.G.A. § 33-24-59.10 (Ava’s Law) mandate layer. Prior auth: assessment Not required for assessment codes 97151, 97152, 0362T; treatment Required. - [UnitedHealthcare / Optum in Georgia](https://carelu.com/payers/unitedhealthcare-georgia) ([Markdown](https://carelu.com/payers/unitedhealthcare-georgia.md)) — Commercial insurance. Optum Supplemental Clinical Criteria (BH803ABASCC) + the O.C.G.A. § 33-24-59.10 (Ava’s Law) mandate layer. Prior auth: assessment Required; treatment Required. ## Hawaii (HI) State autism mandate: Luke’s Law (HRS § 431:10A-133; under 14, $25,000/yr ABA cap) - [Hawaii Medicaid (Med-QUEST / QUEST Integration)](https://carelu.com/payers/hawaii-medicaid) ([Markdown](https://carelu.com/payers/hawaii-medicaid.md)) — State Medicaid program. Med-QUEST / QUEST Integration. Hawaii calls ABA Intensive Behavioral Therapy; memo QI-2431 / FFS 24-13 sets the benefit, each QI plan runs the authorization. Prior auth: assessment see guide; treatment Required. - [AlohaCare (QUEST Integration)](https://carelu.com/payers/alohacare) ([Markdown](https://carelu.com/payers/alohacare.md)) — Medicaid managed care plan (MCO). QUEST Integration plan, Medicaid-only and Hawaii-based. Has its own ABA policy (MP-37, 2026) and requires PA on every ABA code, including 97151. Prior auth: assessment Required; treatment Required for all treatment services (97153–97158, 0373T). - [Kaiser Permanente Hawaii (QUEST Integration)](https://carelu.com/payers/kaiser-permanente-hawaii) ([Markdown](https://carelu.com/payers/kaiser-permanente-hawaii.md)) — Medicaid managed care plan (MCO). Kaiser Permanente QUEST Integration plan. Integrated model — most care in-house; outside ABA providers need an ARM authorization. ABA rules undocumented publicly. Prior auth: assessment see guide; treatment Required for outside providers. - [Ohana Health Plan (WellCare of Hawaii)](https://carelu.com/payers/ohana-health-plan) ([Markdown](https://carelu.com/payers/ohana-health-plan.md)) — Medicaid managed care plan (MCO). QUEST Integration plan run by WellCare (Centene). LEAVES QUEST on Dec 31, 2026 — members move to another plan Jan 1, 2027. PA on 97151–97158. Prior auth: assessment Required; treatment Required. - [UnitedHealthcare Community Plan of Hawaii](https://carelu.com/payers/unitedhealthcare-community-plan-hawaii) ([Markdown](https://carelu.com/payers/unitedhealthcare-community-plan-hawaii.md)) — Medicaid managed care plan (MCO). QUEST Integration plan. ABA is managed by Optum (United Behavioral Health) since 2016 — authorizations through Provider Express or fax. Prior auth: assessment see guide; treatment Required. - [Aetna in Hawaii](https://carelu.com/payers/aetna-hawaii) ([Markdown](https://carelu.com/payers/aetna-hawaii.md)) — Commercial insurance. CPB 0554 (ABA) + CPB 0648 (ASD) + Hawaii’s Luke’s Law (under 14, $25K/yr ABA). Prior auth: assessment Required; treatment Required. - [Cigna / Evernorth in Hawaii](https://carelu.com/payers/cigna-hawaii) ([Markdown](https://carelu.com/payers/cigna-hawaii.md)) — Commercial insurance. EN0499 + autism resource guide + Hawaii’s Luke’s Law (under 14, $25K/yr ABA). Prior auth: assessment Not required for 97151, 97152 and 0362T with an autism diagnosis, when the provider is independently licensed…; treatment Required. - [Hawaii Medical Service Assoc (HMSA) - Blue Cross Blue Shield of Hawaii](https://carelu.com/payers/hmsa) ([Markdown](https://carelu.com/payers/hmsa.md)) — Commercial insurance. Hawaii’s Blue Cross Blue Shield licensee. Runs QUEST Integration and commercial lines; ABA is on both precertification lists. Prior auth: assessment see guide; treatment Required. - [UnitedHealthcare / Optum in Hawaii](https://carelu.com/payers/unitedhealthcare-hawaii) ([Markdown](https://carelu.com/payers/unitedhealthcare-hawaii.md)) — Commercial insurance. UnitedHealthcare commercial in Hawaii — Optum behavioral health, Optum ABA criteria, and Luke’s Law (under 14, $25K/yr ABA). Prior auth: assessment see guide; treatment Required. ## Idaho (ID) State autism mandate: No autism statute — DOI Bulletin 18-02 (habilitative-parity floor, plan years from 2019) - [Idaho Medicaid](https://carelu.com/payers/idaho-medicaid) ([Markdown](https://carelu.com/payers/idaho-medicaid.md)) — State Medicaid program. No ABA CPT codes, no MCO: CHIS is fee-for-service, Telligen PA, H-code billing, no ASD diagnosis required — functional screening instead. Prior auth: assessment Not before the initial assessment; treatment Required. - [Aetna in Idaho](https://carelu.com/payers/aetna-idaho) ([Markdown](https://carelu.com/payers/aetna-idaho.md)) — Commercial insurance. Aetna’s national ABA guide + precert list, on top of Idaho’s Bulletin 18-02 in place of an autism statute. Prior auth: assessment Required; treatment see guide. - [Blue Cross of Idaho](https://carelu.com/payers/blue-cross-of-idaho) ([Markdown](https://carelu.com/payers/blue-cross-of-idaho.md)) — Commercial insurance. Idaho’s largest local carrier: no published commercial ABA policy, ABA PA listed for FEP only, Bulletin 18-02 as the coverage floor. - [Cigna / Evernorth in Idaho](https://carelu.com/payers/cigna-idaho) ([Markdown](https://carelu.com/payers/cigna-idaho.md)) — Commercial insurance. Evernorth EN0499 + the autism resource guide (no assessment PA) on top of Idaho’s Bulletin 18-02. Prior auth: assessment Not required for assessment codes 97151, 97152, 0362T with an autism diagnosis, when the provider is…; treatment Required. - [Regence BlueShield of Idaho](https://carelu.com/payers/regence-blueshield-of-idaho) ([Markdown](https://carelu.com/payers/regence-blueshield-of-idaho.md)) — Commercial insurance. Regence BH18/BH33 with an Idaho-specific form: no assessment PA except FEP, 6-month treatment auths, one standardized assessment required. Prior auth: assessment Not required except for FEP; treatment see guide. - [UnitedHealthcare / Optum in Idaho](https://carelu.com/payers/unitedhealthcare-idaho) ([Markdown](https://carelu.com/payers/unitedhealthcare-idaho.md)) — Commercial insurance. Optum ABA criteria (no Idaho supplement) + Idaho’s Bulletin 18-02; assessment and treatment both authorized. Prior auth: assessment Required; treatment Required. ## Illinois (IL) State autism mandate: Illinois autism mandate (215 ILCS 5/356z.14; under 21, $36,000/yr CPI-adjusted) - [Illinois Medicaid (HFS)](https://carelu.com/payers/illinois-medicaid) ([Markdown](https://carelu.com/payers/illinois-medicaid.md)) — State Medicaid program. ABA is "Adaptive Behavior Support" for under-21s with ASD; FFS PA via HFS.ABS email; published rates ($13.00 RBT, $20.39 BCBA per 15 min). Prior auth: assessment Fee-for-service: only beyond 6 hours; treatment Fee-for-service: yes. - [Aetna Better Health of Illinois](https://carelu.com/payers/aetna-better-health-illinois) ([Markdown](https://carelu.com/payers/aetna-better-health-illinois.md)) — Medicaid managed care plan (MCO). HealthChoice Illinois plan: 97151/97152 approved without review if notified within 1 business day (2026); concurrent review after. Prior auth: assessment Notification instead of PA since January 1, 2026: for 97151 and 97152, “if Aetna Better Health of Illinois…; treatment see guide. - [Blue Cross Community Health Plans (BCBSIL Medicaid)](https://carelu.com/payers/blue-cross-community-health-plans-illinois) ([Markdown](https://carelu.com/payers/blue-cross-community-health-plans-illinois.md)) — Medicaid managed care plan (MCO). BCBSIL’s HealthChoice plan: all ABA codes on its PA list (MCG B-806-T) but notify within 24 hours of starting ABS (2026). Prior auth: assessment 97151 and 97152 are on the BCCHP prior authorization code list; treatment Yes beyond the notification window: 97153–97158, 0362T and 0373T are on the code list (ABA Clinical Service…. - [CountyCare Health Plan (Cook County)](https://carelu.com/payers/countycare-illinois) ([Markdown](https://carelu.com/payers/countycare-illinois.md)) — Medicaid managed care plan (MCO). Cook County Health’s HealthChoice plan: no PA for 97151/97152 from 1/1/2026; ABA treatment still needs PA (4-day routine decisions). Prior auth: assessment No; treatment Required. - [Meridian (Meridian Health Plan of Illinois)](https://carelu.com/payers/meridian-illinois) ([Markdown](https://carelu.com/payers/meridian-illinois.md)) — Medicaid managed care plan (MCO). Centene’s HealthChoice plan: notify within 24 hours of 97151/97152 (from 5/1/2026); treatment needs PA under CP.BH.104. Prior auth: assessment Notification, not PA: “Effective May 1, 2026, providers must notify Meridian within 24 hours of conducting…; treatment Required. - [Molina Healthcare of Illinois](https://carelu.com/payers/molina-healthcare-illinois) ([Markdown](https://carelu.com/payers/molina-healthcare-illinois.md)) — Medicaid managed care plan (MCO). HealthChoice plan: no auth for the ABA assessment or the first 48 therapy units a year; concurrent review from unit 49 (2026). Prior auth: assessment No; treatment Concurrent review only: “ABA services are no longer eligible for prior authorization and require concurrent…. - [YouthCare (HealthChoice Illinois for DCFS youth)](https://carelu.com/payers/youthcare-illinois) ([Markdown](https://carelu.com/payers/youthcare-illinois.md)) — Medicaid managed care plan (MCO). Meridian-run HealthChoice plan for DCFS youth: notify within 24 hours of an ABA assessment; treatment needs PA (CP.BH.104). Prior auth: assessment Notification: the September 2026 manual lists “Adaptive Behavior Treatment – initial assessment” under…; treatment Yes: “Adaptive Behavior Treatment (initial assessment requires notification within 24 hours)” is under “Prior…. - [Aetna in Illinois](https://carelu.com/payers/aetna-illinois) ([Markdown](https://carelu.com/payers/aetna-illinois.md)) — Commercial insurance. Aetna ABA guide + CPB 0554/0648 + Illinois’s 356z.14 mandate and IDFPR licensure; Aetna Better Health is its IL Medicaid plan. - [Blue Cross and Blue Shield of Illinois (HCSC)](https://carelu.com/payers/bcbs-illinois) ([Markdown](https://carelu.com/payers/bcbs-illinois.md)) — Commercial insurance. BCBSIL (HCSC), the dominant Illinois carrier: PA on 97153–97158/0362T/0373T, preservice by phone since April 2026, CPCP011 billing rules. - [Cigna / Evernorth in Illinois](https://carelu.com/payers/cigna-illinois) ([Markdown](https://carelu.com/payers/cigna-illinois.md)) — Commercial insurance. EN0499 + autism resource guide + Evernorth’s Illinois addendum + Illinois’s 356z.14 mandate; no PA on assessment codes. Prior auth: assessment Not required for 97151, 97152 and 0362T with an autism diagnosis when the provider is independently licensed…; treatment see guide. - [UnitedHealthcare / Optum in Illinois](https://carelu.com/payers/unitedhealthcare-illinois) ([Markdown](https://carelu.com/payers/unitedhealthcare-illinois.md)) — Commercial insurance. Optum criteria (BH803ABASCC) + Illinois’s 356z.14 mandate; Illinois is not in Optum’s state-mandate supplement; no UHC IL Medicaid plan. ## Indiana (IN) State autism mandate: Indiana autism insurance mandate (IC 27-8-14.2) - [Indiana Medicaid (IHCP)](https://carelu.com/payers/indiana-medicaid) ([Markdown](https://carelu.com/payers/indiana-medicaid.md)) — State Medicaid program. All-PA ABA, 2026 EPSDT-only shift, 4,000-hr lifetime cap, published rate phasedown. Prior auth: assessment Required; treatment Required. - [Anthem BCBS Indiana (Medicaid)](https://carelu.com/payers/anthem-indiana-medicaid) ([Markdown](https://carelu.com/payers/anthem-indiana-medicaid.md)) — Medicaid managed care plan (MCO). IHCP criteria restated in Anthem's UM guideline; Availity/ICR submission, F84.0 + daily schedule. Prior auth: assessment Required; treatment see guide. - [CareSource Indiana](https://carelu.com/payers/caresource-indiana) ([Markdown](https://carelu.com/payers/caresource-indiana.md)) — Medicaid managed care plan (MCO). Defers to IHCP criteria (own policy archived); portal-first PA, one-agency rule, ABA audit posture. Prior auth: assessment Required; treatment see guide. - [MDwise (Indiana)](https://carelu.com/payers/mdwise-indiana) ([Markdown](https://carelu.com/payers/mdwise-indiana.md)) — Medicaid managed care plan (MCO). ENDED as an HIP/Hoosier Healthwise MCE effective 1/1/2026 — members reassigned to Anthem, CareSource, or MHS. Prior auth: assessment Required; treatment see guide. - [MHS — Managed Health Services (Indiana)](https://carelu.com/payers/mhs-indiana) ([Markdown](https://carelu.com/payers/mhs-indiana.md)) — Medicaid managed care plan (MCO). IHCP criteria + MHS's own OTR form: named diagnostic instrument, outcome measure, utilization reporting. Prior auth: assessment Required; treatment Required. - [UnitedHealthcare Community Plan of Indiana](https://carelu.com/payers/unitedhealthcare-community-plan-indiana) ([Markdown](https://carelu.com/payers/unitedhealthcare-community-plan-indiana.md)) — Medicaid managed care plan (MCO). Hoosier Care Connect + PathWays for Aging ABA via the Optum carve-out — not HIP/Hoosier Healthwise. Prior auth: assessment Required; treatment Required. - [Aetna in Indiana](https://carelu.com/payers/aetna-indiana) ([Markdown](https://carelu.com/payers/aetna-indiana.md)) — Commercial insurance. CPB 0554 (ABA) + CPB 0648 (ASD) + the Ind. Code 27-8-14.2 mandate layer. Prior auth: assessment Required; treatment Required. - [Anthem BCBS Indiana](https://carelu.com/payers/anthem-bcbs-indiana) ([Markdown](https://carelu.com/payers/anthem-bcbs-indiana.md)) — Commercial insurance. No dollar, age, visit or hour cap in the mandate; Indiana now licenses LBAs; Anthem reviews in-house. - [Anthem Blue Cross and Blue Shield Indiana (commercial)](https://carelu.com/payers/anthem-indiana) ([Markdown](https://carelu.com/payers/anthem-indiana.md)) — Commercial insurance. Anthem commercial in Indiana: ABA precert stays with Anthem, not Carelon Behavioral Health; uncapped IC 27-8-14.2 mandate. - [CareSource Indiana Marketplace](https://carelu.com/payers/caresource-indiana-marketplace) ([Markdown](https://carelu.com/payers/caresource-indiana-marketplace.md)) — Commercial insurance. CareSource's Indiana exchange plan: ABA has no benefit limit in the 2026 EOC, PA every 6 months, new ABA policy MP-MM-1329 from 10/1/2026. Prior auth: assessment Required; treatment Required. - [Cigna / Evernorth in Indiana](https://carelu.com/payers/cigna-indiana) ([Markdown](https://carelu.com/payers/cigna-indiana.md)) — Commercial insurance. EN0499 + autism resource guide + the Ind. Code 27-8-14.2 mandate layer. Prior auth: assessment Not required for assessment codes 97151, 97152, 0362T; treatment Required. - [UnitedHealthcare / Optum in Indiana](https://carelu.com/payers/unitedhealthcare-indiana) ([Markdown](https://carelu.com/payers/unitedhealthcare-indiana.md)) — Commercial insurance. Optum Supplemental Clinical Criteria (BH803ABASCC) + the Ind. Code 27-8-14.2 mandate layer. Prior auth: assessment Required; treatment Required. ## Iowa (IA) State autism mandate: Iowa autism mandates (Iowa Code §§ 514C.31, 514C.28; caps and age limits removed by H.F. 330 from 1/1/2026) - [Iowa Medicaid (IA Health Link)](https://carelu.com/payers/iowa-medicaid) ([Markdown](https://carelu.com/payers/iowa-medicaid.md)) — State Medicaid program. IA Health Link MCOs own ABA auth; RBT claims go out under the supervising LBA; Hawki excludes ABA; state ASP is the fallback. - [Iowa Total Care (Centene)](https://carelu.com/payers/iowa-total-care) ([Markdown](https://carelu.com/payers/iowa-total-care.md)) — Medicaid managed care plan (MCO). Centene IA Health Link plan; CP.BH.104 criteria, six-month auths, 6 hr/day–30 hr/wk soft cap, no ABA for Hawki. Prior auth: assessment see guide; treatment Required in practice: ABA is reviewed against CP.BH.104 initiation and continuation criteria in six-month…. - [Molina Healthcare of Iowa](https://carelu.com/payers/molina-healthcare-iowa) ([Markdown](https://carelu.com/payers/molina-healthcare-iowa.md)) — Medicaid managed care plan (MCO). IA Health Link MCO; Molina policy MCP 482 (18 months+, >25 hr/wk scrutiny, telehealth for caregiver training/supervision only). - [Wellpoint Iowa (formerly Amerigroup Iowa)](https://carelu.com/payers/wellpoint-iowa) ([Markdown](https://carelu.com/payers/wellpoint-iowa.md)) — Medicaid managed care plan (MCO). IA Health Link MCO (formerly Amerigroup Iowa); Carelon behind BH, own Clinical UM Guidelines, BH outpatient fax 1-844-451-2826. - [Aetna in Iowa](https://carelu.com/payers/aetna-iowa) ([Markdown](https://carelu.com/payers/aetna-iowa.md)) — Commercial insurance. Aetna national ABA guide + CPB 0554, layered on Iowa's mandate (no age or dollar caps from 1/1/2026). Prior auth: assessment Required; treatment Required. - [Cigna in Iowa](https://carelu.com/payers/cigna-iowa) ([Markdown](https://carelu.com/payers/cigna-iowa.md)) — Commercial insurance. Evernorth EN0499 criteria; no PA on 97151/97152/0362T; 1–2 hrs supervision per 10 direct; Iowa mandate (no caps from 2026). Prior auth: assessment Not required; treatment Required. - [UnitedHealthcare in Iowa](https://carelu.com/payers/unitedhealthcare-iowa) ([Markdown](https://carelu.com/payers/unitedhealthcare-iowa.md)) — Commercial insurance. Optum ABA criteria (1–2 hrs supervision per 10 direct), 32-unit 97153 daily edit, telehealth only for supervision/caregiver training; Iowa mandate. Prior auth: assessment Required; treatment Required. - [Wellmark Blue Cross and Blue Shield of Iowa](https://carelu.com/payers/wellmark-blue-cross-blue-shield-iowa) ([Markdown](https://carelu.com/payers/wellmark-blue-cross-blue-shield-iowa.md)) — Commercial insurance. Iowa's Blue plan; ABA policy and auth list are behind a provider login, so the Iowa mandate (no age or dollar caps since 2026) is the public floor. ## Kansas (KS) State autism mandate: Kansas autism insurance mandate (K.S.A. 40-2,194) - [KanCare (Kansas Medicaid)](https://carelu.com/payers/kansas-medicaid) ([Markdown](https://carelu.com/payers/kansas-medicaid.md)) — State Medicaid program. CCTS + IIS under EPSDT (not "ABA"); 3 MCOs, KMAP 26140 diagnostician rule, 50 h/yr + 25 h/wk limits. Prior auth: assessment Required; treatment Required. - [Healthy Blue Kansas](https://carelu.com/payers/healthy-blue-kansas) ([Markdown](https://carelu.com/payers/healthy-blue-kansas.md)) — Medicaid managed care plan (MCO). Newest MCO (1/1/2025, absorbed Aetna members); Availity intake, own autism-testing form, thin public policy. Prior auth: assessment Required; treatment Required. - [Sunflower Health Plan (KS)](https://carelu.com/payers/sunflower-health-plan-kansas) ([Markdown](https://carelu.com/payers/sunflower-health-plan-kansas.md)) — Medicaid managed care plan (MCO). PA on 97151 via the Autism PA form, CP.BH.104 (not KS.CP.01) on the policy index, KMAP telehealth codes, Kan Be Healthy gate. Prior auth: assessment Required; treatment Required. - [UnitedHealthcare Community Plan of Kansas](https://carelu.com/payers/unitedhealthcare-community-plan-kansas) ([Markdown](https://carelu.com/payers/unitedhealthcare-community-plan-kansas.md)) — Medicaid managed care plan (MCO). Optum-run; KMAP 26140 diagnostician rule (no recency clock), 40 h/wk plan ceiling, monthly progress reviews, KMAP-first credentialing. Prior auth: assessment Required; treatment Required. - [Aetna in Kansas](https://carelu.com/payers/aetna-kansas) ([Markdown](https://carelu.com/payers/aetna-kansas.md)) — Commercial insurance. CPB 0554 (ABA) + CPB 0648 (ASD) + the K.S.A. 40-2,194 mandate layer; no KanCare plan anymore. Prior auth: assessment Required; treatment Required. - [Cigna / Evernorth in Kansas](https://carelu.com/payers/cigna-kansas) ([Markdown](https://carelu.com/payers/cigna-kansas.md)) — Commercial insurance. EN0499 + autism resource guide + the K.S.A. 40-2,194 mandate layer; no Kansas carve-out. Prior auth: assessment Not required for assessment codes 97151, 97152, 0362T; treatment Required. - [UnitedHealthcare / Optum in Kansas](https://carelu.com/payers/unitedhealthcare-kansas) ([Markdown](https://carelu.com/payers/unitedhealthcare-kansas.md)) — Commercial insurance. Optum Supplemental Clinical Criteria (BH803ABASCC) + the K.S.A. 40-2,194 mandate layer. Prior auth: assessment Required; treatment Required. ## Kentucky (KY) State autism mandate: KRS 304.17A-142 autism coverage (no age, annual-benefit or visit caps since 2019) - [Kentucky Medicaid](https://carelu.com/payers/kentucky-medicaid) ([Markdown](https://carelu.com/payers/kentucky-medicaid.md)) — State Medicaid program. ABA is a 907 KAR 15:010 behavioral health service; five MCOs (Anthem exited 1/1/2025), PA reinstated mid-2025, licensed behavior analysts, published FFS rates. - [Aetna Better Health of Kentucky](https://carelu.com/payers/aetna-better-health-kentucky) ([Markdown](https://carelu.com/payers/aetna-better-health-kentucky.md)) — Medicaid managed care plan (MCO). Kentucky Medicaid MCO (also runs SKY foster care): PA on all ABA codes since 6/25/2025, MCG criteria, ASD diagnosis required on claims. Prior auth: assessment Required; treatment Yes, for 97153–97158 from 6/25/2025. - [Humana Healthy Horizons in Kentucky](https://carelu.com/payers/humana-healthy-horizons-kentucky) ([Markdown](https://carelu.com/payers/humana-healthy-horizons-kentucky.md)) — Medicaid managed care plan (MCO). Kentucky Medicaid MCO: all eight ABA codes on the PA list since 7/1/2025; claims need an F84/F88/F89 diagnosis. Prior auth: assessment Required; treatment Yes, 97153–97158, reinstated July 1, 2025. - [Passport by Molina Healthcare](https://carelu.com/payers/passport-by-molina-kentucky) ([Markdown](https://carelu.com/payers/passport-by-molina-kentucky.md)) — Medicaid managed care plan (MCO). Kentucky Medicaid MCO: no PA on 97151/97152; treatment codes need PA only after 48 units per member per calendar year. Prior auth: assessment No; treatment Yes, after 48 units: "Prior authorization required after 48 units, for any combination of CPT Codes listed,…. - [UnitedHealthcare Community Plan of Kentucky](https://carelu.com/payers/unitedhealthcare-community-plan-kentucky) ([Markdown](https://carelu.com/payers/unitedhealthcare-community-plan-kentucky.md)) — Medicaid managed care plan (MCO). Kentucky Medicaid MCO: Optum manages behavioral health; all eight ABA codes need PA via Provider Express (assessment, then treatment). Prior auth: assessment Required; treatment Yes, 97153–97158, submitted on Provider Express (separate "ABA treatment requests" path). - [WellCare of Kentucky](https://carelu.com/payers/wellcare-kentucky) ([Markdown](https://carelu.com/payers/wellcare-kentucky.md)) — Medicaid managed care plan (MCO). Centene’s Kentucky Medicaid MCO: PA on every ABA code (97157 back on the list from 10/1/2026); InterQual criteria. Prior auth: assessment Required; treatment Yes for every ABA code: the Q4 2026 list shows 97153, 97154, 97155, 97156 and 97158 requiring authorization…. - [Aetna in Kentucky](https://carelu.com/payers/aetna-kentucky) ([Markdown](https://carelu.com/payers/aetna-kentucky.md)) — Commercial insurance. Aetna national ABA guide + precert list, layered on Kentucky’s KRS 304.17A-142 mandate (no age or visit caps since 2019). Prior auth: assessment Required: all ten ABA codes, 97151 included, are on Aetna’s behavioral health precertification list; treatment see guide. - [Anthem Blue Cross and Blue Shield (Kentucky)](https://carelu.com/payers/anthem-bcbs-kentucky) ([Markdown](https://carelu.com/payers/anthem-bcbs-kentucky.md)) — Commercial insurance. Kentucky’s Blue (Anthem Health Plans of Kentucky): ABA on the 2026 precert list, Anthem-managed; commercial only since Anthem left KY Medicaid in 2025. Prior auth: assessment see guide; treatment Required: ABA is on the precertification list for "OH, IN, KY Blues products" (updated January 1, 2026), with…. - [Cigna / Evernorth in Kentucky](https://carelu.com/payers/cigna-kentucky) ([Markdown](https://carelu.com/payers/cigna-kentucky.md)) — Commercial insurance. Evernorth EN0499 + autism resource guide + Kentucky’s KRS 304.17A-142 mandate; no PA on assessment codes. Prior auth: assessment Not required for 97151, 97152 and 0362T with an autism diagnosis when the provider is independently licensed…; treatment Required: treatment requests with the completed assessment and treatment plan. - [UnitedHealthcare / Optum in Kentucky](https://carelu.com/payers/unitedhealthcare-kentucky) ([Markdown](https://carelu.com/payers/unitedhealthcare-kentucky.md)) — Commercial insurance. Optum ABA criteria + Optum’s Kentucky commercial mandate section (KRS 304.17A-142); separate from UHC Community Plan (Medicaid). Prior auth: assessment Required: the ABA Supplemental Clinical Criteria require prior authorization for ABA "unless otherwise…; treatment see guide. ## Louisiana (LA) State autism mandate: La. R.S. 22:1050 (under 21, $36,000/yr cap) - [Louisiana Medicaid (Healthy Louisiana)](https://carelu.com/payers/louisiana-medicaid) ([Markdown](https://carelu.com/payers/louisiana-medicaid.md)) — State Medicaid program. ABA for under-21s, run entirely through the Healthy Louisiana MCOs; two-step PA, 2:10 supervision, published state floor rates. Prior auth: assessment Required; treatment Required. - [Aetna Better Health of Louisiana](https://carelu.com/payers/aetna-better-health-louisiana) ([Markdown](https://carelu.com/payers/aetna-better-health-louisiana.md)) — Medicaid managed care plan (MCO). Healthy Louisiana plan that applies the LDH ABA manual plus MCG criteria (Policy 7000.11); ABA telehealth on POS 02/10 with modifier 95. Prior auth: assessment Required; treatment Required. - [AmeriHealth Caritas Louisiana](https://carelu.com/payers/amerihealth-caritas-louisiana) ([Markdown](https://carelu.com/payers/amerihealth-caritas-louisiana.md)) — Medicaid managed care plan (MCO). Healthy Louisiana plan whose ABA policy CCP.4040 mirrors the LDH manual; 2-business-day / 7-day PA clock, 365-day filing. Prior auth: assessment Required; treatment Required. - [Healthy Blue (Louisiana Medicaid)](https://carelu.com/payers/healthy-blue-louisiana) ([Markdown](https://carelu.com/payers/healthy-blue-louisiana.md)) — Medicaid managed care plan (MCO). Leaving Healthy Louisiana 12/31/2026: all ABA codes need precert via Availity or fax; new plans honor its PAs up to 60 days. Prior auth: assessment Required; treatment Yes: 97153–97158, 0362T and 0373T are on the PA list. - [Humana Healthy Horizons in Louisiana](https://carelu.com/payers/humana-healthy-horizons-louisiana) ([Markdown](https://carelu.com/payers/humana-healthy-horizons-louisiana.md)) — Medicaid managed care plan (MCO). Healthy Louisiana plan; ABA policy LA.CLI.022 tracks the LDH manual; PA via Availity or fax 1-833-974-0059. Prior auth: assessment Required; treatment Required. - [Louisiana Healthcare Connections](https://carelu.com/payers/louisiana-healthcare-connections) ([Markdown](https://carelu.com/payers/louisiana-healthcare-connections.md)) — Medicaid managed care plan (MCO). Centene’s Healthy Louisiana plan: ABA reviewed in-house (formerly Magellan) under LA.UM.49; uniform ABA form via portal or fax. Prior auth: assessment Required; treatment Required. - [Aetna in Louisiana](https://carelu.com/payers/aetna-louisiana) ([Markdown](https://carelu.com/payers/aetna-louisiana.md)) — Commercial insurance. Aetna’s national ABA guide and BH precert list + Louisiana’s R.S. 22:1050 mandate (under 21, $36,000/yr cap). Prior auth: assessment Required: all ten ABA codes, 97151 included, are on Aetna’s behavioral health precertification list; treatment Required: 97153–97158, 0362T and 0373T are on the precertification list. - [Blue Cross and Blue Shield of Louisiana (Louisiana Blue)](https://carelu.com/payers/blue-cross-blue-shield-louisiana) ([Markdown](https://carelu.com/payers/blue-cross-blue-shield-louisiana.md)) — Commercial insurance. Louisiana Blue: ABA authorized in-house since 2026 (no more Lucet) via iLinkBlue; policy 00816; 21+ investigational; LBA/SCABA/RLT modifiers. Prior auth: assessment see guide; treatment Required: "Authorization is required for Applied Behavioral Analysis services". - [Cigna / Evernorth in Louisiana](https://carelu.com/payers/cigna-louisiana) ([Markdown](https://carelu.com/payers/cigna-louisiana.md)) — Commercial insurance. Evernorth EN0499 + autism resource guide (no PA on assessment codes) + Louisiana’s R.S. 22:1050 mandate. Prior auth: assessment Not required for 97151, 97152 and 0362T with an autism diagnosis when the provider is independently licensed…; treatment Required: attach the completed assessment and treatment plan to the ABA Prior Authorization Form. - [UnitedHealthcare in Louisiana](https://carelu.com/payers/unitedhealthcare-louisiana) ([Markdown](https://carelu.com/payers/unitedhealthcare-louisiana.md)) — Commercial insurance. UHC commercial ABA runs through Optum: PA, credential modifiers, a 3-code telehealth list, plus Louisiana’s R.S. 22:1050 mandate. Prior auth: assessment see guide; treatment Required: "Prior authorization is required for ABA *(unless otherwise specified or mandated by contract or…. ## Maine (ME) State autism mandate: Maine autism mandate (24-A M.R.S. §§ 2768, 2847-T, 4259; age 10 and under, $36,000/yr ABA cap allowed) - [MaineCare (Maine Medicaid)](https://carelu.com/payers/maine-medicaid) ([Markdown](https://carelu.com/payers/maine-medicaid.md)) — State Medicaid program. MaineCare is fee-for-service: ABA is a Section 28 benefit under 21, gated by Acentra’s Single Assessment and prior auth, billed H2021 U1 HK. Prior auth: assessment There is no separate assessment code to authorize: Section 28 bills ABA only as H2021 U1 HK and lists no…; treatment Required. - [Aetna in Maine](https://carelu.com/payers/aetna-maine) ([Markdown](https://carelu.com/payers/aetna-maine.md)) — Commercial insurance. Aetna’s national ABA guide + precert on all ten ABA codes + Maine’s autism mandate (age 10 and under, $36,000 ABA cap allowed). Prior auth: assessment Required: all ten ABA codes, 97151 included, are on Aetna’s behavioral health precertification list; treatment see guide. - [Anthem Blue Cross and Blue Shield (Maine)](https://carelu.com/payers/anthem-bcbs-maine) ([Markdown](https://carelu.com/payers/anthem-bcbs-maine.md)) — Commercial insurance. Maine’s Blue plan: ABA is on the Maine precert list, reviewed by Anthem Behavioral Health; billing rules from Anthem’s ABA resource guide. Prior auth: assessment see guide; treatment Yes: "Applied behavior analysis (ABA)" is on the Maine precertification list under behavioral health…. - [Cigna / Evernorth in Maine](https://carelu.com/payers/cigna-maine) ([Markdown](https://carelu.com/payers/cigna-maine.md)) — Commercial insurance. EN0499 + autism resource guide + Maine’s autism mandate (age 10 and under); no PA on assessment codes; Evernorth’s Maine addendum. Prior auth: assessment Not required for 97151, 97152 and 0362T with an autism diagnosis when the provider is independently licensed…; treatment Required: after the assessment and treatment plan, submit the Applied Behavior Analysis Prior Authorization…. - [Harvard Pilgrim Health Care (Maine)](https://carelu.com/payers/harvard-pilgrim-maine) ([Markdown](https://carelu.com/payers/harvard-pilgrim-maine.md)) — Commercial insurance. Point32Health’s Maine commercial plan: PA on all ABA codes via InterQual (MNG eff. 7/1/2026), ME behavioral telehealth paid at 100%. Prior auth: assessment Yes: 97151 and 97152 require prior authorization for Harvard Pilgrim commercial products (MNG effective July…; treatment Yes: 97153–97158, 0362T and 0373T require prior authorization. - [UnitedHealthcare / Optum in Maine](https://carelu.com/payers/unitedhealthcare-maine) ([Markdown](https://carelu.com/payers/unitedhealthcare-maine.md)) — Commercial insurance. Optum criteria (BH803ABASCC) + Maine’s autism mandate (age 10 and under); no Maine state supplement; telehealth limited to 97155–97157. Prior auth: assessment Required: Optum’s ABA Supplemental Clinical Criteria say "Prior authorization is required for ABA" unless…; treatment see guide. ## Maryland (MD) State autism mandate: Habilitative services mandate (Md. Ins. § 15-835 + COMAR 31.10.39.03) - [Maryland Medicaid (Medical Assistance)](https://carelu.com/payers/maryland-medicaid) ([Markdown](https://carelu.com/payers/maryland-medicaid.md)) — State Medicaid program. EPSDT under 21, FFS via Carelon BHASO — the 9 HealthChoice MCOs never touch ABA. Prior auth: assessment Required; treatment Required. - [Aetna in Maryland](https://carelu.com/payers/aetna-maryland) ([Markdown](https://carelu.com/payers/aetna-maryland.md)) — Commercial insurance. CPB 0554 (ABA) + CPB 0648 (ASD) + Maryland's habilitative-services mandate with 25/10-hr floors. Prior auth: assessment Required; treatment Required. - [CareFirst BlueCross BlueShield (Maryland)](https://carelu.com/payers/carefirst-maryland) ([Markdown](https://carelu.com/payers/carefirst-maryland.md)) — Commercial insurance. Maryland's dominant Blue plan: Medical Policy 3.01.015 + Operating Procedure 8.01.011A, ABA preauthorized, RBTs billed under the supervising licensed BCBA. Prior auth: assessment see guide; treatment Required. - [Cigna / Evernorth in Maryland](https://carelu.com/payers/cigna-maryland) ([Markdown](https://carelu.com/payers/cigna-maryland.md)) — Commercial insurance. EN0499 + autism resource guide + Maryland's habilitative-services mandate with 25/10-hr floors. Prior auth: assessment Not required for assessment codes 97151, 97152, 0362T; treatment Required. - [Johns Hopkins US Family Health Plan](https://carelu.com/payers/johns-hopkins-usfhp) ([Markdown](https://carelu.com/payers/johns-hopkins-usfhp.md)) — Commercial insurance. A TRICARE Prime designated-provider plan that administers the ACD itself — Hopkins authorizes, not Humana Military. Prior auth: assessment Required; treatment Required. - [UnitedHealthcare / Optum in Maryland](https://carelu.com/payers/unitedhealthcare-maryland) ([Markdown](https://carelu.com/payers/unitedhealthcare-maryland.md)) — Commercial insurance. Optum BH803ABASCC + a published Maryland State Mandates entry adopting the COMAR 25/10-hr floors. Prior auth: assessment Required; treatment Required. ## Massachusetts (MA) State autism mandate: ARICA — Ch. 207, Acts of 2010 (M.G.L. c. 175 § 47AA et al.) - [MassHealth (Massachusetts Medicaid)](https://carelu.com/payers/masshealth-massachusetts-medicaid) ([Markdown](https://carelu.com/payers/masshealth-massachusetts-medicaid.md)) — State Medicaid program. EPSDT under 21, no caps, 100% managed-care ABA via six BH administrators; 1:10 audit live. Prior auth: assessment Required; treatment Required. - [Fallon Health (MassHealth ACPPs)](https://carelu.com/payers/fallon-health-massachusetts) ([Markdown](https://carelu.com/payers/fallon-health-massachusetts.md)) — Medicaid managed care plan (MCO). Three ACPPs (2023 roster), Carelon-run BH, state-baseline rules; first-wave audit recoupments. Prior auth: assessment Required; treatment Required. - [Health New England — BeHealthy Partnership](https://carelu.com/payers/health-new-england-massachusetts) ([Markdown](https://carelu.com/payers/health-new-england-massachusetts.md)) — Medicaid managed care plan (MCO). Western-MA ACPP (BeHealthy Partnership); ABA auth is the MBHP flow, state-baseline rules. Prior auth: assessment Required; treatment Required. - [Mass General Brigham Health Plan (MassHealth ACPP)](https://carelu.com/payers/mass-general-brigham-health-plan) ([Markdown](https://carelu.com/payers/mass-general-brigham-health-plan.md)) — Medicaid managed care plan (MCO). The Optum-run MassHealth ACPP: BH803ABA state supplement, 30 hr/wk EI cap, codified 1:10 ratio. Prior auth: assessment Required; treatment Required. - [Massachusetts Behavioral Health Partnership (MBHP)](https://carelu.com/payers/mbhp-massachusetts) ([Markdown](https://carelu.com/payers/mbhp-massachusetts.md)) — Medicaid managed care plan (MCO). The biggest MA ABA gatekeeper: PCC Plan + Primary Care ACOs + HNE, Carelon-run, standard form. Prior auth: assessment Required; treatment Required. - [Tufts Health Together (Point32Health)](https://carelu.com/payers/tufts-health-together) ([Markdown](https://carelu.com/payers/tufts-health-together.md)) — Medicaid managed care plan (MCO). MCO product discontinued 1/1/2026 — only its 2 ACPPs (w/ Cambridge Health Alliance, w/ UMass Memorial) remain. Prior auth: assessment Required; treatment Required. - [WellSense Health Plan](https://carelu.com/payers/wellsense-massachusetts) ([Markdown](https://carelu.com/payers/wellsense-massachusetts.md)) — Medicaid managed care plan (MCO). Largest ACPP footprint (8 of 15) + Essential MCO; insourced BH from Carelon 1/1/2026, hosts the standard form. Prior auth: assessment Required; treatment Required. - [Aetna in Massachusetts](https://carelu.com/payers/aetna-massachusetts) ([Markdown](https://carelu.com/payers/aetna-massachusetts.md)) — Commercial insurance. CPB 0554/0648 + ARICA (no caps, any age) + Aetna's own hosted MA Standard ABA form. Prior auth: assessment Required; treatment Required. - [Blue Cross Blue Shield of Massachusetts](https://carelu.com/payers/blue-cross-blue-shield-massachusetts) ([Markdown](https://carelu.com/payers/blue-cross-blue-shield-massachusetts.md)) — Commercial insurance. Medical Policy 091 (ASD and Down syndrome, 30–40 hr/wk comprehensive) + ARICA + prior auth for every ABA code, faxed or via Authorization Manager. Prior auth: assessment Required; treatment Required for every ABA treatment code (97153–97158, 0373T) on HMO, POS, PPO and Indemnity commercial plans. - [Cigna / Evernorth in Massachusetts](https://carelu.com/payers/cigna-massachusetts) ([Markdown](https://carelu.com/payers/cigna-massachusetts.md)) — Commercial insurance. EN0499 (no MA carve-out) + ARICA's no-cap, any-age floor for fully-insured plans. Prior auth: assessment Not required for assessment codes 97151, 97152, 0362T; treatment Required. - [UnitedHealthcare / Optum in Massachusetts](https://carelu.com/payers/unitedhealthcare-massachusetts) ([Markdown](https://carelu.com/payers/unitedhealthcare-massachusetts.md)) — Commercial insurance. Optum BH803ABASCC + ARICA + two explicit MA entries in Optum's state-mandate supplement. Prior auth: assessment Required; treatment Required. ## Michigan (MI) State autism mandate: Michigan autism mandate (MCL 500.3406s, 550.1416e; through age 18, $50K/$40K/$30K caps allowed) - [Michigan Medicaid](https://carelu.com/payers/michigan-medicaid) ([Markdown](https://carelu.com/payers/michigan-medicaid.md)) — State Medicaid program. ABA is carved out to 10 regional PIHPs/CMHs, not the health plans; under 21, PCP exam first, 1:10 supervision. Prior auth: assessment see guide; treatment Required. - [Detroit Wayne Integrated Health Network (DWIHN)](https://carelu.com/payers/detroit-wayne-integrated-health-network-michigan) ([Markdown](https://carelu.com/payers/detroit-wayne-integrated-health-network-michigan.md)) — Medicaid managed care plan (MCO). Wayne County PIHP: Access Center 1-800-241-4949, independent evaluation centers, up to 90 days from diagnosis to 1:1 ABA. Prior auth: assessment see guide; treatment Required. - [Macomb County Community Mental Health (MCCMH)](https://carelu.com/payers/macomb-county-community-mental-health-michigan) ([Markdown](https://carelu.com/payers/macomb-county-community-mental-health-michigan.md)) — Medicaid managed care plan (MCO). Macomb County PIHP: 855-99-MCCMH, exam within the past year, 3-year autism enrollment, auth 14+ days ahead, no backdating. Prior auth: assessment MCCMH requests authorization for each six-month assessment/evaluation period, 14 or more days before the…; treatment Required. - [Mid-State Health Network (MSHN)](https://carelu.com/payers/mid-state-health-network-michigan) ([Markdown](https://carelu.com/payers/mid-state-health-network-michigan.md)) — Medicaid managed care plan (MCO). 21-county PIHP (12 CMHSPs): no wrong door, outside evaluations accepted if under 3 years old, 14-day UM decisions. Prior auth: assessment see guide; treatment Required. - [Oakland Community Health Network (OCHN)](https://carelu.com/payers/oakland-community-health-network-michigan) ([Markdown](https://carelu.com/payers/oakland-community-health-network-michigan.md)) — Medicaid managed care plan (MCO). Oakland County PIHP: Access (248) 464-6363, in-house diagnostician, MDHHS approval in 12–48 hours, provider link in 7 days. Prior auth: assessment see guide; treatment Required. - [Southwest Michigan Behavioral Health (SWMBH)](https://carelu.com/payers/southwest-michigan-behavioral-health) ([Markdown](https://carelu.com/payers/southwest-michigan-behavioral-health.md)) — Medicaid managed care plan (MCO). 8-county PIHP: screen with M-CHAT or SCQ, ~3-hour evaluation (ADOS-2, ADI-R, DD-CGAS) sent to MDHHS for approval. Prior auth: assessment see guide; treatment Required. - [Aetna in Michigan](https://carelu.com/payers/aetna-michigan) ([Markdown](https://carelu.com/payers/aetna-michigan.md)) — Commercial insurance. CPB 0554 + CPB 0648 + precert on all ABA codes, layered on Michigan’s capped mandate (MCL 500.3406s). Prior auth: assessment Required; treatment see guide. - [Blue Cross Blue Shield of Michigan](https://carelu.com/payers/blue-cross-blue-shield-michigan) ([Markdown](https://carelu.com/payers/blue-cross-blue-shield-michigan.md)) — Commercial insurance. Michigan’s Blue plan: ABA regardless of age since 2022, AAEC or independent evaluation, Blue Cross Behavioral Health PA. Prior auth: assessment Required for BCN HMO plans and for Blue Cross PPO fully insured and select self-funded groups; treatment Required through Blue Cross Behavioral Health for all BCN HMO plans and for Blue Cross PPO fully insured and…. - [Cigna / Evernorth in Michigan](https://carelu.com/payers/cigna-michigan) ([Markdown](https://carelu.com/payers/cigna-michigan.md)) — Commercial insurance. EN0499 + autism resource guide: no PA on assessments, all ABA codes telehealth-eligible, plus Michigan’s capped mandate. Prior auth: assessment Not required for 97151, 97152 or 0362T with an autism diagnosis when the provider is independently licensed…; treatment Required. - [Health Alliance Plan (HAP) — Michigan](https://carelu.com/payers/hap-michigan) ([Markdown](https://carelu.com/payers/hap-michigan.md)) — Commercial insurance. Henry Ford Health’s plan: ABA treatment on HAP’s PA list; criteria behind login; SB 247 7-day/72-hour clock. Prior auth: assessment see guide; treatment Required. - [Priority Health (Michigan)](https://carelu.com/payers/priority-health-michigan) ([Markdown](https://carelu.com/payers/priority-health-michigan.md)) — Commercial insurance. Michigan carrier: PA on every ABA code incl. 97151, InterQual criteria, BCBA supervision 1 hr per 15 hrs. Prior auth: assessment Required; treatment Required. - [UnitedHealthcare (Optum Behavioral Health) in Michigan](https://carelu.com/payers/unitedhealthcare-michigan) ([Markdown](https://carelu.com/payers/unitedhealthcare-michigan.md)) — Commercial insurance. Optum ABA criteria (BH803ABASCC): PA required, 1–2 hrs supervision per 10, 97153+97155 concurrent billing, Michigan’s capped mandate. Prior auth: assessment see guide; treatment Required. ## Minnesota (MN) State autism mandate: Minn. Stat. § 62A.3094 (large-employer plans, children under 18) - [Minnesota Medical Assistance (EIDBI)](https://carelu.com/payers/minnesota-medicaid) ([Markdown](https://carelu.com/payers/minnesota-medicaid.md)) — State Medicaid program. ABA is a modality of the EIDBI benefit (under 21): CMDE first, then an ITP authorized by Acentra Health (FFS) or the member’s MCO. Prior auth: assessment No for the first CMDE each calendar year; treatment Required. - [Blue Plus (Blue Cross and Blue Shield of Minnesota) — Medical Assistance](https://carelu.com/payers/blue-plus-minnesota) ([Markdown](https://carelu.com/payers/blue-plus-minnesota.md)) — Medicaid managed care plan (MCO). Blue Cross’s Medical Assistance HMO: EIDBI follows DHS rules, PA via Availity or fax with CMDE, ITP and the Blue Cross EIDBI request form. Prior auth: assessment see guide; treatment Required. - [HealthPartners — Minnesota Health Care Programs](https://carelu.com/payers/healthpartners-minnesota) ([Markdown](https://carelu.com/payers/healthpartners-minnesota.md)) — Medicaid managed care plan (MCO). HealthPartners MHCP: EIDBI policy mirrors DHS criteria; PA by fax with the CMDE; claims need rendering and QSP loops. Prior auth: assessment No for 97151 per HealthPartners’ EIDBI policy, whose prior-authorization code list covers 0373T and…; treatment Yes: "Prior authorization is required" for 0373T, 97153, 97154, 97155, 97156 and 97157, reviewed by the…. - [Hennepin Health](https://carelu.com/payers/hennepin-health-minnesota) ([Markdown](https://carelu.com/payers/hennepin-health-minnesota.md)) — Medicaid managed care plan (MCO). Medical Assistance plan: EIDBI PA by fax, 1:16 supervision, and QSP notes due every three months since July 2026. Prior auth: assessment Not on Hennepin Health’s EIDBI prior-authorization list, which names 97153, 97154, 0373T, 97155, 97156, 97157…; treatment Yes: 97153UB, 97154UB, 0373T, 97155UB, 97156UB, 97157UB and H0046UB need prior authorization. - [IMCare (Itasca Medical Care)](https://carelu.com/payers/imcare-minnesota) ([Markdown](https://carelu.com/payers/imcare-minnesota.md)) — Medicaid managed care plan (MCO). Itasca County’s local county health plan: EIDBI authorized by fax or secure email; most plan-specific EIDBI rules are unpublished. - [Medica — Minnesota Health Care Programs](https://carelu.com/payers/medica-minnesota) ([Markdown](https://carelu.com/payers/medica-minnesota.md)) — Medicaid managed care plan (MCO). Medica’s Medical Assistance plans: behavioral health and EIDBI run through Optum; fax the CMDE and ITP to 855-454-8155. Prior auth: assessment see guide; treatment "Select services require authorization. - [Medica One Health Plan (formerly UCare Medical Assistance)](https://carelu.com/payers/medica-one-health-plan-minnesota) ([Markdown](https://carelu.com/payers/medica-one-health-plan-minnesota.md)) — Medicaid managed care plan (MCO). The former UCare Medical Assistance plans, under Medica since Oct. 1, 2026; EIDBI through Optum with the same fax as Medica. Prior auth: assessment see guide; treatment "Select services require authorization. - [PrimeWest Health](https://carelu.com/payers/primewest-health-minnesota) ([Markdown](https://carelu.com/payers/primewest-health-minnesota.md)) — Medicaid managed care plan (MCO). Medical Assistance plan with a full EIDBI manual chapter: portal authorization, no retro auths, O&D near 20%, POS 02 telehealth. Prior auth: assessment No: "The annual CMDE" is on PrimeWest’s list of services that "do not require authorization prior to service…; treatment Yes: individual, group and higher-intensity intervention, family/caregiver training and observation and…. - [South Country Health Alliance](https://carelu.com/payers/south-country-health-alliance-minnesota) ([Markdown](https://carelu.com/payers/south-country-health-alliance-minnesota.md)) — Medicaid managed care plan (MCO). Medical Assistance plan: EIDBI on its BH prior-auth list with form #4894, the CMDE and ITP; 5-business-day decisions; 180-day filing. Prior auth: assessment see guide; treatment Yes: "Authorization Required - authorization cannot exceed 180 day time span" for 97153, 97154, 97155, 97156,…. - [Aetna in Minnesota](https://carelu.com/payers/aetna-minnesota) ([Markdown](https://carelu.com/payers/aetna-minnesota.md)) — Commercial insurance. Aetna’s national ABA guide + precert list, under Minnesota’s large-employer mandate (§ 62A.3094, under 18) and BA licensure. Prior auth: assessment Required: all ten ABA codes, 97151 included, are on Aetna’s behavioral health precertification list; treatment see guide. - [Blue Cross and Blue Shield of Minnesota](https://carelu.com/payers/blue-cross-blue-shield-minnesota) ([Markdown](https://carelu.com/payers/blue-cross-blue-shield-minnesota.md)) — Commercial insurance. Medical policy X-43 (2 hours supervision per 10, diagnosis within 24 months) + Minnesota’s large-employer mandate and BA licensure. - [Cigna / Evernorth in Minnesota](https://carelu.com/payers/cigna-minnesota) ([Markdown](https://carelu.com/payers/cigna-minnesota.md)) — Commercial insurance. Evernorth EN0499 + autism resource guide (no PA on assessments) + Minnesota’s large-employer mandate and BA licensure. Prior auth: assessment Not required for 97151, 97152 and 0362T with an autism diagnosis when the provider is independently licensed…; treatment see guide. - [UnitedHealthcare / Optum in Minnesota](https://carelu.com/payers/unitedhealthcare-minnesota) ([Markdown](https://carelu.com/payers/unitedhealthcare-minnesota.md)) — Commercial insurance. Optum criteria (BH803ABASCC) + Minnesota’s large-employer mandate; no Minnesota entry in Optum’s ABA state mandates. Prior auth: assessment Required: "Prior authorization is required for ABA *(unless otherwise specified or mandated by contract or…; treatment see guide. ## Mississippi (MS) State autism mandate: Miss. Code Ann. § 83-9-26 (HB 885, 2015; ABA may stop at age 8 and 25 hr/wk unless medically necessary) - [Mississippi Medicaid](https://carelu.com/payers/mississippi-medicaid) ([Markdown](https://carelu.com/payers/mississippi-medicaid.md)) — State Medicaid program. ASD services under EPSDT (under 21), mostly through three CCOs; FFS PA via Telligen; 97151 needs no PA; published ASD fee schedule. Prior auth: assessment Fee-for-service: no for 97151 (the PA column is blank on the July 2026 ASD fee schedule and 97151 is not on…; treatment Fee-for-service: yes. - [Magnolia Health (MississippiCAN / CHIP)](https://carelu.com/payers/magnolia-health-mississippi) ([Markdown](https://carelu.com/payers/magnolia-health-mississippi.md)) — Medicaid managed care plan (MCO). Centene’s MississippiCAN/CHIP plan: PA on 97152–97158, 0362T, 0373T (not 97151); CP.BH.104 criteria with 6-hour/30-hour day/week screen. Prior auth: assessment Not for 97151: Magnolia’s CMS 0057-F PA list names 0362T, 0373T and 97152–97158 under Applied Behavioral…; treatment Required for 97153–97158 and 0373T. - [Molina Healthcare of Mississippi (MississippiCAN / CHIP)](https://carelu.com/payers/molina-healthcare-mississippi) ([Markdown](https://carelu.com/payers/molina-healthcare-mississippi.md)) — Medicaid managed care plan (MCO). Molina’s MississippiCAN/CHIP plan: ABA requires PA (2026 Pre-Service Review Guide); MCP-482 criteria; BH auth 1-844-826-4335. Prior auth: assessment see guide; treatment Required: "Applied Behavioral Analysis (ABA) – for treatment of Autism Spectrum Disorder (ASD)" is on…. - [TrueCare (MississippiCAN / CHIP)](https://carelu.com/payers/truecare-mississippi) ([Markdown](https://carelu.com/payers/truecare-mississippi.md)) — Medicaid managed care plan (MCO). CareSource’s MississippiCAN/CHIP plan since 7/1/2025: MM-1477 ABA criteria, 6-month reviews, PY-1639 billing rules; LBA required. Prior auth: assessment No for 97151: TrueCare’s Procedure Code Lookup Tool (Mississippi Medicaid, outpatient) returns "Auth is…; treatment Yes: TrueCare’s Procedure Code Lookup Tool (Mississippi Medicaid, outpatient, any place of service) returns…. - [Aetna in Mississippi](https://carelu.com/payers/aetna-mississippi) ([Markdown](https://carelu.com/payers/aetna-mississippi.md)) — Commercial insurance. Aetna ABA guide + precert list, layered on Mississippi’s § 83-9-26 mandate (age 8 / 25 hr) and LBA licensure. Prior auth: assessment Required: all ten ABA codes, 97151 included, are on Aetna’s behavioral health precertification list; treatment see guide. - [Blue Cross & Blue Shield of Mississippi](https://carelu.com/payers/blue-cross-blue-shield-mississippi) ([Markdown](https://carelu.com/payers/blue-cross-blue-shield-mississippi.md)) — Commercial insurance. BCBSMS medical policy L.8.01.403: no age limit, no hour cap (from 10/15/2025), no treatment-plan PA (from 8/1/2024); 97151 once per 6 months. Prior auth: assessment No prior authorization since 8/1/2024 for fully insured, self-funded group and State Health Plan members; treatment No: "submission of the individualized ABA treatment plan for approval by the Company is no longer required"…. - [Cigna / Evernorth in Mississippi](https://carelu.com/payers/cigna-mississippi) ([Markdown](https://carelu.com/payers/cigna-mississippi.md)) — Commercial insurance. EN0499 + autism resource guide (no PA on assessment codes) + Mississippi’s § 83-9-26 mandate and LBA licensure. Prior auth: assessment Not required for 97151, 97152 and 0362T with an autism diagnosis when the provider is independently licensed…; treatment Required: after the assessment, submit the Applied Behavior Analysis Prior Authorization Form with the…. - [UnitedHealthcare / Optum in Mississippi](https://carelu.com/payers/unitedhealthcare-mississippi) ([Markdown](https://carelu.com/payers/unitedhealthcare-mississippi.md)) — Commercial insurance. Optum criteria (BH803ABASCC) + Mississippi’s § 83-9-26 mandate; no Mississippi state supplement; UHC left MississippiCAN 6/30/2025. Prior auth: assessment Required: Optum’s ABA Supplemental Clinical Criteria require prior authorization for ABA "unless otherwise…; treatment see guide. ## Missouri (MO) State autism mandate: Missouri autism insurance mandate (RSMo § 376.1224) - [MO HealthNet (Missouri Medicaid)](https://carelu.com/payers/missouri-medicaid) ([Markdown](https://carelu.com/payers/missouri-medicaid.md)) — State Medicaid program. Full FFS carve-out: one payer, one fax precert (form 2575-045), no MCO contracting. Prior auth: assessment Required; treatment Required. - [Aetna in Missouri](https://carelu.com/payers/aetna-missouri) ([Markdown](https://carelu.com/payers/aetna-missouri.md)) — Commercial insurance. CPB 0554 (ABA) + CPB 0648 (ASD) + the RSMo § 376.1224 mandate layer. Prior auth: assessment Required; treatment Required. - [Anthem BCBS Missouri](https://carelu.com/payers/anthem-bcbs-missouri) ([Markdown](https://carelu.com/payers/anthem-bcbs-missouri.md)) — Commercial insurance. Inflation-indexed ABA cap ($57,311 for 2025); Anthem reviews in-house; 6-month statutory review ceiling. - [Cigna / Evernorth in Missouri](https://carelu.com/payers/cigna-missouri) ([Markdown](https://carelu.com/payers/cigna-missouri.md)) — Commercial insurance. EN0499 + autism resource guide + the RSMo § 376.1224 mandate layer. Prior auth: assessment Not required for assessment codes 97151, 97152, 0362T; treatment Required. - [UnitedHealthcare / Optum in Missouri](https://carelu.com/payers/unitedhealthcare-missouri) ([Markdown](https://carelu.com/payers/unitedhealthcare-missouri.md)) — Commercial insurance. Optum Supplemental Clinical Criteria (BH803ABASCC) + the RSMo § 376.1224 mandate layer. Prior auth: assessment Required; treatment Required. ## Montana (MT) State autism mandate: Montana autism mandate (MCA 33-22-515; group plans, through age 18, caps of $50,000/yr to age 8 and $20,000/yr ages 9–18 allowed) - [Montana Medicaid](https://carelu.com/payers/montana-medicaid) ([Markdown](https://carelu.com/payers/montana-medicaid.md)) — State Medicaid program. No MCOs: DPHHS runs ABA directly. Up to 20 for ASD; first 180 days/1,260 units start on an Intent to Initiate form, then PA through Mountain-Pacific. Prior auth: assessment No prior authorization for the initial span; treatment Not for the first 180 calendar days or 1,260 units, whichever comes first. - [Aetna in Montana](https://carelu.com/payers/aetna-montana) ([Markdown](https://carelu.com/payers/aetna-montana.md)) — Commercial insurance. Aetna’s national ABA guide + precert of all ten codes, layered on Montana’s group mandate (through 18, caps allowed) and BA licensure. Prior auth: assessment Required: all ten ABA codes, 97151 included, are on Aetna’s behavioral health precertification list; treatment see guide. - [Blue Cross and Blue Shield of Montana](https://carelu.com/payers/blue-cross-blue-shield-montana) ([Markdown](https://carelu.com/payers/blue-cross-blue-shield-montana.md)) — Commercial insurance. HCSC Blue plan: ABA PA on treatment codes, MCG criteria, 36-month diagnosis window, no age/dollar/visit limits since 2021. Prior auth: assessment see guide; treatment Required: 97153–97158, 0362T and 0373T are on BCBSMT’s 2026 behavioral health PA code list, requested on the…. - [Cigna / Evernorth in Montana](https://carelu.com/payers/cigna-montana) ([Markdown](https://carelu.com/payers/cigna-montana.md)) — Commercial insurance. Evernorth EN0499 + autism resource guide (no PA on assessment codes), layered on Montana’s group mandate and BA licensure. Prior auth: assessment Not required for 97151, 97152 and 0362T with an autism diagnosis when the provider is independently licensed…; treatment Required: the completed assessment and treatment plan go with the Applied Behavior Analysis Prior…. - [UnitedHealthcare / Optum in Montana](https://carelu.com/payers/unitedhealthcare-montana) ([Markdown](https://carelu.com/payers/unitedhealthcare-montana.md)) — Commercial insurance. Optum ABA criteria (no Montana state supplement), PA on ABA, three telehealth codes, layered on Montana’s group mandate and BA licensure. Prior auth: assessment Required: Optum’s ABA Supplemental Clinical Criteria say "Prior authorization is required for ABA" unless…; treatment see guide. ## Nebraska (NE) State autism mandate: Neb. Rev. Stat. § 44-7,106 (autism coverage, 25 hr/wk cap) - [Nebraska Medicaid (Heritage Health)](https://carelu.com/payers/nebraska-medicaid) ([Markdown](https://carelu.com/payers/nebraska-medicaid.md)) — State Medicaid program. Under 21 via EPSDT; ASD dx NOT required; deep Aug 2025 rate cuts (97153 → $18.70). Prior auth: assessment MCO-administered; treatment Required. - [Molina Healthcare of Nebraska](https://carelu.com/payers/molina-healthcare-nebraska) ([Markdown](https://carelu.com/payers/molina-healthcare-nebraska.md)) — Medicaid managed care plan (MCO). Newest MCO (2024); state-baseline rules, Availity intake, quarterly PA-list churn. Prior auth: assessment see guide; treatment Required. - [Nebraska Total Care (Centene)](https://carelu.com/payers/nebraska-total-care) ([Markdown](https://carelu.com/payers/nebraska-total-care.md)) — Medicaid managed care plan (MCO). Closest to the state baseline; OTR-based PA, documentation-heavy NE.CP.BH.105 policy. Prior auth: assessment Required; treatment Required. - [UnitedHealthcare Community Plan of Nebraska](https://carelu.com/payers/unitedhealthcare-community-plan-nebraska) ([Markdown](https://carelu.com/payers/unitedhealthcare-community-plan-nebraska.md)) — Medicaid managed care plan (MCO). ABA carved to Optum since 2017; all autism services need PA, two-step assessment→treatment auth. Prior auth: assessment Required; treatment Required. - [Aetna in Nebraska](https://carelu.com/payers/aetna-nebraska) ([Markdown](https://carelu.com/payers/aetna-nebraska.md)) — Commercial insurance. CPB 0554 (ABA) + CPB 0648 (ASD) + the Neb. Rev. Stat. § 44-7,106 mandate layer. Prior auth: assessment Required; treatment Required. - [Ambetter from Nebraska Total Care](https://carelu.com/payers/nebraska-total-care-ambetter) ([Markdown](https://carelu.com/payers/nebraska-total-care-ambetter.md)) — Commercial insurance. Nebraska Total Care's Marketplace plan (Celtic Insurance): ABA covered with no benefit limit, PA on every ABA code, outside the state mandate, cost sharing applies. Prior auth: assessment Required; treatment Required. - [Blue Cross Blue Shield Nebraska](https://carelu.com/payers/bcbs-nebraska) ([Markdown](https://carelu.com/payers/bcbs-nebraska.md)) — Commercial insurance. Nebraska's Blue plan: Medical Policy I.178 (preauthorization required), 2 hrs supervision per 10 direct, office or telehealth only, 25 hr/wk mandate cap on state-regulated plans. Prior auth: assessment Required; treatment Required. - [Cigna / Evernorth in Nebraska](https://carelu.com/payers/cigna-nebraska) ([Markdown](https://carelu.com/payers/cigna-nebraska.md)) — Commercial insurance. EN0499 + autism resource guide + the Neb. Rev. Stat. § 44-7,106 mandate layer. Prior auth: assessment Not required for assessment codes 97151, 97152, 0362T; treatment Required. - [UnitedHealthcare / Optum in Nebraska](https://carelu.com/payers/unitedhealthcare-nebraska) ([Markdown](https://carelu.com/payers/unitedhealthcare-nebraska.md)) — Commercial insurance. Optum Supplemental Clinical Criteria (BH803ABASCC) + the Neb. Rev. Stat. § 44-7,106 mandate layer. Prior auth: assessment Required; treatment Required. ## Nevada (NV) State autism mandate: NRS 689B.0335 autism mandate (under 18, or 22 in high school; $72,000/yr ABA cap) - [Nevada Medicaid](https://carelu.com/payers/nevada-medicaid) ([Markdown](https://carelu.com/payers/nevada-medicaid.md)) — State Medicaid program. ABA for Medicaid members of any age (MSM 3700); no PA on assessments; five MCOs statewide from 2026; published PT 85 rates. Prior auth: assessment No; treatment Required. - [Anthem Blue Cross and Blue Shield Healthcare Solutions (Nevada Medicaid)](https://carelu.com/payers/anthem-nevada-medicaid) ([Markdown](https://carelu.com/payers/anthem-nevada-medicaid.md)) — Medicaid managed care plan (MCO). Nevada Medicaid MCO (Community Care Health Plan of Nevada); covers ABA at any age; BH requests through Availity; manual still prints a 14-day clock. Prior auth: assessment see guide; treatment Required. - [CareSource Nevada (Medicaid)](https://carelu.com/payers/caresource-nevada) ([Markdown](https://carelu.com/payers/caresource-nevada.md)) — Medicaid managed care plan (MCO). Nevada Medicaid MCO new in 2026; its own ABA medical and reimbursement policies mirror MSM 3700, add a 24-month diagnosis-age rule and require signed plans before claims. Prior auth: assessment No; treatment Required. - [Health Plan of Nevada (Nevada Medicaid)](https://carelu.com/payers/health-plan-of-nevada) ([Markdown](https://carelu.com/payers/health-plan-of-nevada.md)) — Medicaid managed care plan (MCO). UnitedHealth-owned Nevada Medicaid MCO; since 11/17/2025 PA for all ABA therapy, reviewed by HPN’s own BH team on InterQual. Prior auth: assessment see guide; treatment Yes, for all ABA therapy services from November 17, 2025, reviewed by HPN’s Behavioral Health team under…. - [Molina Healthcare of Nevada (Medicaid)](https://carelu.com/payers/molina-healthcare-nevada) ([Markdown](https://carelu.com/payers/molina-healthcare-nevada.md)) — Medicaid managed care plan (MCO). Nevada Medicaid MCO; its 2026 manual never names ABA, so PA rules sit in the Availity lookup and the state MSM 3700 rules apply underneath. - [SilverSummit Healthplan (Nevada Medicaid)](https://carelu.com/payers/silversummit-healthplan-nevada) ([Markdown](https://carelu.com/payers/silversummit-healthplan-nevada.md)) — Medicaid managed care plan (MCO). Centene’s Nevada Medicaid MCO; ABA on its PA list, FA-11E/FA-11F plus a full treatment plan, CP.BH.104 revised for DOS from 5/30/2026. Prior auth: assessment see guide; treatment Required. - [Aetna in Nevada](https://carelu.com/payers/aetna-nevada) ([Markdown](https://carelu.com/payers/aetna-nevada.md)) — Commercial insurance. Aetna ABA guide + precert list + Nevada’s NRS 689B.0335 mandate (under 18, or 22 in high school; $72,000/yr ABA cap) and NV licensure. Prior auth: assessment Required: all ten ABA codes, 97151 included, are on Aetna’s behavioral health precertification list; treatment see guide. - [Anthem Blue Cross and Blue Shield Nevada](https://carelu.com/payers/anthem-bcbs-nevada) ([Markdown](https://carelu.com/payers/anthem-bcbs-nevada.md)) — Commercial insurance. Nevada’s Blue plan (Rocky Mountain Hospital and Medical Service / HMO Nevada): outpatient behavioral health on the NV precert list; ABA billing rules from Anthem’s resource guide. - [Cigna / Evernorth in Nevada](https://carelu.com/payers/cigna-nevada) ([Markdown](https://carelu.com/payers/cigna-nevada.md)) — Commercial insurance. EN0499 + autism resource guide + Nevada’s NRS 689B.0335 mandate; no PA on assessment codes; Evernorth’s Nevada addendum gives 45 days’ fee-change notice. Prior auth: assessment Not required for 97151, 97152 and 0362T with an autism diagnosis when the provider is independently licensed…; treatment Required: after the assessment and treatment plan, complete the Applied Behavior Analysis Prior Authorization…. - [UnitedHealthcare / Optum in Nevada](https://carelu.com/payers/unitedhealthcare-nevada) ([Markdown](https://carelu.com/payers/unitedhealthcare-nevada.md)) — Commercial insurance. Two UHC tracks in Nevada: Optum criteria for UHC-branded plans; HPN/Sierra plans reviewed by HPN on InterQual. Plus Nevada’s NRS 689B.0335 mandate. Prior auth: assessment Required on Optum-managed plans: the ABA Supplemental Clinical Criteria require prior authorization for ABA…; treatment see guide. ## New Hampshire (NH) State autism mandate: RSA 417-E:2 autism coverage (HB 569, 2010; no age or dollar caps in current text) - [New Hampshire Medicaid](https://carelu.com/payers/new-hampshire-medicaid) ([Markdown](https://carelu.com/payers/new-hampshire-medicaid.md)) — State Medicaid program. ABA is an EPSDT benefit (under 21), carved in to three MCOs; FFS needs Form 272A and publishes low rates. Prior auth: assessment Fee-for-service: yes; treatment Fee-for-service: yes for 97153, 97155 and 97156 (Form 272A to DHHS Medicaid Medical Services). - [AmeriHealth Caritas New Hampshire](https://carelu.com/payers/amerihealth-caritas-new-hampshire) ([Markdown](https://carelu.com/payers/amerihealth-caritas-new-hampshire.md)) — Medicaid managed care plan (MCO). NH Medicaid MCO that lists ABA under EPSDT; PA rules sit in a lookup tool, and its manual still prints a 14-day clock. Prior auth: assessment Required; treatment Required for every ABA treatment code. - [NH Healthy Families](https://carelu.com/payers/nh-healthy-families) ([Markdown](https://carelu.com/payers/nh-healthy-families.md)) — Medicaid managed care plan (MCO). Centene’s NH Medicaid plan: ABA runs on the behavioral health platform (payer ID 68068) with PA via OTR form or portal. Prior auth: assessment Required; treatment Required. - [WellSense Health Plan (New Hampshire)](https://carelu.com/payers/wellsense-new-hampshire) ([Markdown](https://carelu.com/payers/wellsense-new-hampshire.md)) — Medicaid managed care plan (MCO). NH Medicaid MCO with its own NH ABA form: 3-month initial, 6-month continued, units per period, BCBA signs. Prior auth: assessment Required; treatment Required. - [Aetna in New Hampshire](https://carelu.com/payers/aetna-new-hampshire) ([Markdown](https://carelu.com/payers/aetna-new-hampshire.md)) — Commercial insurance. CPB 0554 (ABA) + CPB 0648 (ASD) + New Hampshire’s RSA 417-E mandate layer. Prior auth: assessment Required: all ten ABA codes, 97151 included, are on Aetna’s behavioral health precertification list; treatment see guide. - [Anthem Blue Cross and Blue Shield New Hampshire](https://carelu.com/payers/anthem-bcbs-new-hampshire) ([Markdown](https://carelu.com/payers/anthem-bcbs-new-hampshire.md)) — Commercial insurance. New Hampshire’s Blue plan: every ABA code is on the NH precert list, reviewed by Anthem BH on MCG criteria. Prior auth: assessment Yes: 97151 and 97152 are on the New Hampshire precertification list (updated 10/15/26), reviewed by Anthem on…; treatment Yes: 97153–97158, 0362T and 0373T are all on the NH precertification list. - [Cigna / Evernorth in New Hampshire](https://carelu.com/payers/cigna-new-hampshire) ([Markdown](https://carelu.com/payers/cigna-new-hampshire.md)) — Commercial insurance. EN0499 + autism resource guide + New Hampshire’s RSA 417-E mandate layer; no PA on assessment codes. Prior auth: assessment Not required for 97151, 97152 and 0362T with an autism diagnosis when the provider is independently licensed…; treatment Required: completed assessment and treatment plan attached to the ABA Prior Authorization Form. - [Harvard Pilgrim Health Care (New Hampshire)](https://carelu.com/payers/harvard-pilgrim-new-hampshire) ([Markdown](https://carelu.com/payers/harvard-pilgrim-new-hampshire.md)) — Commercial insurance. Point32Health’s NH commercial plan: PA on all ABA codes via InterQual (MNG eff. 7/1/2026); H0031/H0032 dropped. Prior auth: assessment Yes: 97151 and 97152 require prior authorization for Harvard Pilgrim commercial products (MNG effective July…; treatment Yes: 97153–97158, 0362T and 0373T require prior authorization. - [UnitedHealthcare / Optum in New Hampshire](https://carelu.com/payers/unitedhealthcare-new-hampshire) ([Markdown](https://carelu.com/payers/unitedhealthcare-new-hampshire.md)) — Commercial insurance. Optum criteria (BH803ABASCC) + New Hampshire’s RSA 417-E mandate; no NH state supplement, no NH Medicaid plan. Prior auth: assessment Required: the ABA Supplemental Clinical Criteria require prior authorization for ABA "unless otherwise…; treatment see guide. ## New Jersey (NJ) State autism mandate: P.L. 2009, c.115 (N.J.S.A. 17:48-6ii et al.) - [NJ FamilyCare (New Jersey Medicaid)](https://carelu.com/payers/new-jersey-medicaid) ([Markdown](https://carelu.com/payers/new-jersey-medicaid.md)) — State Medicaid program. EPSDT via 5 MCOs since 4/2020; no-PA FFS window pending enrollment, published rates. Prior auth: assessment Required via the MCO; treatment Required. - [Aetna Better Health of New Jersey](https://carelu.com/payers/aetna-better-health-new-jersey) ([Markdown](https://carelu.com/payers/aetna-better-health-new-jersey.md)) — Medicaid managed care plan (MCO). Closest to the state baseline: published rate sheet mirrors the FFS schedule, MUE limits verbatim. Prior auth: assessment Required; treatment Required. - [Fidelis Care New Jersey (formerly WellCare)](https://carelu.com/payers/fidelis-care-new-jersey) ([Markdown](https://carelu.com/payers/fidelis-care-new-jersey.md)) — Medicaid managed care plan (MCO). Ex-WellCare Centene plan; state-baseline ABA with no published plan policy — verify specifics. Prior auth: assessment Required; treatment Required. - [Horizon NJ Health](https://carelu.com/payers/horizon-nj-health) ([Markdown](https://carelu.com/payers/horizon-nj-health.md)) — Medicaid managed care plan (MCO). Largest NJ MCO; NaviNet requests, 32-unit assessment fast-track, MCG review, 6-month auths. Prior auth: assessment Required; treatment Required. - [UnitedHealthcare Community Plan (NJ FamilyCare)](https://carelu.com/payers/unitedhealthcare-community-plan-new-jersey) ([Markdown](https://carelu.com/payers/unitedhealthcare-community-plan-new-jersey.md)) — Medicaid managed care plan (MCO). Optum-run; no comprehensive eval needed, school setting OK outside school hours, Provider Express intake. Prior auth: assessment Required; treatment Required. - [Wellpoint New Jersey (formerly Amerigroup)](https://carelu.com/payers/wellpoint-new-jersey) ([Markdown](https://carelu.com/payers/wellpoint-new-jersey.md)) — Medicaid managed care plan (MCO). Ex-Amerigroup Elevance plan; state-baseline ABA via Availity, with Carelon running the BH network. Prior auth: assessment Required; treatment Required. - [Aetna in New Jersey](https://carelu.com/payers/aetna-new-jersey) ([Markdown](https://carelu.com/payers/aetna-new-jersey.md)) — Commercial insurance. CPB 0554 (ABA) + CPB 0648 (ASD) + the P.L. 2009, c.115 mandate layer. Prior auth: assessment Required; treatment Required. - [Cigna / Evernorth in New Jersey](https://carelu.com/payers/cigna-new-jersey) ([Markdown](https://carelu.com/payers/cigna-new-jersey.md)) — Commercial insurance. EN0499 + autism resource guide + the P.L. 2009, c.115 mandate layer. Prior auth: assessment Not required for assessment codes 97151, 97152, 0362T; treatment Required. - [Horizon Blue Cross Blue Shield of New Jersey](https://carelu.com/payers/horizon-bcbs-new-jersey) ([Markdown](https://carelu.com/payers/horizon-bcbs-new-jersey.md)) — Commercial insurance. Medical Policy 165 + ABA reimbursement policy: PA on every ABA code, a daily-unit table, and school-hours rules. Prior auth: assessment Required; treatment Required. - [UnitedHealthcare / Optum in New Jersey](https://carelu.com/payers/unitedhealthcare-new-jersey) ([Markdown](https://carelu.com/payers/unitedhealthcare-new-jersey.md)) — Commercial insurance. Optum Supplemental Clinical Criteria (BH803ABASCC) + the P.L. 2009, c.115 mandate layer. Prior auth: assessment Required; treatment Required. ## New Mexico (NM) State autism mandate: New Mexico autism insurance mandate (NMSA 1978 § 59A-22-49) - [New Mexico Medicaid (Turquoise Care)](https://carelu.com/payers/new-mexico-medicaid) ([Markdown](https://carelu.com/payers/new-mexico-medicaid.md)) — State Medicaid program. ASD or at-risk, adults included; no PA on assessment; LOD #53 rate floor for MCOs. Prior auth: assessment Not required; treatment Required for 97153 only (97155/97156 are PA-free). - [Blue Cross and Blue Shield of New Mexico (Turquoise Care)](https://carelu.com/payers/blue-cross-blue-shield-new-mexico) ([Markdown](https://carelu.com/payers/blue-cross-blue-shield-new-mexico.md)) — Medicaid managed care plan (MCO). Shared state LOC criteria; ABA Clinical Service Request Form at least 2 weeks pre-start. Prior auth: assessment State baseline applies via the shared Turquoise Care LOC guidelines; treatment Required. - [Molina Healthcare of New Mexico (Turquoise Care)](https://carelu.com/payers/molina-healthcare-new-mexico) ([Markdown](https://carelu.com/payers/molina-healthcare-new-mexico.md)) — Medicaid managed care plan (MCO). New to NM 7/2024; PA via Availity Essentials; no published ABA policy — verify in portal. - [Presbyterian Health Plan (Turquoise Care)](https://carelu.com/payers/presbyterian-health-plan-new-mexico) ([Markdown](https://carelu.com/payers/presbyterian-health-plan-new-mexico.md)) — Medicaid managed care plan (MCO). State criteria with its own Stage 3 review forms; Medicaid BH fax (505) 843-3019 — not Magellan. Prior auth: assessment Required; treatment Required on every ABA treatment code. - [UnitedHealthcare Community Plan of New Mexico (Turquoise Care)](https://carelu.com/payers/unitedhealthcare-community-plan-new-mexico) ([Markdown](https://carelu.com/payers/unitedhealthcare-community-plan-new-mexico.md)) — Medicaid managed care plan (MCO). Optum-run ABA; PA only on 97153 & 0373T; Provider Express; 6-month claim deadline. Prior auth: assessment Not required; treatment Required only for 97153 and 0373T. - [Aetna in New Mexico](https://carelu.com/payers/aetna-new-mexico) ([Markdown](https://carelu.com/payers/aetna-new-mexico.md)) — Commercial insurance. CPB 0554 (ABA) + CPB 0648 (ASD) + the NMSA § 59A-22-49 mandate layer. Prior auth: assessment Required; treatment see guide. - [Cigna / Evernorth in New Mexico](https://carelu.com/payers/cigna-new-mexico) ([Markdown](https://carelu.com/payers/cigna-new-mexico.md)) — Commercial insurance. EN0499 + autism resource guide + the NMSA § 59A-22-49 mandate layer. Prior auth: assessment Not required for assessment codes 97151, 97152, 0362T; treatment Required. - [UnitedHealthcare / Optum in New Mexico](https://carelu.com/payers/unitedhealthcare-new-mexico) ([Markdown](https://carelu.com/payers/unitedhealthcare-new-mexico.md)) — Commercial insurance. Optum criteria (BH803ABASCC) + the NMSA § 59A-22-49 mandate + a Turquoise Care plan. Prior auth: assessment Required; treatment Required. ## New York (NY) State autism mandate: NY autism mandate (Ins. Law §§ 3216(i)(25), 3221(l)(17), 4303(ee)) - [New York Medicaid (NYS DOH / eMedNY)](https://carelu.com/payers/new-york-medicaid) ([Markdown](https://carelu.com/payers/new-york-medicaid.md)) — State Medicaid program. Under 21, ASD/Rett; FFS has NO prior auth (referral only) — but most kids sit in MCOs that do. Prior auth: assessment FFS: NO prior authorization; treatment FFS: none stated. - [Anthem Blue Cross and Blue Shield HP (NY Medicaid)](https://carelu.com/payers/anthem-healthplus-new-york) ([Markdown](https://carelu.com/payers/anthem-healthplus-new-york.md)) — Medicaid managed care plan (MCO). Treatment Plan Request Form via Availity; Comprehensive-vs-Focused framing; incomplete forms returned. Prior auth: assessment Required; treatment Required. - [CDPHP (NY Medicaid)](https://carelu.com/payers/cdphp-new-york) ([Markdown](https://carelu.com/payers/cdphp-new-york.md)) — Medicaid managed care plan (MCO). Capital District plan; ABA codes named in-house at CDPHP's own Behavioral Health Access Center — but PA specifics and limits sit behind the secure portal. - [EmblemHealth (NY Medicaid)](https://carelu.com/payers/emblemhealth-new-york) ([Markdown](https://carelu.com/payers/emblemhealth-new-york.md)) — Medicaid managed care plan (MCO). Published ABA content restates the state criteria verbatim; PA specifics unpublished — verify. - [Excellus BlueCross BlueShield (NY Medicaid)](https://carelu.com/payers/excellus-bcbs-new-york) ([Markdown](https://carelu.com/payers/excellus-bcbs-new-york.md)) — Medicaid managed care plan (MCO). Central/Western NY + Southern Tier; own named ABA medical policy (3.01.11) — but outpatient PA specifics sit behind the portal login. - [Fidelis Care New York (Centene)](https://carelu.com/payers/fidelis-care-new-york) ([Markdown](https://carelu.com/payers/fidelis-care-new-york.md)) — Medicaid managed care plan (MCO). Largest NY plan; full Centene-style policy: named instruments, graphs, 6-month reauth cycle. Prior auth: assessment Authorization-based; treatment Required. - [Healthfirst (New York)](https://carelu.com/payers/healthfirst-new-york) ([Markdown](https://carelu.com/payers/healthfirst-new-york.md)) — Medicaid managed care plan (MCO). Own ABA authorization policy; PA routed through Availity Essentials — policy text unpublished, verify. - [Highmark Western and Northeastern New York (NY Medicaid)](https://carelu.com/payers/highmark-western-new-york) ([Markdown](https://carelu.com/payers/highmark-western-new-york.md)) — Medicaid managed care plan (MCO). 8 WNY counties; ABA requires authorization and carries a stated $45,000/year cap — delegate is Wellpoint Partnership Plan (a Carelon mention in the same manual is unresolved). Prior auth: assessment Required; treatment Required. - [Independent Health (NY Medicaid)](https://carelu.com/payers/independent-health-new-york) ([Markdown](https://carelu.com/payers/independent-health-new-york.md)) — Medicaid managed care plan (MCO). Erie County/Buffalo only (not Monroe); Carelon runs general BH, but ABA looks to be administered directly by Independent Health — confirm which before routing a case. - [MetroPlusHealth (NY Medicaid)](https://carelu.com/payers/metroplus-health-new-york) ([Markdown](https://carelu.com/payers/metroplus-health-new-york.md)) — Medicaid managed care plan (MCO). NYC H+H plan; ABA auth by fax, email or provider portal; Medicaid follows the state 2-year referral; the annual diagnosis re-validation applies to its marketplace (QHP) line. Prior auth: assessment see guide; treatment Required. - [Molina Healthcare of New York](https://carelu.com/payers/molina-healthcare-new-york) ([Markdown](https://carelu.com/payers/molina-healthcare-new-york.md)) — Medicaid managed care plan (MCO). Ex-Affinity; ABA PA named on 97151/97152/97153/97155; new clinical policy MCP 482 and weekly unit billing from 9/15/2026. Prior auth: assessment Required; treatment Required. - [MVP Health Plan (NY Medicaid)](https://carelu.com/payers/mvp-health-plan-new-york) ([Markdown](https://carelu.com/payers/mvp-health-plan-new-york.md)) — Medicaid managed care plan (MCO). In-house BH/ABA UM; PA required for both assessment and treatment — but 0362T/0373T are excluded from Medicaid Managed Care reimbursement. Prior auth: assessment Required; treatment Required. - [UnitedHealthcare Community Plan of New York](https://carelu.com/payers/unitedhealthcare-community-plan-new-york) ([Markdown](https://carelu.com/payers/unitedhealthcare-community-plan-new-york.md)) — Medicaid managed care plan (MCO). State-baseline clinical criteria, but ALL ABA services are PA-gated through Optum's Provider Express. Prior auth: assessment Required; treatment Required. - [Aetna in New York](https://carelu.com/payers/aetna-new-york) ([Markdown](https://carelu.com/payers/aetna-new-york.md)) — Commercial insurance. Aetna ABA Medical Necessity Guide + CPB 0648 (ASD) + the NY autism mandate: no ABA-only visit caps, no age limit, LBA-only. Prior auth: assessment Required; treatment Required. - [Anthem BCBS New York (formerly Empire)](https://carelu.com/payers/anthem-bcbs-new-york) ([Markdown](https://carelu.com/payers/anthem-bcbs-new-york.md)) — Commercial insurance. The 680-hour cap was repealed in 2020; Empire is now Anthem; 28-county service area. Prior auth: assessment Required; treatment Required. - [Cigna / Evernorth in New York](https://carelu.com/payers/cigna-new-york) ([Markdown](https://carelu.com/payers/cigna-new-york.md)) — Commercial insurance. EN0499 + autism resource guide + the NY mandate: no ABA-only visit caps, no age limit, LBA-only. Prior auth: assessment Not required for assessment codes 97151, 97152, 0362T; treatment Required. - [Martin’s Point US Family Health Plan](https://carelu.com/payers/martins-point-usfhp) ([Markdown](https://carelu.com/payers/martins-point-usfhp.md)) — Commercial insurance. TRICARE Prime designated provider across northern New England, upstate NY, northern PA and Ohio — administers the ACD directly. Prior auth: assessment Required; treatment Required. - [UnitedHealthcare / Optum in New York](https://carelu.com/payers/unitedhealthcare-new-york) ([Markdown](https://carelu.com/payers/unitedhealthcare-new-york.md)) — Commercial insurance. Optum Supplemental Clinical Criteria (BH803ABASCC) + the NY mandate: no ABA-only visit caps, no age limit, LBA-only. Prior auth: assessment Required; treatment Required. ## North Carolina (NC) State autism mandate: N.C.G.S. § 58-3-192 (autism coverage) - [North Carolina Medicaid](https://carelu.com/payers/north-carolina-medicaid) ([Markdown](https://carelu.com/payers/north-carolina-medicaid.md)) — State Medicaid program. RB-BHT under CCP 8F: PA on everything, tiered 180/90-day auths, published rates, HB 696 shakeup. Prior auth: assessment Required; treatment Required. - [Alliance Health (NC Tailored Plan)](https://carelu.com/payers/alliance-health-north-carolina) ([Markdown](https://carelu.com/payers/alliance-health-north-carolina.md)) — Medicaid managed care plan (MCO). Tailored Plan publishing real rates + the strictest diagnostic-tool and service-order enforcement. Prior auth: assessment Required; treatment see guide. - [AmeriHealth Caritas North Carolina](https://carelu.com/payers/amerihealth-caritas-north-carolina) ([Markdown](https://carelu.com/payers/amerihealth-caritas-north-carolina.md)) — Medicaid managed care plan (MCO). CCP 8F deference; NaviNet + PA Lookup Tool; thinnest public paper trail of the NC plans. - [Carolina Complete Health](https://carelu.com/payers/carolina-complete-health) ([Markdown](https://carelu.com/payers/carolina-complete-health.md)) — Medicaid managed care plan (MCO). Explicit CCP 8F deference + an ABA treatment-request checklist; statewide since 4/1/2026 (absorbed WellCare NC). Prior auth: assessment Required; treatment Required. - [Healthy Blue (NC)](https://carelu.com/payers/healthy-blue-north-carolina) ([Markdown](https://carelu.com/payers/healthy-blue-north-carolina.md)) — Medicaid managed care plan (MCO). Straight CCP 8F via Availity/ICR; RB-BHT exempt from network distance rules; CFSP sibling plan. Prior auth: assessment Required; treatment Required. - [Partners Health Management (NC Tailored Plan)](https://carelu.com/payers/partners-health-management) ([Markdown](https://carelu.com/payers/partners-health-management.md)) — Medicaid managed care plan (MCO). Merged into Vaya Partners on 10/1/2026; legacy Partners issued one ALL-codes RB-BHT authorization via ProAuth. Prior auth: assessment Required; treatment Required. - [Trillium Health Resources (NC Tailored Plan)](https://carelu.com/payers/trillium-health-resources) ([Markdown](https://carelu.com/payers/trillium-health-resources.md)) — Medicaid managed care plan (MCO). Tailored Plan with the best single reference doc: tiered 180/90-day TARs, adult coverage, GT/KX modifier rules. Prior auth: assessment Required; treatment Required. - [UnitedHealthcare Community Plan of North Carolina](https://carelu.com/payers/unitedhealthcare-community-plan-north-carolina) ([Markdown](https://carelu.com/payers/unitedhealthcare-community-plan-north-carolina.md)) — Medicaid managed care plan (MCO). The Optum carve-out: separate assessment & treatment auths on Provider Express, own criteria. Prior auth: assessment Required; treatment Required. - [Vaya Health (NC Tailored Plan)](https://carelu.com/payers/vaya-health) ([Markdown](https://carelu.com/payers/vaya-health.md)) — Medicaid managed care plan (MCO). Western-NC Tailored Plan, now Vaya Partners (merged with Partners 10/1/2026); 8F via SARs in ProviderCONNECT — key documents must be pulled manually. Prior auth: assessment Required; treatment Required. - [WellCare of North Carolina](https://carelu.com/payers/wellcare-north-carolina) ([Markdown](https://carelu.com/payers/wellcare-north-carolina.md)) — Medicaid managed care plan (MCO). MERGED into Carolina Complete Health effective 4/1/2026 — no longer a standalone Standard Plan. Prior auth: assessment see guide; treatment Required. - [Aetna in North Carolina](https://carelu.com/payers/aetna-north-carolina) ([Markdown](https://carelu.com/payers/aetna-north-carolina.md)) — Commercial insurance. CPB 0554 (ABA) + CPB 0648 (ASD) + the N.C.G.S. § 58-3-192 mandate layer. Prior auth: assessment Required; treatment see guide. - [Blue Cross Blue Shield of North Carolina](https://carelu.com/payers/blue-cross-north-carolina) ([Markdown](https://carelu.com/payers/blue-cross-north-carolina.md)) — Commercial insurance. Blue Cross NC commercial plans. Benefits and eligibility come from the Blue e portal, not the phone (line closed 9/1/2026); ABA runs under the Adaptive Behavioral Treatment policy with prior authorization after the initial evaluation. Prior auth: assessment Not required for the initial evaluation; treatment Required. - [Cigna / Evernorth in North Carolina](https://carelu.com/payers/cigna-north-carolina) ([Markdown](https://carelu.com/payers/cigna-north-carolina.md)) — Commercial insurance. EN0499 + autism resource guide + the N.C.G.S. § 58-3-192 mandate layer. Prior auth: assessment Not required for assessment codes 97151, 97152, 0362T; treatment Required. - [MedCost Benefit Services](https://carelu.com/payers/medcost) ([Markdown](https://carelu.com/payers/medcost.md)) — Commercial insurance. Carolinas self-funded plan administrator and network. The ID card shows whether precert applies; ABA codes 97153–97158 are on its outpatient-review list. - [UnitedHealthcare / Optum in North Carolina](https://carelu.com/payers/unitedhealthcare-north-carolina) ([Markdown](https://carelu.com/payers/unitedhealthcare-north-carolina.md)) — Commercial insurance. Optum Supplemental Clinical Criteria (BH803ABASCC) + the N.C.G.S. § 58-3-192 mandate layer. Prior auth: assessment Required; treatment Required. ## North Dakota (ND) State autism mandate: No autism statute — Insurance Dept. Bulletin 2018-1 (insured plans may not exclude ABA as experimental; federal parity limits) - [North Dakota Medicaid](https://carelu.com/payers/north-dakota-medicaid) ([Markdown](https://carelu.com/payers/north-dakota-medicaid.md)) — State Medicaid program. ABA is a fee-for-service state plan benefit through age 20: a prior approval letter, then web service authorizations twice a year; rates published. Prior auth: assessment Required; treatment Required. - [Aetna in North Dakota](https://carelu.com/payers/aetna-north-dakota) ([Markdown](https://carelu.com/payers/aetna-north-dakota.md)) — Commercial insurance. Aetna’s national ABA guide and precert list + North Dakota’s Bulletin 2018-1 (no autism statute) and behavior-analyst licensure. Prior auth: assessment Required: all ten ABA codes, 97151 included, are on Aetna’s behavioral health precertification list; treatment see guide. - [Blue Cross Blue Shield of North Dakota](https://carelu.com/payers/blue-cross-blue-shield-north-dakota) ([Markdown](https://carelu.com/payers/blue-cross-blue-shield-north-dakota.md)) — Commercial insurance. The dominant ND carrier: ABA rules sit behind a member-specific PA tool; Bulletin 2018-1 bars excluding ABA as experimental; 12-month filing. - [Cigna / Evernorth in North Dakota](https://carelu.com/payers/cigna-north-dakota) ([Markdown](https://carelu.com/payers/cigna-north-dakota.md)) — Commercial insurance. EN0499 + autism resource guide; in North Dakota Cigna’s behavioral network is contracted through HealthPartners; Bulletin 2018-1 layer. Prior auth: assessment Not required for 97151, 97152 and 0362T with an autism diagnosis when the provider is independently licensed…; treatment Required: the completed assessment and treatment plan go with the ABA prior authorization request. - [UnitedHealthcare / Optum in North Dakota](https://carelu.com/payers/unitedhealthcare-north-dakota) ([Markdown](https://carelu.com/payers/unitedhealthcare-north-dakota.md)) — Commercial insurance. Optum criteria (BH803ABASCC) and two-step authorization; no North Dakota state supplement; Bulletin 2018-1 and ND licensure layer. Prior auth: assessment Required: Optum’s ABA Supplemental Clinical Criteria say "Prior authorization is required for ABA" unless…; treatment see guide. ## Ohio (OH) State autism mandate: Ohio autism insurance mandate (R.C. 3923.84) - [Ohio Medicaid](https://carelu.com/payers/ohio-medicaid) ([Markdown](https://carelu.com/payers/ohio-medicaid.md)) — State Medicaid program. OAC 5160-34: all-PA ABA, 6-month reviews, published rates, and the OhioRISE carve-out myth. - [AmeriHealth Caritas Ohio](https://carelu.com/payers/amerihealth-caritas-ohio) ([Markdown](https://carelu.com/payers/amerihealth-caritas-ohio.md)) — Medicaid managed care plan (MCO). State-rule-driven UM; NaviNet/Jiva workflow — thinnest public ABA paper trail of the OH plans. Prior auth: assessment see guide; treatment Required. - [Anthem BCBS Ohio (Medicaid)](https://carelu.com/payers/anthem-ohio-medicaid) ([Markdown](https://carelu.com/payers/anthem-ohio-medicaid.md)) — Medicaid managed care plan (MCO). CG-BEH-02 adopted on top of the state rule; Availity/ICR, EPSDT framing in the provider manual. - [Buckeye Health Plan (OH)](https://carelu.com/payers/buckeye-health-plan) ([Markdown](https://carelu.com/payers/buckeye-health-plan.md)) — Medicaid managed care plan (MCO). In-network assessments PA-free; CP.BH.104 hour parameters (6/day, 30/wk) and school rules. Prior auth: assessment Not required in-network; treatment Required. - [CareSource Ohio](https://carelu.com/payers/caresource-ohio) ([Markdown](https://carelu.com/payers/caresource-ohio.md)) — Medicaid managed care plan (MCO). The strictest OH policy: named diagnostician specialties, ADOS/ADI-R/CARS-2, docs-before-claims. Prior auth: assessment Required; treatment Required. - [Humana Healthy Horizons in Ohio](https://carelu.com/payers/humana-healthy-horizons-ohio) ([Markdown](https://carelu.com/payers/humana-healthy-horizons-ohio.md)) — Medicaid managed care plan (MCO). Cleanest all-codes PA statement in Ohio; state-policy criteria plus Availity logistics. Prior auth: assessment Required; treatment Required. - [Molina Healthcare of Ohio](https://carelu.com/payers/molina-healthcare-ohio) ([Markdown](https://carelu.com/payers/molina-healthcare-ohio.md)) — Medicaid managed care plan (MCO). Tracks state ABA policy; Availity-only PA since 1/2026 — key documents best pulled via portal. - [UnitedHealthcare Community Plan of Ohio](https://carelu.com/payers/unitedhealthcare-community-plan-ohio) ([Markdown](https://carelu.com/payers/unitedhealthcare-community-plan-ohio.md)) — Medicaid managed care plan (MCO). Optum's OH supplemental criteria: 80% utilization trigger, tool lists, Provider Type 19 detail. Prior auth: assessment see guide; treatment Required. - [Aetna in Ohio](https://carelu.com/payers/aetna-ohio) ([Markdown](https://carelu.com/payers/aetna-ohio.md)) — Commercial insurance. CPB 0554 (ABA) + CPB 0648 (ASD) + the Ohio R.C. § 3923.84 mandate layer. Prior auth: assessment Required; treatment see guide. - [Anthem BCBS Ohio](https://carelu.com/payers/anthem-bcbs-ohio) ([Markdown](https://carelu.com/payers/anthem-bcbs-ohio.md)) — Commercial insurance. 20 hrs/week is a floor, not a cap; individual and small-group plans are carved out; COBA required. Prior auth: assessment Required; treatment Required. - [Cigna / Evernorth in Ohio](https://carelu.com/payers/cigna-ohio) ([Markdown](https://carelu.com/payers/cigna-ohio.md)) — Commercial insurance. EN0499 + autism resource guide + the Ohio R.C. § 3923.84 mandate layer. Prior auth: assessment Not required for assessment codes 97151, 97152, 0362T; treatment Required. - [UnitedHealthcare / Optum in Ohio](https://carelu.com/payers/unitedhealthcare-ohio) ([Markdown](https://carelu.com/payers/unitedhealthcare-ohio.md)) — Commercial insurance. Optum Supplemental Clinical Criteria (BH803ABASCC) + the Ohio R.C. § 3923.84 mandate layer. Prior auth: assessment Required; treatment Required. ## Oklahoma (OK) State autism mandate: Nick’s Law (36 O.S. § 6060.21; age and hour caps removed 2022) - [Oklahoma Medicaid (SoonerCare / SoonerSelect) - Oklahoma Health Care Authority](https://carelu.com/payers/oklahoma-medicaid) ([Markdown](https://carelu.com/payers/oklahoma-medicaid.md)) — State Medicaid program. SoonerCare/SoonerSelect, under 21. OHCA pays four ABA codes, prior-authorizes everything, opens extensions only 7 days out and cuts hours when parent training lapses. Prior auth: assessment Required; treatment Required. - [Aetna Better Health of Oklahoma](https://carelu.com/payers/aetna-better-health-oklahoma) ([Markdown](https://carelu.com/payers/aetna-better-health-oklahoma.md)) — Medicaid managed care plan (MCO). SoonerSelect MCO. Delivers the SoonerCare ABA benefit; its August 2026 manual adds ABA parameters: 10% case supervision, 97153 up to 6 hrs/day or 30 hrs/week, 97151-TS reassessment. Prior auth: assessment see guide; treatment Required. - [Centene - Oklahoma Complete Health](https://carelu.com/payers/oklahoma-complete-health) ([Markdown](https://carelu.com/payers/oklahoma-complete-health.md)) — Medicaid managed care plan (MCO). SoonerSelect MCO (Centene) and the only Children’s Specialty Program plan. OK.CP.BH.500 adopts OHCA’s ABA rules; 10% case supervision since 6/30/2026. Prior auth: assessment Required; treatment Required for 97153, 97155 and 97156 for all providers. - [Humana Healthy Horizons in Oklahoma](https://carelu.com/payers/humana-healthy-horizons-oklahoma) ([Markdown](https://carelu.com/payers/humana-healthy-horizons-oklahoma.md)) — Medicaid managed care plan (MCO). SoonerSelect MCO. Follows OHCA’s Part 30; PA on 97151/97153/97155/97156, 24-unit initial assessment, 10% case supervision from 10/12/2026. Prior auth: assessment Required; treatment Required. - [Aetna in Oklahoma](https://carelu.com/payers/aetna-oklahoma) ([Markdown](https://carelu.com/payers/aetna-oklahoma.md)) — Commercial insurance. CPB 0554 + the ABA medical necessity guide + Nick’s Law (36 O.S. § 6060.21): no age limit, no hour cap on insured plans. Prior auth: assessment Required; treatment Required. - [Blue Cross and Blue Shield of Oklahoma](https://carelu.com/payers/blue-cross-blue-shield-oklahoma) ([Markdown](https://carelu.com/payers/blue-cross-blue-shield-oklahoma.md)) — Commercial insurance. HCSC Blue plan: MCG criteria since 1/1/2026, phone intake for ABA since April 2026, CPCP011 billing rules, 36-month dx window. Prior auth: assessment Not on the PA code list; treatment Required. - [Cigna / Evernorth in Oklahoma](https://carelu.com/payers/cigna-oklahoma) ([Markdown](https://carelu.com/payers/cigna-oklahoma.md)) — Commercial insurance. EN0499 + the Evernorth autism resource guide + Nick’s Law: no PA on assessment codes, all ABA codes payable by telehealth. Prior auth: assessment Not required for 97151, 97152 or 0362T "with a diagnosis of autism, as long as the provider is independently…; treatment Required. - [UnitedHealthcare in Oklahoma](https://carelu.com/payers/unitedhealthcare-oklahoma) ([Markdown](https://carelu.com/payers/unitedhealthcare-oklahoma.md)) — Commercial insurance. Optum ABA criteria (BH803ABASCC) + Nick’s Law: assessment and treatment both authorized, concurrent 97153/97155 billable. Prior auth: assessment Required; treatment Required. ## Oregon (OR) State autism mandate: Oregon Laws 2013, ch. 771, § 2 (ABA up to 25 hr/wk, first requested under 9) + ORS 743A.168 parity - [Oregon Health Plan (Medicaid)](https://carelu.com/payers/oregon-medicaid) ([Markdown](https://carelu.com/payers/oregon-medicaid.md)) — State Medicaid program. OHP covers ABA (HERC Line 192, Guideline Note 75) mostly through 12 CCOs; FFS needs PA on treatment codes but not on 97151/97152, and rates are published. Prior auth: assessment Fee-for-service (open card): no; treatment Fee-for-service: yes for 97153–97157 (fee schedule "PA"). - [Advanced Health](https://carelu.com/payers/advanced-health) ([Markdown](https://carelu.com/payers/advanced-health.md)) — Medicaid managed care plan (MCO). Coos and Curry County CCO: ABA requests go on its Behavioral Health Authorization form; 7-day decisions; 120-day timely filing. - [AllCare CCO](https://carelu.com/payers/allcare-cco) ([Markdown](https://carelu.com/payers/allcare-cco.md)) — Medicaid managed care plan (MCO). Southern Oregon CCO (Curry, Jackson, Josephine, south Douglas): no ABA policy published; ABA paid at least the OHA FFS rate; OHP rules apply. - [Cascade Health Alliance](https://carelu.com/payers/cascade-health-alliance) ([Markdown](https://carelu.com/payers/cascade-health-alliance.md)) — Medicaid managed care plan (MCO). Klamath County CCO: ABA for ASD needs PA every 6 months on 97151–97156 (BH auth grid, 6/24/2026); 7-day decisions; 120-day filing. Prior auth: assessment Yes: CHA’s BH Auth Grid (6/24/2026) requires "PA every 6 months for codes: 97151, 97152, 97153, 97154, 97155,…; treatment Yes: same grid row, PA every six months for 97153–97156. - [Columbia Pacific CCO](https://carelu.com/payers/columbia-pacific-cco) ([Markdown](https://carelu.com/payers/columbia-pacific-cco.md)) — Medicaid managed care plan (MCO). Clatsop/Columbia/Tillamook CCO (CareOregon): ABA assessments approved without clinical documentation; treatment PA; 7-day decisions. Prior auth: assessment An authorization is submitted, but CareOregon approves ABA assessment requests for CPCCO members "without the…; treatment Yes, via CareOregon Connect or fax, with a comprehensive treatment plan and units for a six-month…. - [Eastern Oregon CCO (EOCCO)](https://carelu.com/payers/eastern-oregon-cco) ([Markdown](https://carelu.com/payers/eastern-oregon-cco.md)) — Medicaid managed care plan (MCO). 12-county eastern Oregon CCO (Moda/GOBHI): every ABA code 97151–97158 on the September 2026 PA list; GOBHI runs an ABA program with a PCP-prescription front door. Prior auth: assessment Yes: EOCCO’s Prior Authorization List (September 2026) lists 97151 through 97158 "Applied Behavior Analysis…; treatment Yes: the same list covers 97153–97158. - [Health Share of Oregon](https://carelu.com/payers/health-share-of-oregon) ([Markdown](https://carelu.com/payers/health-share-of-oregon.md)) — Medicaid managed care plan (MCO). Portland-metro CCO; CareOregon runs its behavioral health UM: PA for the ABA assessment and treatment, ADOS/CARS-2, Medical Director review at 13+ or over 25 hours. Prior auth: assessment Required; treatment Yes, via CareOregon Connect or fax, with a comprehensive treatment plan. - [InterCommunity Health Network CCO (IHN-CCO)](https://carelu.com/payers/intercommunity-health-network-cco) ([Markdown](https://carelu.com/payers/intercommunity-health-network-cco.md)) — Medicaid managed care plan (MCO). Benton/Lincoln/Linn CCO (Samaritan): every ABA code including 97151 on the 2026 PA code list; ABA rates kept at or above OHA FFS. Prior auth: assessment Yes: IHN’s 2026 Prior Authorization Code List puts 97151 and 97152 under "Applied Behavioral therapy (ABA)…; treatment Yes: 97153–97157 (and 99366/99368) are on the same 2026 code list. - [Jackson Care Connect](https://carelu.com/payers/jackson-care-connect) ([Markdown](https://carelu.com/payers/jackson-care-connect.md)) — Medicaid managed care plan (MCO). Jackson County CCO (CareOregon): ABA assessments approved without clinical documentation; treatment PA with a full plan; 7-day decisions. Prior auth: assessment An authorization is submitted, but CareOregon approves ABA assessment requests for JCC members "without the…; treatment Yes, via CareOregon Connect or fax, with a comprehensive treatment plan and units for a six-month…. - [PacificSource Community Solutions (Oregon)](https://carelu.com/payers/pacificsource-community-solutions-oregon) ([Markdown](https://carelu.com/payers/pacificsource-community-solutions-oregon.md)) — Medicaid managed care plan (MCO). CCO for Central Oregon, Columbia Gorge and Marion-Polk with a written Medicaid ABA policy: no PA for 97151 up to 32 units, six-month treatment PAs. Prior auth: assessment Not for a standard assessment: PA "is not required if CPT code 97151 is billed for 32 or fewer units (8 hours…; treatment Yes: "Prior Authorization is required for ABA services," requested in increments of up to six months. - [Trillium Community Health Plan (Oregon)](https://carelu.com/payers/trillium-community-health-plan-oregon) ([Markdown](https://carelu.com/payers/trillium-community-health-plan-oregon.md)) — Medicaid managed care plan (MCO). Centene CCO for Lane and the Portland tri-county area: code-level PA tool, an ABA request checklist, 7-day decisions and 180-day dispute window. Prior auth: assessment see guide; treatment Yes: ABA treatment goes through Trillium’s prior-authorization process with its Applied Behavioral Analysis…. - [Umpqua Health Alliance](https://carelu.com/payers/umpqua-health-alliance) ([Markdown](https://carelu.com/payers/umpqua-health-alliance.md)) — Medicaid managed care plan (MCO). Douglas County CCO: ABA on its behavioral health PA list with six-month authorizations; InterQual plus the Prioritized List; 90-day retro window. Prior auth: assessment see guide; treatment Yes: ABA is listed as an in-network behavioral health service requiring PA, authorized for six months at a…. - [Yamhill Community Care (YCCO)](https://carelu.com/payers/yamhill-community-care) ([Markdown](https://carelu.com/payers/yamhill-community-care.md)) — Medicaid managed care plan (MCO). Yamhill County CCO: PA on 97151–97156, 97158, 0362T, 0373T; its own ABA PA form caps the initial 97151 at 32 units and asks for program setting. Prior auth: assessment Yes: YCCO’s PA list (as of 1/29/2026) carries 97151, 97152 and 0362T as active "Applied Behavioral Analysis"…; treatment Yes: 97153–97156, 97158 and 0373T are on the PA list. - [Aetna in Oregon](https://carelu.com/payers/aetna-oregon) ([Markdown](https://carelu.com/payers/aetna-oregon.md)) — Commercial insurance. Aetna’s national ABA guide and precert list + Oregon’s 2013 ABA mandate (under 9 at first request, up to 25 hrs/wk) and ORS 743A.168 parity. Prior auth: assessment Required: all ten ABA codes, 97151 included, are on Aetna’s behavioral health precertification list; treatment see guide. - [Cigna / Evernorth in Oregon](https://carelu.com/payers/cigna-oregon) ([Markdown](https://carelu.com/payers/cigna-oregon.md)) — Commercial insurance. Evernorth EN0499 (eff. 5/15/2026) + Oregon’s 2013 ABA mandate and ORS 743A.168 parity; Oregon addendum sets 90-day credentialing. - [Regence BlueCross BlueShield of Oregon](https://carelu.com/payers/regence-bluecross-blueshield-of-oregon) ([Markdown](https://carelu.com/payers/regence-bluecross-blueshield-of-oregon.md)) — Commercial insurance. Oregon’s dominant Blue: Regence BH18/BH33 (prescription, ITP, standardized assessment) on contracts subject to preauthorization + Oregon’s mandate and parity law. - [UnitedHealthcare / Optum in Oregon](https://carelu.com/payers/unitedhealthcare-oregon) ([Markdown](https://carelu.com/payers/unitedhealthcare-oregon.md)) — Commercial insurance. Optum ABA criteria (BH803ABASCC) + Oregon’s 2013 ABA mandate and ORS 743A.168 parity; no Oregon state supplement; telehealth limited to 97155–97157. Prior auth: assessment Required: the Optum ABA Supplemental Clinical Criteria say "Prior authorization is required for ABA" unless…; treatment see guide. ## Pennsylvania (PA) State autism mandate: Act 62 of 2008 (40 P.S. § 764h; under 21, CPI-adjusted cap $51,908 for 2026) - [Pennsylvania Medicaid (Medical Assistance)](https://carelu.com/payers/pennsylvania-medicaid) ([Markdown](https://carelu.com/payers/pennsylvania-medicaid.md)) — State Medicaid program. ABA runs as IBHS through five county-assigned BH-MCOs; under 21, any BH diagnosis, written order within 12 months. Prior auth: assessment Fee-for-service: not required; treatment Fee-for-service: required for BHT-ABA (97153, 97152) and Assistant BC-ABA (97153 U8, 97152 U8) and group ABA…. - [Carelon Health of Pennsylvania (HealthChoices BH-MCO; formerly Beacon / Value Behavioral Health)](https://carelu.com/payers/carelon-behavioral-health-pennsylvania) ([Markdown](https://carelu.com/payers/carelon-behavioral-health-pennsylvania.md)) — Medicaid managed care plan (MCO). HealthChoices BH-MCO, 11 western counties; IBHS ABA — no PA on the assessment, 180-day treatment auths, Act 62 cover sheet. Prior auth: assessment No; treatment Required. - [Community Behavioral Health (CBH) — Philadelphia HealthChoices BH-MCO](https://carelu.com/payers/community-behavioral-health-philadelphia) ([Markdown](https://carelu.com/payers/community-behavioral-health-philadelphia.md)) — Medicaid managed care plan (MCO). Philadelphia’s BH-MCO; ABA needs PA (initial on a written order only); 6-month cap, 2 caregiver goals, 32 BHT units/day since 2025. Prior auth: assessment Yes, but on a written order alone; treatment Required. - [Community Care Behavioral Health Organization (HealthChoices BH-MCO)](https://carelu.com/payers/community-care-behavioral-health-pennsylvania) ([Markdown](https://carelu.com/payers/community-care-behavioral-health-pennsylvania.md)) — Medicaid managed care plan (MCO). BH-MCO for 41 PA counties; order + assessment registered in ePortal, ABA treatment by packet PA; 6-month auth cap from 9/17/2026. Prior auth: assessment No prior authorization; treatment Required. - [Magellan Behavioral Health of Pennsylvania (HealthChoices BH-MCO)](https://carelu.com/payers/magellan-behavioral-health-pennsylvania) ([Markdown](https://carelu.com/payers/magellan-behavioral-health-pennsylvania.md)) — Medicaid managed care plan (MCO). HealthChoices BH-MCO, 7 counties; IBHS ABA — 97151 registration (96 units/45 days), 6-month treatment auths via Availity. Prior auth: assessment Registration only; treatment Required. - [PerformCare (HealthChoices BH-MCO, AmeriHealth Caritas family)](https://carelu.com/payers/performcare-pennsylvania) ([Markdown](https://carelu.com/payers/performcare-pennsylvania.md)) — Medicaid managed care plan (MCO). HealthChoices BH-MCO, 7 counties; IBHS ABA — 97151 registration in Jiva, 12-month auths, 97153+97155 concurrent billing allowed. Prior auth: assessment Registration only; treatment Required. - [Aetna in Pennsylvania](https://carelu.com/payers/aetna-pennsylvania) ([Markdown](https://carelu.com/payers/aetna-pennsylvania.md)) — Commercial insurance. Aetna ABA medical necessity guide + CPB 0648/0554 + BH precertification list, layered on Pennsylvania’s Act 62 mandate. Prior auth: assessment Required; treatment Required. - [Capital Blue Cross in Pennsylvania](https://carelu.com/payers/capital-blue-cross-pennsylvania) ([Markdown](https://carelu.com/payers/capital-blue-cross-pennsylvania.md)) — Commercial insurance. Central PA and Lehigh Valley Blue Cross plan: preauthorization for 97151–97158 and 0362T/0373T; ABA was removed from its ASD medical policy in 2023. Prior auth: assessment Required for Commercial/CHIP; treatment Required. - [Cigna / Evernorth in Pennsylvania](https://carelu.com/payers/cigna-pennsylvania) ([Markdown](https://carelu.com/payers/cigna-pennsylvania.md)) — Commercial insurance. Evernorth EN0499 + the autism resource guide (no PA on assessment codes), layered on Pennsylvania’s Act 62 mandate. Prior auth: assessment Not required for assessment codes 97151, 97152 or 0362T with an autism diagnosis, if the provider is…; treatment Required. - [Geisinger Health Plan in Pennsylvania](https://carelu.com/payers/geisinger-health-plan-pennsylvania) ([Markdown](https://carelu.com/payers/geisinger-health-plan-pennsylvania.md)) — Commercial insurance. Central/NE PA plan: MP232 applies the 2017 OMHSAS ABA guideline; in-network ABA for autism no longer needs prior authorization. Prior auth: assessment Not required in network for autism; treatment Not required in network for ASD. - [Highmark Blue Cross Blue Shield in Pennsylvania](https://carelu.com/payers/highmark-pennsylvania) ([Markdown](https://carelu.com/payers/highmark-pennsylvania.md)) — Commercial insurance. Medical Policy V-37 (ASD/ABA) + all ABA codes on the prior-auth list since March 1, 2026, managed in-house by Highmark Behavioral Health. Prior auth: assessment Required; treatment Required. - [Independence Blue Cross in Pennsylvania](https://carelu.com/payers/independence-blue-cross-pennsylvania) ([Markdown](https://carelu.com/payers/independence-blue-cross-pennsylvania.md)) — Commercial insurance. Southeastern PA Blue plan: ABA policy 14.00.03b, in-house Autism Case Management since April 2026 (Magellan out), precert on all ABA codes. Prior auth: assessment Required; treatment Required. - [UnitedHealthcare / Optum in Pennsylvania](https://carelu.com/payers/unitedhealthcare-pennsylvania) ([Markdown](https://carelu.com/payers/unitedhealthcare-pennsylvania.md)) — Commercial insurance. Optum ABA criteria (BH803ABASCC) + Optum’s Pennsylvania Commercial state-mandate entry + Act 62; Optum also runs UHC Community Plan’s PA CHIP ABA network. Prior auth: assessment Required; treatment Required, as a separate treatment authorization on Provider Express. - [UPMC Health Plan in Pennsylvania](https://carelu.com/payers/upmc-health-plan-pennsylvania) ([Markdown](https://carelu.com/payers/upmc-health-plan-pennsylvania.md)) — Commercial insurance. Western/central PA provider-owned plan: BH run in-house by UPMC Health Plan BHS with Community Care; no published ABA policy — verify by phone. ## Rhode Island (RI) State autism mandate: R.I. Gen. Laws ch. 27-20.11 (group plans; until age 15; no dollar cap in current text) - [Rhode Island Medicaid](https://carelu.com/payers/rhode-island-medicaid) ([Markdown](https://carelu.com/payers/rhode-island-medicaid.md)) — State Medicaid program. ABA is a subset of Home Based Therapeutic Services (HBTS) under EPSDT, carved in to three MCOs; billed on HCPCS codes, not 97151–97158. Prior auth: assessment Fee-for-service: no separate assessment PA code; treatment Fee-for-service: yes. - [Neighborhood Health Plan of Rhode Island](https://carelu.com/payers/neighborhood-health-plan-rhode-island) ([Markdown](https://carelu.com/payers/neighborhood-health-plan-rhode-island.md)) — Medicaid managed care plan (MCO). RI Medicaid plan; ABA is a subset of HBTS (HCPCS codes), managed in-house since 9/1/2025; its exchange plans cover ABA to age 20. - [Tufts Health RITogether (Tufts Health Public Plans)](https://carelu.com/payers/tufts-health-ritogether-rhode-island) ([Markdown](https://carelu.com/payers/tufts-health-ritogether-rhode-island.md)) — Medicaid managed care plan (MCO). Point32Health’s RI Medicaid plan: no prior authorization or notification for HBTS or ABA ("Providers just bill"); 90-day filing. Prior auth: assessment No; treatment No. - [UnitedHealthcare Community Plan of Rhode Island](https://carelu.com/payers/unitedhealthcare-community-plan-rhode-island) ([Markdown](https://carelu.com/payers/unitedhealthcare-community-plan-rhode-island.md)) — Medicaid managed care plan (MCO). UHC’s RI Medicaid plan: behavioral health through Optum; HBTS/ABA is a contract benefit but the manual publishes no ABA rules. - [Aetna in Rhode Island](https://carelu.com/payers/aetna-rhode-island) ([Markdown](https://carelu.com/payers/aetna-rhode-island.md)) — Commercial insurance. Aetna’s ABA medical necessity guide + precertification of all ABA codes + Rhode Island’s ch. 27-20.11 mandate (to age 15). Prior auth: assessment Required: all ten ABA codes, 97151 included, are on Aetna’s behavioral health precertification list; treatment see guide. - [Blue Cross & Blue Shield of Rhode Island](https://carelu.com/payers/blue-cross-blue-shield-rhode-island) ([Markdown](https://carelu.com/payers/blue-cross-blue-shield-rhode-island.md)) — Commercial insurance. BCBSRI applies the ch. 27-20.11 mandate with no age limit, lists no ABA preauthorization, and pays every ABA code by telehealth. - [Cigna / Evernorth in Rhode Island](https://carelu.com/payers/cigna-rhode-island) ([Markdown](https://carelu.com/payers/cigna-rhode-island.md)) — Commercial insurance. EN0499 + autism resource guide + Rhode Island’s ch. 27-20.11 mandate (to age 15); no PA on assessment codes; all ABA codes telehealth-eligible. Prior auth: assessment Not required for 97151, 97152 and 0362T with an autism diagnosis when the provider is independently licensed…; treatment Required: completed assessment and treatment plan attached to the Applied Behavior Analysis Prior…. - [UnitedHealthcare / Optum in Rhode Island](https://carelu.com/payers/unitedhealthcare-rhode-island) ([Markdown](https://carelu.com/payers/unitedhealthcare-rhode-island.md)) — Commercial insurance. Optum criteria (BH803ABASCC) + Rhode Island’s ch. 27-20.11 mandate (to age 15); no RI state supplement; telehealth limited to 97155–97157. Prior auth: assessment Required: the ABA Supplemental Clinical Criteria require prior authorization for ABA "unless otherwise…; treatment see guide. ## South Carolina (SC) State autism mandate: Ryan’s Law (S.C. Code § 38-71-280; group plans, dx by age 8, under 16, $73,400 behavioral-therapy cap for 2026) - [South Carolina Healthy Connections Medicaid](https://carelu.com/payers/south-carolina-medicaid) ([Markdown](https://carelu.com/payers/south-carolina-medicaid.md)) — State Medicaid program. Healthy Connections covers ABA under 21 through the ASD Services manual; five MCOs run it for most children, Acentra (QIO) authorizes FFS, and the July 2026 manual narrowed telehealth. Prior auth: assessment Fee-for-service: no; treatment Fee-for-service: yes. - [Absolute Total Care](https://carelu.com/payers/absolute-total-care-south-carolina) ([Markdown](https://carelu.com/payers/absolute-total-care-south-carolina.md)) — Medicaid managed care plan (MCO). Centene’s SC Medicaid plan: PA on every ABA code including 97151, a 7-day decision clock, and an ASD form that wants the supervising provider named. Prior auth: assessment Required; treatment Yes: all ABA codes 97151–97158 are on the list, and the provider manual marks ASD services "Prior…. - [First Choice by Select Health of South Carolina](https://carelu.com/payers/first-choice-select-health-south-carolina) ([Markdown](https://carelu.com/payers/first-choice-select-health-south-carolina.md)) — Medicaid managed care plan (MCO). AmeriHealth Caritas’ SC Medicaid plan: PA on all ASD services incl. assessments, InterQual + the SCDHHS manual, and a diagnostic report from the last year. Prior auth: assessment Yes: "Prior authorization is required for all ASD services, including assessments and treatments"; treatment Yes, through NaviNet or the ASD Treatment Request form faxed to Behavioral Health UM (1-888-796-5521). - [Healthy Blue by BlueChoice HealthPlan](https://carelu.com/payers/healthy-blue-south-carolina) ([Markdown](https://carelu.com/payers/healthy-blue-south-carolina.md)) — Medicaid managed care plan (MCO). BlueChoice HealthPlan’s SC Medicaid plan: PA on all ASD services except diagnostics, the SCDHHS ASD manual as its criteria, and a 14-day PA clock in its manual. Prior auth: assessment see guide; treatment Yes: "Prior authorization for all covered services is required, excluding diagnostic services". - [Humana Healthy Horizons in South Carolina](https://carelu.com/payers/humana-healthy-horizons-south-carolina) ([Markdown](https://carelu.com/payers/humana-healthy-horizons-south-carolina.md)) — Medicaid managed care plan (MCO). Humana’s SC Medicaid plan: follows the SCDHHS ASD manual, an ABA authorization form for 97153/97155/97156, a 7-day clock and one-year filing. Prior auth: assessment see guide; treatment Yes: Humana lists an Applied Behavioral Analysis Authorization Form among its South Carolina behavioral…. - [Molina Healthcare of South Carolina](https://carelu.com/payers/molina-healthcare-south-carolina) ([Markdown](https://carelu.com/payers/molina-healthcare-south-carolina.md)) — Medicaid managed care plan (MCO). Molina’s SC Medicaid plan: ABA on its 2026 pre-service review list, a 7-day decision clock, 365-day filing; code-level rules live in its lookup tool. Prior auth: assessment see guide; treatment Yes: ABA for treatment of ASD is on Molina’s South Carolina Medicaid pre-service review (prior authorization)…. - [Aetna in South Carolina](https://carelu.com/payers/aetna-south-carolina) ([Markdown](https://carelu.com/payers/aetna-south-carolina.md)) — Commercial insurance. Aetna’s ABA guide + CPB 0648 + precert on all ten ABA codes, layered on Ryan’s Law (dx by 8, under 16, $73,400 cap for 2026). Prior auth: assessment Required: all ten ABA codes, 97151 included, are on Aetna’s behavioral health precertification list; treatment see guide. - [BlueCross BlueShield of South Carolina](https://carelu.com/payers/bluecross-blueshield-of-south-carolina) ([Markdown](https://carelu.com/payers/bluecross-blueshield-of-south-carolina.md)) — Commercial insurance. SC’s dominant Blue: CAM 387 (rewritten Aug. 2026), PA on all ABA codes via Companion Benefit Alternatives, in-state assessment rule, Ryan’s Law layer. Prior auth: assessment Required: BCBSSC’s standard prior-authorization list includes "ABA for Autism" with 97151 through 97158,…; treatment Required: autism PA requests go to Companion Benefit Alternatives (CBA) at autismsupport@companiongroup.com,…. - [Cigna / Evernorth in South Carolina](https://carelu.com/payers/cigna-south-carolina) ([Markdown](https://carelu.com/payers/cigna-south-carolina.md)) — Commercial insurance. EN0499 + autism resource guide (no PA on assessments) layered on Ryan’s Law (dx by 8, under 16, $73,400 cap for 2026). Prior auth: assessment Not required for 97151, 97152 and 0362T with an autism diagnosis when the provider is independently licensed…; treatment Required: the completed assessment and treatment plan go with the Applied Behavior Analysis Prior…. - [UnitedHealthcare / Optum in South Carolina](https://carelu.com/payers/unitedhealthcare-south-carolina) ([Markdown](https://carelu.com/payers/unitedhealthcare-south-carolina.md)) — Commercial insurance. Optum criteria (BH803ABASCC) + Ryan’s Law; no SC state supplement, three-code telehealth rule, no SC Medicaid plan. Prior auth: assessment Required: the ABA Supplemental Clinical Criteria say "Prior authorization is required for ABA (unless…; treatment see guide. ## South Dakota (SD) State autism mandate: SDCL 58-17-154 to -162 (ABA; annual floors $36,000/$25,000/$12,500 through age 18; ACA individual/small-group exempt) - [South Dakota Medicaid](https://carelu.com/payers/south-dakota-medicaid) ([Markdown](https://carelu.com/payers/south-dakota-medicaid.md)) — State Medicaid program. ABA is an EPSDT benefit (20 and under), run by DSS itself with no MCOs: 6-month prior auth, a 12-month diagnosis rule, and published rates. Prior auth: assessment Required; treatment Required. - [Aetna in South Dakota](https://carelu.com/payers/aetna-south-dakota) ([Markdown](https://carelu.com/payers/aetna-south-dakota.md)) — Commercial insurance. Aetna’s national ABA guide + precert list + South Dakota’s SDCL 58-17 mandate (floors through age 18) and state licensure. Prior auth: assessment Required: all ten ABA codes, 97151 included, are on Aetna’s behavioral health precertification list; treatment see guide. - [Cigna / Evernorth in South Dakota](https://carelu.com/payers/cigna-south-dakota) ([Markdown](https://carelu.com/payers/cigna-south-dakota.md)) — Commercial insurance. EN0499 + autism resource guide + Evernorth’s South Dakota addendum + the SDCL 58-17 mandate; no PA on assessment codes. Prior auth: assessment Not required for 97151, 97152 and 0362T with an autism diagnosis when the provider is independently licensed…; treatment Required: completed assessment and treatment plan attached to the ABA Prior Authorization Form. - [UnitedHealthcare / Optum in South Dakota](https://carelu.com/payers/unitedhealthcare-south-dakota) ([Markdown](https://carelu.com/payers/unitedhealthcare-south-dakota.md)) — Commercial insurance. Optum criteria (BH803ABASCC) + South Dakota’s SDCL 58-17 mandate; no SD state supplement, no SD Medicaid plan. Prior auth: assessment Required: Optum’s ABA Supplemental Clinical Criteria say "Prior authorization is required for ABA" unless…; treatment see guide. - [Wellmark Blue Cross and Blue Shield of South Dakota](https://carelu.com/payers/wellmark-blue-cross-blue-shield-south-dakota) ([Markdown](https://carelu.com/payers/wellmark-blue-cross-blue-shield-south-dakota.md)) — Commercial insurance. South Dakota’s Blue plan: no public ABA medical policy, no ABA code on its medical Authorization Table, so the member’s plan and the SDCL 58-17 mandate decide. ## Tennessee (TN) State autism mandate: Tenn. Code Ann. § 56-7-2367 (neurological parity) - [TennCare (Tennessee Medicaid)](https://carelu.com/payers/tenncare-tennessee-medicaid) ([Markdown](https://carelu.com/payers/tenncare-tennessee-medicaid.md)) — State Medicaid program. Through age 21 via EPSDT, no annual limit, LBA licensure, one tri-MCO program. Prior auth: assessment Required; treatment Required. - [BlueCare Tennessee (BCBST)](https://carelu.com/payers/bluecare-tennessee) ([Markdown](https://carelu.com/payers/bluecare-tennessee.md)) — Medicaid managed care plan (MCO). Shared TennCare program via Availity/BCBST; 26-week auths, 7-day UM decisions. Prior auth: assessment Required; treatment Required. - [TennCare Select](https://carelu.com/payers/tenncare-select) ([Markdown](https://carelu.com/payers/tenncare-select.md)) — Medicaid managed care plan (MCO). Statewide PIHP (VSHP) — separate contract from BlueCare; SSI kids, foster youth, IDD/CHOICES. 37,095 members. Prior auth: assessment Required; treatment Required. - [UnitedHealthcare Community Plan of Tennessee](https://carelu.com/payers/unitedhealthcare-community-plan-tennessee) ([Markdown](https://carelu.com/payers/unitedhealthcare-community-plan-tennessee.md)) — Medicaid managed care plan (MCO). Shared TennCare baseline + UHC's own Level of Care rules: physician order, 20-hr gate. Prior auth: assessment Required; treatment Required. - [Wellpoint Tennessee (formerly Amerigroup)](https://carelu.com/payers/wellpoint-tennessee) ([Markdown](https://carelu.com/payers/wellpoint-tennessee.md)) — Medicaid managed care plan (MCO). Shared TennCare program via Availity ICR; MD-order emphasis, <90% utilization rule. Prior auth: assessment Required; treatment Required. - [Aetna in Tennessee](https://carelu.com/payers/aetna-tennessee) ([Markdown](https://carelu.com/payers/aetna-tennessee.md)) — Commercial insurance. CPB 0554 (ABA) + CPB 0648 (ASD) + the Tenn. Code Ann. § 56-7-2367 mandate layer. Prior auth: assessment Required; treatment Required. - [Blue Cross Blue Shield Tennessee](https://carelu.com/payers/bluecross-blueshield-of-tennessee) ([Markdown](https://carelu.com/payers/bluecross-blueshield-of-tennessee.md)) — Commercial insurance. Tennessee's Blue plan (commercial): ABA covered on fully insured plans since 2018, PA required, ABA codes on the CMS telehealth list, rates by contracted fee schedule. - [Cigna / Evernorth in Tennessee](https://carelu.com/payers/cigna-tennessee) ([Markdown](https://carelu.com/payers/cigna-tennessee.md)) — Commercial insurance. EN0499 + autism resource guide + the Tenn. Code Ann. § 56-7-2367 mandate layer. Prior auth: assessment Not required for assessment codes 97151, 97152, 0362T; treatment Required. - [UnitedHealthcare / Optum in Tennessee](https://carelu.com/payers/unitedhealthcare-tennessee) ([Markdown](https://carelu.com/payers/unitedhealthcare-tennessee.md)) — Commercial insurance. Optum Supplemental Clinical Criteria (BH803ABASCC) + the Tenn. Code Ann. § 56-7-2367 mandate layer. Prior auth: assessment Required; treatment Required. ## Texas (TX) State autism mandate: Texas autism mandate (Tex. Ins. Code § 1355.015) - [Texas Medicaid (THSteps-CCP)](https://carelu.com/payers/texas-medicaid) ([Markdown](https://carelu.com/payers/texas-medicaid.md)) — State Medicaid program. THSteps-CCP EPSDT ages 0–20; PA on everything, 90/90/180 cadence, 3-yr dx recency. Prior auth: assessment Required; treatment Required. - [Aetna Better Health of Texas](https://carelu.com/payers/aetna-better-health-texas) ([Markdown](https://carelu.com/payers/aetna-better-health-texas.md)) — Medicaid managed care plan (MCO). TMPPM state baseline in Bexar & Tarrant; plan-specific PA mechanics not publicly verifiable. Prior auth: assessment Required; treatment Required. - [Blue Cross Blue Shield of Texas (Medicaid)](https://carelu.com/payers/bcbs-texas-medicaid) ([Markdown](https://carelu.com/payers/bcbs-texas-medicaid.md)) — Medicaid managed care plan (MCO). STAR/STAR Kids in Travis; insourced BH from Magellan in 2024; PA code grid confirms 97151-97158. Prior auth: assessment Required; treatment Required. - [Community First Health Plans](https://carelu.com/payers/community-first-health-plans) ([Markdown](https://carelu.com/payers/community-first-health-plans.md)) — Medicaid managed care plan (MCO). Bexar-area plan with the clearest published TX ABA billing crosswalk — a TMPPM digest. Prior auth: assessment Required; treatment Required. - [Community Health Choice](https://carelu.com/payers/community-health-choice-texas) ([Markdown](https://carelu.com/payers/community-health-choice-texas.md)) — Medicaid managed care plan (MCO). Own ABA Medical Review Guideline (adopted 6/2026); TSPA+CCP form; 85% attendance rule on extensions. Prior auth: assessment Required; treatment Required. - [Cook Children's Health Plan](https://carelu.com/payers/cook-childrens-health-plan) ([Markdown](https://carelu.com/payers/cook-childrens-health-plan.md)) — Medicaid managed care plan (MCO). Dedicated 123-page ABA training deck; 6-county Fort Worth-area STAR + STAR Kids; EpicCare Link portal. Prior auth: assessment Required; treatment Required. - [Dell Children's Health Plan](https://carelu.com/payers/dell-childrens-health-plan) ([Markdown](https://carelu.com/payers/dell-childrens-health-plan.md)) — Medicaid managed care plan (MCO). Established pediatric plan (STAR since 2012), Travis SDA (8 counties); ABA delegated to Magellan BH. Prior auth: assessment Required; treatment Required. - [Driscoll Health Plan](https://carelu.com/payers/driscoll-health-plan) ([Markdown](https://carelu.com/payers/driscoll-health-plan.md)) — Medicaid managed care plan (MCO). South Texas plan with its own CCP PA request form for ABA; per-code PA checks via its lookup portal. Prior auth: assessment Required; treatment Required. - [El Paso Health](https://carelu.com/payers/el-paso-health) ([Markdown](https://carelu.com/payers/el-paso-health.md)) — Medicaid managed care plan (MCO). El Paso's founding Medicaid MCO (ex-El Paso First); 85% attendance rule; not the SDA's only plan. Prior auth: assessment Required; treatment Required. - [FirstCare Health Plans](https://carelu.com/payers/firstcare-health-plans) ([Markdown](https://carelu.com/payers/firstcare-health-plans.md)) — Medicaid managed care plan (MCO). Lubbock + MRSA West STAR/CHIP — EXITED Texas Medicaid 8/31/2026; claims for earlier DOS due within 95 days. Prior auth: assessment Required; treatment Required. - [Molina Healthcare of Texas](https://carelu.com/payers/molina-healthcare-texas) ([Markdown](https://carelu.com/payers/molina-healthcare-texas.md)) — Medicaid managed care plan (MCO). TMPPM baseline; verify codes in Molina's PA Code Matrix — its PA guide PDFs sit behind bot walls. - [Parkland Community Health Plan](https://carelu.com/payers/parkland-community-health-plan) ([Markdown](https://carelu.com/payers/parkland-community-health-plan.md)) — Medicaid managed care plan (MCO). Dallas County safety-net STAR plan; BH insourced from Carelon 9/1/2025; PA covers 97151-99366, not 0362T. Prior auth: assessment Required; treatment Required. - [RightCare from Scott and White Health Plan (dba Baylor Scott & White Health Plan)](https://carelu.com/payers/baylor-scott-white-texas) ([Markdown](https://carelu.com/payers/baylor-scott-white-texas.md)) — Medicaid managed care plan (MCO). RightCare/MRSA Central — EXITED Texas Medicaid 8/31/2026; claims for earlier dates of service due within 95 days. Prior auth: assessment Required; treatment Required. - [Superior HealthPlan (TX)](https://carelu.com/payers/superior-healthplan-texas) ([Markdown](https://carelu.com/payers/superior-healthplan-texas.md)) — Medicaid managed care plan (MCO). TMPPM criteria; PA on every ABA code; the only STAR Health (foster care) plan statewide. Prior auth: assessment Required; treatment Required. - [Texas Children's Health Plan](https://carelu.com/payers/texas-childrens-health-plan) ([Markdown](https://carelu.com/payers/texas-childrens-health-plan.md)) — Medicaid managed care plan (MCO). Own 30-page guideline (#11281 v3) that restates TMPPM; PA via portal, fax, phone, or mail. Prior auth: assessment Required; treatment Required. - [UnitedHealthcare Community Plan of Texas](https://carelu.com/payers/unitedhealthcare-community-plan-texas) ([Markdown](https://carelu.com/payers/unitedhealthcare-community-plan-texas.md)) — Medicaid managed care plan (MCO). TMPPM criteria with ABA carved out to Optum's BH network — not the medical PA pipeline. Prior auth: assessment Required (state benefit); treatment Required. - [Wellpoint (formerly Amerigroup Texas)](https://carelu.com/payers/wellpoint-texas) ([Markdown](https://carelu.com/payers/wellpoint-texas.md)) — Medicaid managed care plan (MCO). TMPPM restated; accepts its own ASD form OR the state CCP PA form; Availity submission. Prior auth: assessment Required; treatment Required. - [Aetna in Texas](https://carelu.com/payers/aetna-texas) ([Markdown](https://carelu.com/payers/aetna-texas.md)) — Commercial insurance. CPB 0554 (ABA) + CPB 0648 (ASD) + the Tex. Ins. Code § 1355.015 mandate layer. Prior auth: assessment Required; treatment Required. - [Cigna / Evernorth in Texas](https://carelu.com/payers/cigna-texas) ([Markdown](https://carelu.com/payers/cigna-texas.md)) — Commercial insurance. EN0499 (no TX carve-out) + the Tex. Ins. Code § 1355.015 mandate layer; no TX Medicaid plan. - [UnitedHealthcare / Optum in Texas](https://carelu.com/payers/unitedhealthcare-texas) ([Markdown](https://carelu.com/payers/unitedhealthcare-texas.md)) — Commercial insurance. Optum criteria (no TX mandate entry) + the Tex. Ins. Code § 1355.015 mandate layer. Prior auth: assessment Required; treatment Required. ## Utah (UT) State autism mandate: Utah autism insurance mandate (Utah Code § 31A-22-642; caps removed 2020) - [Utah Medicaid](https://carelu.com/payers/utah-medicaid) ([Markdown](https://carelu.com/payers/utah-medicaid.md)) — State Medicaid program. FFS carve-out — ACO card irrelevant for ABA, no PA on 97151, adults covered, PRISM rates. Prior auth: assessment Not required; treatment Required. - [Select Health (Utah)](https://carelu.com/payers/select-health-utah) ([Markdown](https://carelu.com/payers/select-health-utah.md)) — Medicaid managed care plan (MCO). Two different products under one name: Community Care (Medicaid) rides UT FFS; commercial runs its own Policy #630. Prior auth: assessment Community Care (Medicaid) members: none; treatment Community Care (Medicaid) members: routes to Utah Medicaid FFS. - [Aetna in Utah](https://carelu.com/payers/aetna-utah) ([Markdown](https://carelu.com/payers/aetna-utah.md)) — Commercial insurance. CPB 0554 (ABA) + CPB 0648 (ASD) + the Utah Code § 31A-22-642 mandate layer. Prior auth: assessment Required; treatment Required. - [Cigna / Evernorth in Utah](https://carelu.com/payers/cigna-utah) ([Markdown](https://carelu.com/payers/cigna-utah.md)) — Commercial insurance. EN0499 + autism resource guide + the Utah Code § 31A-22-642 mandate layer. - [UnitedHealthcare / Optum in Utah](https://carelu.com/payers/unitedhealthcare-utah) ([Markdown](https://carelu.com/payers/unitedhealthcare-utah.md)) — Commercial insurance. Optum Supplemental Clinical Criteria (BH803ABASCC) + the Utah Code § 31A-22-642 mandate layer. Prior auth: assessment Required; treatment Required. ## Vermont (VT) State autism mandate: 8 V.S.A. § 4082 (formerly § 4088i; birth to 21, no dollar or hour cap) - [Vermont Medicaid (Green Mountain Care / DVHA)](https://carelu.com/payers/vermont-medicaid) ([Markdown](https://carelu.com/payers/vermont-medicaid.md)) — State Medicaid program. DVHA authorizes and pays ABA itself (no MCOs), under 21; fee-for-service since 7/1/2026; assessments need no PA; Vermont license required. Prior auth: assessment No; treatment Required. - [Aetna in Vermont](https://carelu.com/payers/aetna-vermont) ([Markdown](https://carelu.com/payers/aetna-vermont.md)) — Commercial insurance. Aetna ABA guide + CPB 0648 + Vermont’s § 4082 mandate; Aetna sells no Vermont individual or small-group plan, so check funding. Prior auth: assessment Required: all ten ABA codes, 97151 included, are on Aetna’s behavioral health precertification list; treatment see guide. - [Blue Cross and Blue Shield of Vermont](https://carelu.com/payers/blue-cross-blue-shield-vermont) ([Markdown](https://carelu.com/payers/blue-cross-blue-shield-vermont.md)) — Commercial insurance. Vermont’s home Blue plan: no ABA prior authorization since 2025, annual unit caps per code, telemedicine on all ABA codes with -95. Prior auth: assessment No; treatment No for Blue Cross VT’s own members since 2025: prior approval was removed from all ABA codes ("Prior approval…. - [Cigna / Evernorth in Vermont](https://carelu.com/payers/cigna-vermont) ([Markdown](https://carelu.com/payers/cigna-vermont.md)) — Commercial insurance. EN0499 + autism resource guide + Vermont’s § 4082 mandate; no PA on assessment codes; Evernorth has a Vermont regulatory addendum. Prior auth: assessment Not required for 97151, 97152 and 0362T with an autism diagnosis when the provider is independently licensed…; treatment Required: treatment is authorized on EN0499 criteria with the completed assessment and treatment plan. - [UnitedHealthcare / Optum in Vermont](https://carelu.com/payers/unitedhealthcare-vermont) ([Markdown](https://carelu.com/payers/unitedhealthcare-vermont.md)) — Commercial insurance. Optum criteria (BH803ABASCC) + Vermont’s § 4082 mandate; no Vermont state supplement; Vermont has no Medicaid MCOs. Prior auth: assessment Required: the ABA Supplemental Clinical Criteria say prior authorization is required for ABA "unless…; treatment see guide. ## Virginia (VA) State autism mandate: Virginia autism insurance mandate (§ 38.2-3418.17) - [Virginia Medicaid (DMAS)](https://carelu.com/payers/virginia-medicaid) ([Markdown](https://carelu.com/payers/virginia-medicaid.md)) — State Medicaid program. EPSDT under 21; NO auth on assessment codes, per-code unit SAs, licensure-tiered rates. Prior auth: assessment Not required; treatment Required. - [Aetna Better Health of Virginia](https://carelu.com/payers/aetna-better-health-virginia) ([Markdown](https://carelu.com/payers/aetna-better-health-virginia.md)) — Medicaid managed care plan (MCO). DMAS forms/criteria via Availity; the auth lives on the LBA's NPI — changes need a new auth. Prior auth: assessment Not required; treatment Required. - [Anthem HealthKeepers Plus (VA)](https://carelu.com/payers/anthem-healthkeepers-plus) ([Markdown](https://carelu.com/payers/anthem-healthkeepers-plus.md)) — Medicaid managed care plan (MCO). DMAS forms via Availity/ICR; publishes the clearest code/modifier/POS grid in Virginia. Prior auth: assessment Not required; treatment Required. - [Humana Healthy Horizons in Virginia](https://carelu.com/payers/humana-healthy-horizons-virginia) ([Markdown](https://carelu.com/payers/humana-healthy-horizons-virginia.md)) — Medicaid managed care plan (MCO). Virginia's newest MCO (7/2025, ex-Molina members); DMAS forms, one PA-list quirk on 0362T. Prior auth: assessment Not required for 97151/97152 (off the PA list); treatment Required. - [Sentara Community Plan (VA)](https://carelu.com/payers/sentara-community-plan) ([Markdown](https://carelu.com/payers/sentara-community-plan.md)) — Medicaid managed care plan (MCO). First to post the new DMAS units-per-code form; dedicated BCBA-change workflow, PAL lookup tool. Prior auth: assessment Not required; treatment Required. - [UnitedHealthcare Community Plan of Virginia](https://carelu.com/payers/unitedhealthcare-community-plan-virginia) ([Markdown](https://carelu.com/payers/unitedhealthcare-community-plan-virginia.md)) — Medicaid managed care plan (MCO). DMAS criteria with ABA carved to Optum: Provider Express submission, separate credentialing. Prior auth: assessment Not required; treatment Required. - [Aetna in Virginia](https://carelu.com/payers/aetna-virginia) ([Markdown](https://carelu.com/payers/aetna-virginia.md)) — Commercial insurance. CPB 0554 (ABA) + CPB 0648 (ASD) + the Va. Code § 38.2-3418.17 mandate layer. Prior auth: assessment Required; treatment Required. - [Anthem BCBS Virginia](https://carelu.com/payers/anthem-bcbs-virginia) ([Markdown](https://carelu.com/payers/anthem-bcbs-virginia.md)) — Commercial insurance. Every ABA code is on the precert list; criteria differ HMO vs PPO; $35K ABA cap still in statute. Prior auth: assessment Required; treatment Required. - [Cigna / Evernorth in Virginia](https://carelu.com/payers/cigna-virginia) ([Markdown](https://carelu.com/payers/cigna-virginia.md)) — Commercial insurance. EN0499 + autism resource guide + the Va. Code § 38.2-3418.17 mandate layer. - [UnitedHealthcare / Optum in Virginia](https://carelu.com/payers/unitedhealthcare-virginia) ([Markdown](https://carelu.com/payers/unitedhealthcare-virginia.md)) — Commercial insurance. Optum Supplemental Clinical Criteria (BH803ABASCC) + the Va. Code § 38.2-3418.17 mandate layer. Prior auth: assessment Required; treatment Required. ## Washington (WA) State autism mandate: Mental health parity (RCW 48.44.341 et al.; RCW 48.43.766 from 2027); no stand-alone autism statute - [Washington Apple Health (Medicaid)](https://carelu.com/payers/washington-medicaid) ([Markdown](https://carelu.com/payers/washington-medicaid.md)) — State Medicaid program. Apple Health (HCA) covers ABA for any age under WAC 182-531A: COE evaluation and prescription first, then PA for 97153 and group codes; five MCOs run it for most members. Prior auth: assessment No for fee-for-service: 97151 and 0362T carry no PA on HCA’s fee schedule and billing guide (97151 is limited…; treatment Yes for 97153, 0373T, 97154, 97158 and the H2020 day program. - [Community Health Plan of Washington](https://carelu.com/payers/community-health-plan-of-washington) ([Markdown](https://carelu.com/payers/community-health-plan-of-washington.md)) — Medicaid managed care plan (MCO). Apple Health MCO: ABA needs PA on its 2026 BH list; fax the ABA Initial Request Form with the COE evaluation; 12-month timely filing. Prior auth: assessment see guide; treatment Required. - [Coordinated Care of Washington](https://carelu.com/payers/coordinated-care-washington) ([Markdown](https://carelu.com/payers/coordinated-care-washington.md)) — Medicaid managed care plan (MCO). Centene’s Apple Health plan (also Apple Health Core Connections foster care): WA.CP.BH.104 mirrors WAC 182-531A — COE evaluation, HCA 13-400 and 12-411, six-month reviews. Prior auth: assessment see guide; treatment Required. - [Molina Healthcare of Washington](https://carelu.com/payers/molina-healthcare-washington) ([Markdown](https://carelu.com/payers/molina-healthcare-washington.md)) — Medicaid managed care plan (MCO). Apple Health MCO: PA "typically required" for ABA (check the lookup tool), granted at the group level; BCBAs credentialed individually, CBTs and LABAs rostered. - [UnitedHealthcare Community Plan of Washington](https://carelu.com/payers/unitedhealthcare-community-plan-washington) ([Markdown](https://carelu.com/payers/unitedhealthcare-community-plan-washington.md)) — Medicaid managed care plan (MCO). UHC’s Apple Health plan: Optum Washington Medicaid criteria (Nov 2025) copy WAC 182-531A — COE evaluation, no age limit, 3-month recertification; online ABA request form. Prior auth: assessment see guide; treatment Required. - [Wellpoint Washington](https://carelu.com/payers/wellpoint-washington) ([Markdown](https://carelu.com/payers/wellpoint-washington.md)) — Medicaid managed care plan (MCO). Elevance’s Apple Health plan (formerly Amerigroup): ABA requests need the COE script, an updated plan and the Level of Support form; 3-day electronic decisions. Prior auth: assessment see guide; treatment Required. - [Aetna in Washington](https://carelu.com/payers/aetna-washington) ([Markdown](https://carelu.com/payers/aetna-washington.md)) — Commercial insurance. Aetna’s national ABA guide (no Washington exhibit) + precertification on all ten ABA codes + Washington parity law and DOH licensure. Prior auth: assessment Required: all ten ABA codes, 97151 included, are on Aetna’s behavioral health precertification list; treatment see guide. - [Cigna / Evernorth in Washington](https://carelu.com/payers/cigna-washington) ([Markdown](https://carelu.com/payers/cigna-washington.md)) — Commercial insurance. EN0499 + autism resource guide (no PA on assessment codes) + Washington parity law and DOH licensure. Prior auth: assessment Not required for 97151, 97152 and 0362T with an autism diagnosis when the provider is independently licensed…; treatment Required: completed assessment and treatment plan attached to the ABA Prior Authorization Form. - [Premera Blue Cross](https://carelu.com/payers/premera-blue-cross-washington) ([Markdown](https://carelu.com/payers/premera-blue-cross-washington.md)) — Commercial insurance. Washington’s largest Blue: policy 3.01.510 (May 2026), PA on ABA codes incl. 97151, in-person or video delivery, 2 hrs supervision per 10 hrs, LABAs billed under the LBA. Prior auth: assessment Yes: Premera’s October 2026 code lists put ABA among behavioral health services requiring prior…; treatment Yes: 97153, 97154, 97155, 97156, 97158 and 0373T are "Prior Authorization Required" on the individual-plan…. - [Regence BlueShield (Washington)](https://carelu.com/payers/regence-blueshield-washington) ([Markdown](https://carelu.com/payers/regence-blueshield-washington.md)) — Commercial insurance. Regence BH18/BH33, which name Washington’s parity act as their legal basis: PA only where the contract requires it, one standardized assessment, continuation requests 5–30 days before the end date. - [UnitedHealthcare / Optum in Washington](https://carelu.com/payers/unitedhealthcare-washington) ([Markdown](https://carelu.com/payers/unitedhealthcare-washington.md)) — Commercial insurance. Optum ABA criteria (BH803ABASCC) + Washington parity law; Washington is not in Optum’s ABA State Mandates document; telehealth limited to 97155–97157. Prior auth: assessment Required: Optum’s ABA Supplemental Clinical Criteria say "Prior authorization is required for ABA" unless…; treatment see guide. ## West Virginia (WV) State autism mandate: W. Va. Code § 33-24-7k et al. (group plans; ages 18 months–18, dx by 8, $30,000/yr ABA cap for 3 years then $2,000/month) - [West Virginia Medicaid (BMS)](https://carelu.com/payers/west-virginia-medicaid) ([Markdown](https://carelu.com/payers/west-virginia-medicaid.md)) — State Medicaid program. BMS Policy 519.23: ages 18 months–20, ASD diagnosed before age 8, PA on every code, 40 hr/week cap; four MCOs carry it. Prior auth: assessment Required; treatment Yes for every ABA code (97152–97156, 97158). - [Aetna Better Health of West Virginia](https://carelu.com/payers/aetna-better-health-west-virginia) ([Markdown](https://carelu.com/payers/aetna-better-health-west-virginia.md)) — Medicaid managed care plan (MCO). MHT MCO and the only Mountain Health Promise (foster care) plan; ABA has its own section on the BH PA form; 365-day filing. Prior auth: assessment see guide; treatment Required. - [Highmark Health Options West Virginia (Mountain Health Trust)](https://carelu.com/payers/highmark-health-options-west-virginia) ([Markdown](https://carelu.com/payers/highmark-health-options-west-virginia.md)) — Medicaid managed care plan (MCO). Highmark’s Medicaid MCO: ABA requested on its outpatient BH PA form (fax 1-855-412-7997); InterQual review; 12-month filing. Prior auth: assessment see guide; treatment Required. - [The Health Plan of West Virginia (Mountain Health Trust)](https://carelu.com/payers/the-health-plan-west-virginia) ([Markdown](https://carelu.com/payers/the-health-plan-west-virginia.md)) — Medicaid managed care plan (MCO). Wheeling-based MHT MCO in all 55 counties; its PA list names no ABA code, which clashes with BMS policy, so confirm in the portal. - [Wellpoint West Virginia (Mountain Health Trust)](https://carelu.com/payers/wellpoint-west-virginia) ([Markdown](https://carelu.com/payers/wellpoint-west-virginia.md)) — Medicaid managed care plan (MCO). Formerly UniCare: MHT MCO (Elevance); ABA follows BMS Policy 519.23; PA rules in the lookup tool; 180-day filing. - [Aetna in West Virginia](https://carelu.com/payers/aetna-west-virginia) ([Markdown](https://carelu.com/payers/aetna-west-virginia.md)) — Commercial insurance. Aetna national ABA criteria (CPB 0554, MNG) + West Virginia’s group-plan mandate (18 months–18, dx by age 8, $30K/yr cap). Prior auth: assessment Required: all ten ABA codes, 97151 included, are on Aetna’s behavioral health precertification list; treatment see guide. - [Cigna / Evernorth in West Virginia](https://carelu.com/payers/cigna-west-virginia) ([Markdown](https://carelu.com/payers/cigna-west-virginia.md)) — Commercial insurance. EN0499 + autism resource guide + West Virginia’s group-plan mandate; no PA on assessment codes; Evernorth WV addendum. Prior auth: assessment Not required for 97151, 97152 and 0362T with an autism diagnosis when the provider is independently licensed…; treatment Required: the completed assessment and treatment plan go with the ABA Prior Authorization Form. - [Highmark Blue Cross Blue Shield West Virginia](https://carelu.com/payers/highmark-bcbs-west-virginia) ([Markdown](https://carelu.com/payers/highmark-bcbs-west-virginia.md)) — Commercial insurance. West Virginia’s Blue: every ABA code on Highmark’s PA list since March 1, 2026, reviewed by Highmark Behavioral Health; 365-day filing. Prior auth: assessment Yes: 97151, 97152 and 0362T are on Highmark’s List of Procedures Requiring Authorization (effective…; treatment Yes: 97153–97158 and 0373T are on the same list. - [UnitedHealthcare / Optum in West Virginia](https://carelu.com/payers/unitedhealthcare-west-virginia) ([Markdown](https://carelu.com/payers/unitedhealthcare-west-virginia.md)) — Commercial insurance. Optum criteria (BH803ABASCC) + West Virginia’s group-plan mandate; WV not in Optum’s ABA state-mandate supplement. Prior auth: assessment Required: the ABA Supplemental Clinical Criteria require prior authorization for ABA "unless otherwise…; treatment see guide. ## Wisconsin (WI) State autism mandate: Wis. Stat. § 632.895(12m) + Ins 3.36 (intensive start ages 2–9; 2026 floors $74,240 / $37,119) - [Wisconsin Medicaid (ForwardHealth)](https://carelu.com/payers/wisconsin-medicaid) ([Markdown](https://carelu.com/payers/wisconsin-medicaid.md)) — State Medicaid program. ForwardHealth’s Behavioral Treatment Benefit: carved out of every HMO, run fee-for-service with PA through the Portal. Prior auth: assessment No, up to a limit: ForwardHealth covers "up to 96 units/24 hours of behavior identification assessment…; treatment Required. - [Aetna in Wisconsin](https://carelu.com/payers/aetna-wisconsin) ([Markdown](https://carelu.com/payers/aetna-wisconsin.md)) — Commercial insurance. Aetna’s national ABA guide + precert on all ABA codes, layered on Wisconsin’s § 632.895(12m) mandate and licensed-BCBA rule. - [Anthem Blue Cross and Blue Shield Wisconsin](https://carelu.com/payers/anthem-bcbs-wisconsin) ([Markdown](https://carelu.com/payers/anthem-bcbs-wisconsin.md)) — Commercial insurance. Wisconsin’s Blue plan: a Wisconsin-specific ABA resource guide, weekly-unit billing since 1/1/2026, and the autism-treatment row on the precert list. - [Cigna / Evernorth in Wisconsin](https://carelu.com/payers/cigna-wisconsin) ([Markdown](https://carelu.com/payers/cigna-wisconsin.md)) — Commercial insurance. EN0499 + autism resource guide + Wisconsin’s § 632.895(12m) mandate; no PA on assessment codes; HealthPartners network in western WI. Prior auth: assessment Not required for 97151, 97152 and 0362T with an autism diagnosis when the provider is independently licensed…; treatment Required: after the assessment, submit the treatment plan on the Applied Behavior Analysis Prior…. - [UnitedHealthcare / Optum in Wisconsin](https://carelu.com/payers/unitedhealthcare-wisconsin) ([Markdown](https://carelu.com/payers/unitedhealthcare-wisconsin.md)) — Commercial insurance. Optum criteria (BH803ABASCC) + Wisconsin’s § 632.895(12m) mandate; no Wisconsin state supplement; Medicaid ABA bypasses the HMO. ## Wyoming (WY) State autism mandate: No autism statute — DOI Bulletin 01-2019 (mental-health parity, W.S. 26-20-701; no ABA exclusions from 7/1/2019) - [Wyoming Medicaid](https://carelu.com/payers/wyoming-medicaid) ([Markdown](https://carelu.com/payers/wyoming-medicaid.md)) — State Medicaid program. Fee-for-service only (no MCOs). ABA under EPSDT for ages 0–20; no up-front PA, but PA via Telligen after 30 behavioral-health visit dates a year. Prior auth: assessment No up-front prior authorization: the 10/01/2026 fee schedule’s PRIOR_AUTH column is blank for 97151 and every…; treatment Not up front, but in practice yes: 97151–97158 are inside the 30-visit-per-year behavioral-health threshold,…. - [Aetna in Wyoming](https://carelu.com/payers/aetna-wyoming) ([Markdown](https://carelu.com/payers/aetna-wyoming.md)) — Commercial insurance. Aetna’s national ABA guide + precert list + Wyoming’s Bulletin 01-2019 parity layer (no autism statute); Wyoming licenses BCBAs. Prior auth: assessment Required: all ten ABA codes, 97151 included, are on Aetna’s behavioral health precertification list; treatment see guide. - [Blue Cross Blue Shield of Wyoming](https://carelu.com/payers/blue-cross-blue-shield-of-wyoming) ([Markdown](https://carelu.com/payers/blue-cross-blue-shield-of-wyoming.md)) — Commercial insurance. Wyoming’s dominant carrier. ABA policy 15.01.002: current ASD diagnosis, an FBA within 12 months and a measurable plan for authorization; no school-setting ABA. Bulletin 01-2019 parity layer applies. Prior auth: assessment see guide; treatment Yes: medical policy 15.01.002 lists the guidelines that "must be met" to "determine the appropriate initial…. - [Cigna / Evernorth in Wyoming](https://carelu.com/payers/cigna-wyoming) ([Markdown](https://carelu.com/payers/cigna-wyoming.md)) — Commercial insurance. EN0499 + autism resource guide + Wyoming’s Bulletin 01-2019 parity layer; no PA on assessment codes; Evernorth carries a Wyoming addendum. Prior auth: assessment Not required for 97151, 97152 and 0362T with an autism diagnosis when the provider is independently licensed…; treatment Required: completed assessment and treatment plan on the Applied Behavior Analysis Prior Authorization Form. - [UnitedHealthcare / Optum in Wyoming](https://carelu.com/payers/unitedhealthcare-wyoming) ([Markdown](https://carelu.com/payers/unitedhealthcare-wyoming.md)) — Commercial insurance. Optum criteria (BH803ABASCC) + Wyoming’s Bulletin 01-2019 parity layer; no Wyoming state supplement; only three ABA codes by telehealth. Prior auth: assessment Required: the ABA Supplemental Clinical Criteria say "Prior authorization is required for ABA" unless…; treatment see guide. Source: Carelu ABA Payer Directory — https://carelu.com/payers. Free to cite with attribution.