---
title: "Absolute Total Care ABA coverage: the intake guide."
url: "https://carelu.com/payers/absolute-total-care-south-carolina"
markdown_url: "https://carelu.com/payers/absolute-total-care-south-carolina.md"
state: SC (South Carolina)
payer: Absolute Total Care
kind: Medicaid managed care plan (MCO)
parent_program: South Carolina Healthy Connections Medicaid
description: "How Absolute Total Care, Centene’s South Carolina Medicaid plan, covers ABA: prior authorization on every ABA code including the 97151 assessment, the ASD authorization form, decision timeframes, claims limits, and what intake should collect."
last_reviewed: October 2026
---

# Absolute Total Care ABA coverage: the intake guide.

_Payer Guide · Absolute Total Care · South Carolina · Last updated October 2026 · 11 primary sources_

> 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.

Absolute Total Care is Centene’s Healthy Connections Medicaid plan in South Carolina and one of the five MCOs SCDHHS lists. Its January 2026 provider manual covers Autism Spectrum Disorder (ASD) services for members ages 0 to 21 with prior authorization required, and its 2026 prior-authorization list puts every ABA code, including the 97151 assessment, behind authorization. That is stricter than South Carolina fee-for-service, where 97151 needs none.

This plan administers the **South Carolina Healthy Connections Medicaid** ABA benefit: the state rules are the floor, and this page covers what the plan layers on top. Read it together with the [South Carolina Healthy Connections Medicaid guide](https://carelu.com/payers/south-carolina-medicaid).

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Yes. Absolute Total Care’s prior-authorization list names "Applied Behavioral Analysis (ABA)" with 97151 through 97158, so the assessment needs authorization, unlike SC fee-for-service [2]
- **Prior auth for treatment**: Yes: all ABA codes 97151–97158 are on the list, and the provider manual marks ASD services "Prior Authorization Required" [2][1]
- **Autism diagnosis required?**: Yes. The manual covers services "to treat ASD" for members ages 0 to 21, recommended by a licensed psychologist, developmental pediatrician or LPES, and the ASD form requires a primary diagnosis and the standardized tools used [1][3]

## At a glance

- **Covers ABA?:** Yes, ASD services for members ages 0 to 21
- **Prior auth:** Required on 97151–97158 (list effective 12/31/2025)
- **Submit via:** Secure Provider Portal or outpatient BH authorization fax 1-833-493-3350; PA/provider line (866) 433-6041
- **Decision clock:** 7 calendar days standard (+14 extension); 72 hours expedited
- **Timely filing:** 365 days from the date of service; disputes 60 days from the EOP
- **Licensure:** None in SC; BACB certification governs

## Coverage and prior authorization

The manual lists "Autism Spectrum Disorder (ASD) Services — Prior Authorization Required" for "eligible Medicaid beneficiaries ages 0 to 21," services that "must be recommended by a Licensed Psychologist, Developmental Pediatrician, or a Licensed Psycho-Educational Specialist (LPES)" and that may be provided in the home, a clinical setting or other settings authorized in the SCDHHS manual. Behavioral health services, ASD included, "are authorized and provided by behavioral health clinicians." The 2026 prior-authorization list (effective 12/31/2025) names "Applied Behavioral Analysis (ABA) 97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158"; the full code list is in the online Pre-Auth Check tool. Non-contracted providers need authorization for all non-emergent services. [1][2][3][4]

The plan’s ASD authorization form (2023 edition) asks for the billing and the supervising provider, the primary diagnosis, the "Standardized Tools Used for Diagnosis" and diagnosis date, IEP/504 and early-intervention status, and other therapies. For an initial assessment it wants "Comprehensive diagnostic information, including standardized measures and referral from diagnosing provider"; treatment plans need objective testing, coordination with school and therapists, a schedule naming the provider type, measurable goals and a parent-training plan. "Retrospective dates will not be processed." The manual says the plan generally uses InterQual criteria for utilization review. [1][2][3][4]

## Claims, disputes and timelines

Claims are due within 365 days of the date of service, as are corrected claims and reconsiderations; a formal provider dispute must be filed within 60 calendar days of the notice of adverse action. Absolute Total Care says it adjudicates 90% of clean claims within 30 days and 99% within 90 days. Standard prior-authorization decisions are made within 7 calendar days, expedited ones within 72 hours. South Carolina does not license behavior analysts, so credentialing rests on BACB certification and Medicaid enrollment. [1][10]

The manual’s timely-submission table: initial claim, 365 days from the date of service; corrected claim or reconsideration, 365 days from the date of service; provider dispute, 60 days from the date of the EOP; coordination of benefits, 365 days from the date of service. COB or secondary claims can be sent electronically following the 5010 companion guides. The manual publishes no check-run or weekly cut-off schedule. [1][10]

## Intake gates

The questions that decide whether a family can start with Absolute Total Care, and what they have to bring.

- **Age limit**: Ages 0 to 21, per the manual’s ASD services entry. [1]
- **Referral required?**: Yes. Services must be recommended by a licensed psychologist, developmental pediatrician or LPES, and the initial assessment request needs a "referral from diagnosing provider for Applied Behavioral Analysis services to include estimated duration of care." [1][3]
- **Prior-auth decision time**: Standard decisions "within 7 calendar days of receipt of the request" (submit at least 10 days ahead), extendable by 14 days; expedited within 72 hours; retrospective review within 30 days. Federal managed-care rules cap standard decisions at 7 calendar days for rating periods from January 1, 2026. [1][8]
- **Other insurance (who pays first)**: Providers "should submit the claim to that insurance as Medicaid is the payer of last resort"; for Medicare-covered services, follow Medicare’s authorization rules and no Absolute Total Care authorization is needed. COB claims are due within 365 days. [1][9]
- **Who may diagnose** _(plan-dependent)_: The manual says ASD services must be "recommended by a Licensed Psychologist, Developmental Pediatrician, or a Licensed Psycho-Educational Specialist (LPES)." It does not separately say who may diagnose; the SCDHHS manual limits that to MD/DO, PhD/PsyD or LPES. [1][5]
  - Ask the plan: Absolute Total Care behavioral health UM, 1-866-534-5976.
- **Diagnostic tools required** _(plan-dependent)_: The form requires the "Standardized Tools Used for Diagnosis" and "standardized measures" with the initial assessment request, without naming instruments. [3]
  - Ask the plan: Absolute Total Care behavioral health UM: ask whether it requires the SCDHHS list (in-person ADI-R, ADOS or CARS).
- **Telehealth** _(plan-dependent)_: Absolute Total Care publishes no ABA telehealth rule. The state baseline: Under the SCDHHS ASD manual (July 1, 2026), only two ABA codes may be delivered by telehealth: 97156 (family guidance), with the GT modifier and no extra authorization, and 97155 (protocol modification), only when the QIO approves it during prior authorization, for up to 25% of authorized and rendered 97155 units, for a member receiving in-home ABA in a rural location with limited access. Telehealth must be synchronous audio and video, GT goes in the secondary modifier position, and POS is 02 or 10. "The BIA can not be completed by telehealth," and 97152, 97153, 97154, 97157, 97158, 0362T and 0373T are not deliverable by telehealth. An ASD diagnosis made by telehealth is not valid. [1][5]
  - Ask the plan: Absolute Total Care behavioral health UM, 1-866-534-5976: ask which ABA codes it pays by telehealth and with what modifier and POS.
- **Diagnosis recency** _(ask the plan)_: Not stated. The ASD form asks for the diagnosis date and the date of the most recent reassessment but sets no limit. [3]
  - Ask the plan: Absolute Total Care behavioral health UM, 1-866-534-5976: ask how recent the diagnostic evaluation must be.

## Delivery and billing rules

Coverage decides whether Absolute Total Care pays. These decide whether the claim survives: staffing and supervision, concurrent billing, per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.

- **Place of service**: ASD services may be provided "in the Member’s home, clinical setting, or other settings as authorized in the applicable section of the SCDHHS Services Provider Manual." [1]
- **Supervision** _(plan-dependent)_: Absolute Total Care publishes no ABA supervision ratio of its own; its ASD form only requires the supervising provider to attest to "actively participating in the treatment plan." The SCDHHS ASD manual sets the state baseline, which the plan may apply: BACB supervision applies: "each RBT must be supervised for a minimum of 5% of the hours spent providing ABA services per month," with at least two face-to-face, real-time contacts a month, one of which observes the RBT with the member; that professional supervision is not billable. Caseload caps: a BCBA may carry 12 cases (16 with a BCaBA), a BCaBA 12, where 30–40 hours a week is one case, 10–25 hours half a case and under 10 hours a quarter case. A behavior technician gets one 90-day grace period to earn the RBT credential, and may work only in a clinic with a BCBA on site during it. [3][5]
  - Ask the plan: Absolute Total Care behavioral health UM, 1-866-534-5976: ask whether it applies the SCDHHS ASD manual’s supervision and caseload rules.
- **Bill as provider** _(plan-dependent)_: The ASD authorization form lists a billing provider (NPI, Tax ID) and a separate supervising provider; the billing provider attests that "all professionals and paraprofessionals rendering service … have the appropriate training and education." The plan does not say whose NPI goes in the rendering field. [3]
  - Ask the plan: Absolute Total Care Provider Services, (866) 433-6041: ask whether RBT services bill under the supervising BCBA’s NPI as in SC fee-for-service.
- **Concurrent billing (97153 + 97155)** _(ask the plan)_: Not addressed in the provider manual or the ASD form. On ABA alongside other therapies, Absolute Total Care publishes nothing of its own; the state baseline: the SCDHHS ASD manual's non-covered list is explicit — "Concurrent billing of 97153 with any other service or therapy is excluded except as detailed in Section 8," and Section 8's exceptions are ABA-with-ABA only. It also excludes "ABA services while the member is at another medical appointment," and, in the other direction, ABA treatment "that precludes, or requires the member's family to stop engaging with other critical supports … speech therapy, occupational therapy, or IDEA recommended school-based curriculum and supports." So speech and ABA can both continue, but not on the same clock time as a billed 97153 unit. The manual also binds providers to the National Correct Coding Initiative edits and related coding policy unless it says otherwise. [5][1][3]
  - Ask the plan: Absolute Total Care Provider Services, (866) 433-6041, or your provider agreement: ask whether it follows the SCDHHS manual’s 97153/97155 and 97153/97156 concurrent-billing rules.
- **Daily limits / MUEs** _(ask the plan)_: The plan publishes no ABA unit limits; units are requested per code on the ASD form. [3][1]
  - Ask the plan: Absolute Total Care behavioral health UM, 1-866-534-5976: ask whether the SCDHHS section 8 frequency limits (e.g., 97153 160 units a week) apply.
- **Session-note signature** _(ask the plan)_: The plan publishes no ABA session-note signature rule. [1]
  - Ask the plan: Absolute Total Care Provider Services, (866) 433-6041, or your provider agreement’s documentation standards.

## What intake should collect for Absolute Total Care

- **Member ID:** Confirm Absolute Total Care (not FFS or another plan) on the date of service.
- **Diagnostic report + tools used:** The ASD form asks for the standardized tools behind the diagnosis and the diagnosis date.
- **Referral from the diagnosing provider:** Required with the initial assessment request, with estimated duration of care.
- **IEP / 504 / IFSP:** Attach a copy if the child has one.
- **Other insurance:** Medicaid is payer of last resort; bill the primary first.

Free verification-call checklist (PDF): https://carelu.com/downloads/aba-verification-call-checklist.pdf

## Common questions

### How fast does Absolute Total Care pay, and what is the secondary-claim deadline?

It adjudicates 90% of clean claims within 30 days of receipt and 99% within 90 days. Secondary (COB) claims, like initial and corrected claims, are due within 365 days of the date of service. No check-run schedule is published.

### Does Absolute Total Care cover ABA therapy?

Yes, as ASD services for South Carolina Medicaid members ages 0 to 21, with prior authorization.

### Does the ABA assessment need prior authorization with Absolute Total Care?

Yes. 97151 is on its prior-authorization list with the other ABA codes, unlike SC fee-for-service.

### How fast does Absolute Total Care decide an ABA request?

Within 7 calendar days for standard requests (it asks for submission at least 10 days ahead) and 72 hours for expedited ones, with possible 14-day extensions.

### What is Absolute Total Care’s timely filing limit?

365 days from the date of service for initial and corrected claims; provider disputes within 60 days of the notice.

## Primary sources

1. [Absolute Total Care — Medicaid Provider Manual (published January 2026)](https://www.absolutetotalcare.com/content/dam/centene/absolute-total-care/2026-assets/2026-provider-docs/ATC%20SC%20Medicaid%20Provider%20Manual%20JAN%202026_FINAL.pdf)
2. [Absolute Total Care — Medicaid Prior Authorization Requirements (list effective 12/31/2025; approved 03/05/2026)](https://www.absolutetotalcare.com/content/dam/centene/absolute-total-care/2026-assets/SC_AbsTotalCare_11_Medicaid_PriorAuthReq_FINAL_R.pdf)
3. [Absolute Total Care — Autism Spectrum Disorder (ASD) Authorization Form (2023 edition)](https://www.absolutetotalcare.com/content/dam/centene/absolute-total-care/test/Medicaid-Provider-ASDAuthForm-2023.pdf)
4. [Absolute Total Care — Medicaid Pre-Auth Check (code lookup)](https://www.absolutetotalcare.com/providers/preauth-check/medicaid-pre-auth.html)
5. [SCDHHS — Autism Spectrum Disorder (ASD) Services Provider Manual (July 1, 2026)](https://www.scdhhs.gov/sites/dhhs/files/documents/ASD%20Services%20Provider%20Manual%207.1.26.pdf)
6. [SCDHHS Medicaid Bulletin MB# 26-015 — Updates to ASD Services Provider Manual (May 15, 2026; effective July 1, 2026)](https://www.scdhhs.gov/communications/updates-asd-services-provider-manual)
7. [SCDHHS — Managed Care Carve-in (Jan. 1, 2026; MCO prior-authorization and provider help lines)](https://scdhhs.gov/partners/managed-care/managed-care-carve)
8. [42 CFR 438.210(d) — Medicaid managed care authorization timeframes (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-438/subpart-D/section-438.210)
9. [42 CFR 433.139 — Medicaid third-party liability (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-433/subpart-D/section-433.139)
10. [BACB — U.S. Licensure of Behavior Analysts (South Carolina not listed)](https://www.bacb.com/u-s-licensure-of-behavior-analysts/)
11. [Absolute Total Care — Provider News (provider notices archive)](https://www.absolutetotalcare.com/providers/provider-news.html)

Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed October 2026; it is general information, not billing, legal, or clinical advice. Always verify current requirements against the payer's live policy and a benefits check for the specific member.

Source: Carelu ABA Payer Directory — https://carelu.com/payers. Free to cite with attribution.