Aetna Better Health of Louisiana is one of the Healthy Louisiana plans, and it will remain one after Healthy Blue leaves in 2027. Its ABA rules are the state’s: the plan says it "is aligned with the Louisiana Department of Health’s (LDH) Medicaid Services Manual," and its ABA prior-authorization policy (7000.11) repeats the manual’s requirements. What it adds is a second layer of criteria, MCG’s ABA guideline, applied where the manual is silent.
Policy 7000.11 (effective January 20, 2022, enforced from May 8, 2022) defines how the plan authorizes ABA. It restates the LDH requirements: a CDE by a qualified health care professional before any request, prior authorization of the behavior identification assessment and supporting assessments, reassessment at least every six months, authorization periods of no more than 180 days, and a behavior treatment plan with the LDH template’s content. For medical necessity, "In addition to the LDH ABA Provider Manual, the primary medical necessity criteria used to authorize ABA services is 25th Edition MCG Applied Behavioral Analysis ORG: B-806-T (BHG). In instances where the criteria differ, Aetna Better Health follows the LDH ABA Provider Manual guidelines." MCG asks, among other things, for serious dysfunction in daily living, individualized treatment intensity, and family engagement. Only the behavioral health medical director can deny or reduce an ABA request, and a denial letter offers a peer-to-peer.[1][2][3]
The plan’s guidance for evaluators adds two practical points: the CDE’s author must be in network (or on a single case agreement) to bill for it, and extra psychological or neuropsychological testing codes (96121, 96130–96139) need prior approval with an explanation of why they are necessary.[1][2][3]
Telehealth: the November 2023 edition of the plan’s provider manual covered ABA by telehealth for new and established patients (97151 through 97158, place of service 02 or 10 "based on the member’s location at the time of service," "appended with modifier -95"). The current manual, revised 09-29-2026, drops that section; its general modifier table lists "Modifier GT telemedicine," so confirm the POS and modifier with the plan. The LDH manual still allows ABA telehealth with prior authorization.[4][5][3][6]
Claims (manual revised 09-29-2026): new claims, including third-party-liability claims, are due "within 365 days the date services … were performed"; resubmissions "within 180 days from the date of adverse determination"; and a corrected version of a processed claim within 180 days of the retracted date, marked as a replacement (frequency code 7) or void. The plan screens a claim within five business days of receipt, pays or denies 90% of clean claims within 15 business days and 99% within 30 calendar days, and adjudicates pended claims within 60 days. "Our claims team will use the ABA description code and fee schedule found on the Louisiana Medicaid Fee Schedule website," and an unlicensed rendering provider’s NPI goes in box 24J, or the claim is denied.[4][5][3][6]
The questions that decide whether a family can start with Aetna Better Health of Louisiana, and what they have to bring. Each maps onto something intake should ask on the first call.
Under 21: "ABA is a covered service for members under the age of 21" who meet the state criteria.[1][3]
The plan sets no recency rule, so the state’s applies. No expiry. "MCOs shall not deny services based solely on the age of the CDE," and "The CDE only needs to be included in the first PA request per member per provider." The MCO "shall deny service if no CDE exists," and if it asks for a new CDE it "shall not deny or delay available ABA services while waiting for a CDE." A family that switches ABA providers needs the CDE sent again with the new provider’s first request.[1][6]
The plan’s current evaluator guidance lists the same QHCPs as the LDH manual. A qualified health care professional (QHCP). Pediatricians may diagnose using the MCHAT-R/F and clinical judgment (a score of 8 or more lets them diagnose independently; 3–7 means a follow-up interview, then diagnose or refer). The subspecialists are a pediatric neurologist, developmental pediatrician, psychologist or medical psychologist, psychiatrist, a pediatrician working with a qualified interdisciplinary team, a nurse practitioner supervised by one of those specialists, or a licensed SLP, LCSW or LPC whose scope includes ASD differential diagnosis and who has two years of diagnostic experience or works under a QHCP who co-signs the CDE.[3][6]
None required by name. The plan tells evaluators that Louisiana Medicaid "does NOT require specific assessments (such as the Autism Diagnostic Observation Schedule or the Vineland Adaptive Behavior Scales)"; extra testing is for unclear cases and needs prior approval under codes 96121 and 96130–96139.[3]
A prescription "ordered by a qualified health care professional," satisfied by a CDE that recommends ABA. The CDE’s author must be in network or on a single case agreement to bill the plan for the evaluation.[1][3][6]
The plan’s current manual (revised 09-29-2026) decides non-urgent pre-service requests for 80% of standard authorizations "within two (2) business days of obtaining appropriate medical information … But no later than 7 calendar days from receipt of the request" for approvals (14 calendar days for denials), and urgent pre-service requests within "72 hours from receipt of request." PA criteria must be online or furnished within 24 hours of a request, and denial notices go to the provider in writing within 3 days of the decision. Federal law caps a Medicaid managed care standard authorization decision at 7 calendar days for rating periods starting on or after January 1, 2026 (one 14-day extension allowed).[4][9]
The plan’s manual: "the Medicaid program by law is intended to be the payer of last resort," and other coverage must pay first; third-party-liability claims share the 365-day filing limit. Medicaid pays last (42 CFR 433.139). The LDH manual lets the MCO "bypass the prior authorization (PA) process and acknowledge the PA granted by the primary insurer" when another insurer covers ABA. The MCOs tightened this in November 2025: with the new uniform ABA form, if the primary insurance covers ABA, "Medicaid will remain the payor of last resort, and the authorization will be placed in a pending status until primary coverage is confirmed," so send the primary insurer’s approval or denial with the Medicaid request.[4][10][6][8]
Yes under the state rule, but the plan’s billing instruction is no longer published. The November 2023 edition of the plan’s manual billed ABA telehealth with POS 02 (member not at home) or 10 (member at home) and modifier 95 and needed no authorization addendum for established patients; the current manual (revised 09-29-2026) has no ABA telehealth section, and its modifier table lists only "Modifier GT telemedicine." Confirm the POS and modifier with the plan before billing. Yes, with prior authorization. The LDH manual lists 97151–97158 as codes that "can be performed via telehealth," with reimbursement rules otherwise unchanged; services must be "rendered or directed by a RLT, LBA, or CaBA" over "an interactive audio/visual telecommunications system." Reassessments and treatment plans may be done remotely "only if the same standard of care can be met," and RLT supervision "may be conducted via telehealth in lieu of the LBA/CaBA being physically present." 0362T and 0373T are not on the telehealth list. "Telehealth requires PA for services," and approved PAs can be amended to add units or reflect reassessment goals. The chapter names no telehealth place-of-service code or modifier, so each MCO’s billing rules decide those.[4][5][6]
Ask the plan: Aetna Better Health of Louisiana Provider Services, 1-855-242-0802: ask which POS (02/10) and modifier (95 or GT) it wants on ABA telehealth lines and whether the authorization must note telehealth.
Coverage decides whether Aetna Better Health of Louisiana pays. These decide whether the claim survives: how sessions must be staffed and supervised, what may be billed concurrently, the per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.
The plan’s policy repeats the state’s staffing rule (technician services require supervision by a licensed behavior analyst in the treatment plan) and publishes no ratio of its own, so the LDH manual’s ratio applies. Louisiana Medicaid sets the ratio in the ABA manual chapter: supervision "shall be approved on a 2:10 basis; that is two hours of supervision for every ten hours of therapy," part of it "must be done in the presence of the beneficiary" and the CaBA or registered line technician (RLT), and it "will not be approved if the licensed supervising professional is delivering the direct therapy." The licensed supervising professional "shall supervise no more than 24 technicians a day" (more if a CaBA is on the team) and "no more than 10 CaBAs." If technician services are in the plan, supervision by a licensed behavior analyst must be part of it.[1][6]
The plan publishes no ABA concurrent-billing rule of its own and says it is aligned with the LDH manual, which allows it. Yes. The LDH manual says: "One-on-one supervision may by be conducted and billed simultaneously and concurrently with one-on-one therapeutic behavioral services. Supervision can only occur when a non-licensed professional is providing the therapeutic behavioral services." In practice that is 97155 alongside 97153 when an RLT or CaBA is delivering the session.[2][6]
The plan publishes no ABA note rule of its own and says it follows the LDH manual. Start and stop times are required "for every code billed" (at the start of the session, after any break of 12 minutes or more, and on a switch of billing code). "The person delivering the service must sign, date, and include their credentials in the documentation for each day and distinct session," and the daily log must also carry the "Name, signature, and credentials for supervising BCBA who is also rendering provider for billing." For an RLT session, recorded data can replace the narrative. Records are kept at least six years.[2][6]
The plan publishes no ABA setting rule of its own; its current manual (revised 09-29-2026) says only that ABA claims are paid from the Louisiana Medicaid fee schedule. Services "must be provided in a natural setting (e.g., home and community-based settings, including clinics and school)," and school-based ABA by ABA providers is allowed. A treatment plan that puts services in a school "will not be approved until an IEP is provided" to the MCO. Sessions at a "non-ABA facility" (any place other than the home that does not offer ABA as a primary service) need an addendum explaining why they cannot happen at home or at the ABA facility. A change of setting mid-authorization needs a treatment-plan addendum. Overlap with other therapies (speech, OT, PT, waiver services): ABA may be delivered "simultaneously with another service, if allowed per medically unlikely edits and coding guidelines," only when "the other service in question must not have a restriction that keeps it from being performed at the same time as another service," and the treatment-plan addendum must give the frequency and duration of sessions when the ABA provider and the other provider are both present and what the other provider needs to implement the skill.[4][6]
The plan publishes no ABA-specific rendering rule and says it follows the LDH manual. The supervisor. "When billing for ABA services, the rendering provider on the claim form must be the provider that provided supervision for those services and signed documentation indicating that they supervised the services being billed for on the claim," and "Payment for services must be billed by the licensed professional" (an LBA, licensed psychologist or licensed medical psychologist). RLTs are not billed as rendering providers.[2][6]
No ABA unit cap is published by the plan or the LDH manual; hours come from the authorized treatment plan, and MCG asks that intensity be "individualized and designed to meet needs of patient."[1][6]
Ask the plan: Aetna Better Health of Louisiana BH utilization management, 1-855-242-0802: ask how units are authorized and edited.
Yes, for the assessment and for treatment, under Policy 7000.11. Requests are judged against the LDH ABA manual and MCG’s ABA guideline, with the LDH manual controlling where they differ.
No. Louisiana Medicaid covers ABA for any condition ABA is recognized to treat, including autism, after a comprehensive diagnostic evaluation. The plan’s own guidance says so.
Codes 97151–97158 with place of service 02 or 10 (by where the child is) and modifier 95. An existing authorization does not need an addendum.
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.
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