---
title: "Aetna ABA coverage in Hawaii: the intake guide."
url: "https://carelu.com/payers/aetna-hawaii"
markdown_url: "https://carelu.com/payers/aetna-hawaii.md"
state: HI (Hawaii)
payer: Aetna in Hawaii
kind: Commercial insurance
description: "How Aetna covers ABA for Hawaii families — the national clinical policy, precertification on every ABA code, Luke’s Law (under 14, $25,000/yr ABA cap, exemptions), Hawaii behavior-analyst licensure, and what intake should verify."
last_reviewed: October 2026
---

# Aetna ABA coverage in Hawaii: the intake guide.

_Payer Guide · Aetna · Hawaii · Last updated October 2026 · 15 primary sources_

> CPB 0554 (ABA) + CPB 0648 (ASD) + Hawaii’s Luke’s Law (under 14, $25K/yr ABA).

For a Hawaii intake team, an Aetna card means three layers: Aetna’s national ABA policy, Hawaii’s autism mandate (Luke’s Law, HRS § 431:10A-133), and the plan’s funding type, which decides whether the mandate applies. Aetna runs no QUEST plan in Hawaii, and we found no Hawaii-specific Aetna ABA policy — the national documents plus the state law are the whole picture.

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Required — precertification per Aetna’s behavioral health precertification list (eff. 8/1/2024), which names 97151 and 97152 among the ABA codes; CPB 0554 itself sets no precertification rule [4][1]
- **Prior auth for treatment**: Required — all ABA codes (97151–97158, 0362T, 0373T) on the precertification list; progress re-evaluated every six months [4][3]
- **Autism diagnosis required?**: Yes — DSM-5 ASD (F84.0, F84.3–F84.9); ABA for non-ASD indications is experimental [3][1]

## At a glance

- **Covers ABA?:** Yes — for ASD, per Aetna’s national policy
- **State mandate:** Luke’s Law — HRS § 431:10A-133 (insurers), a parallel HRS ch. 432 art. 1 section (mutual benefit societies such as HMSA), HRS § 432D-23 (HMOs such as Kaiser); Act 235, 2015
- **Mandate age:** Individuals under fourteen years of age
- **Mandate caps:** ABA capped at $25,000 per year for children ages thirteen and under; cost-sharing no less favorable than for substantially all medical services
- **Exempt from mandate:** Self-funded employer (ERISA) plans; disability, accident-only, Medicare, Medicare supplement, student accident and health, dental-only and vision-only policies, and policies or renewals of six months or less
- **Licensure:** Yes — HRS ch. 465D licensed behavior analyst (DCCA): passed BCBA exam + active BCBA/BCBA-D; RBTs and BCaBAs exempt when working under a licensed behavior analyst

## The national policy, applied in Hawaii

Aetna covers ABA for autism spectrum disorder under CPB 0554 (with CPB 0648 for ASD) and its ABA medical necessity guide, and considers ABA "experimental, investigational, or unproven" for Down syndrome without ASD and for all other non-ASD indications. The guide requires a DSM-5 ASD diagnosis by an appropriate provider, functional impairment on a standardized scale within the past 12 months, and a treatment plan with defined targets, baselines, generalization and titration. Progress is evaluated every six months. The behavioral health precertification list names all ten ABA codes. [1][2][3][4]

## The Hawaii mandate: Luke’s Law

Hawaii’s autism mandate is Luke’s Law, Act 235 of 2015. It added the same autism section three times — to the insurance code as HRS § 431:10A-133, to chapter 432 for mutual benefit societies (HMSA’s chapter), and, through HRS § 432D-23, to HMO contracts — so every state-regulated carrier in Hawaii carries it. The text is narrow by current standards. Policies issued or renewed after January 1, 2016 must cover the diagnosis and treatment of autism for "individuals under fourteen years of age," and applied behavior analysis "shall be subject to a maximum benefit of $25,000 per year for services for children ages thirteen and under." Payments for anything other than ABA do not count toward that cap, and cost-sharing may be "no less favorable" than for substantially all medical services. [6][7]

The statute also sets rules intake should know: treatment requests "shall include a treatment plan," and the carrier may review the plan and medical necessity at its discretion; treatment must be "prescribed or ordered" by a licensed physician, psychiatrist, psychologist, licensed clinical social worker or registered nurse practitioner; coverage excludes custodial care, services by family or household members, experimental treatment and "services provided outside of the State"; network autism providers must clear state and federal criminal background checks; and a child diagnosed under an older DSM edition "may be required to undergo repeat evaluation" when a new edition is published. Exempt: self-funded employer plans (not state-regulated insurance) and disability, accident-only, Medicare, Medicare supplement, student, dental-only and vision-only policies and policies of six months or less. Whether a $25,000 annual ABA dollar limit can still be applied to a given plan alongside federal parity rules is a plan-level question; the statute text itself has not been amended since 2015. [6][7]

## Licensure in Hawaii

Hawaii licenses behavior analysts under HRS chapter 465D, run by the Department of Commerce and Consumer Affairs. A license requires having passed the BCBA examination and maintaining active BACB status as a BCBA or BCBA-D (HRS § 465D-8). Section 465D-7 exempts, among others, BCaBAs practicing "under the direction of a licensed behavior analyst," RBTs who directly implement ABA "under the direction of a licensed behavior analyst or a licensed psychologist," licensed psychologists and their supervisees, and graduate students and people accruing BACB experience hours under a licensed behavior analyst. Luke’s Law then limits covered autism treatment to providers "licensed by a state licensure board," so the supervising analyst on a commercial claim needs the Hawaii license, not just BACB certification. [9][8][16][6]

## Rates

Aetna does not publish commercial ABA fee schedules for Hawaii; rates are set in your participating-provider agreement. Med-QUEST’s published FFS ABA rates (97153 at $17.66 per 15 minutes for 2025) are a public reference point, not a commercial floor. [17]

## How fast must Aetna pay a clean ABA claim in Hawaii?

Hawaii’s prompt-pay statute covers insurers issuing comprehensive medical plans, as well as mutual benefit societies and HMOs. "Unless shorter payment timeframes are otherwise specified in a contract," a claim that is not contested or denied must be paid within thirty calendar days of receiving a written claim or fifteen calendar days of receiving an electronic one. A contested or denied claim must be flagged within 15 days (written) or 7 days (electronic), naming the contested part and the reason, unless the plan sends at least a monthly reimbursement report carrying that information. After you supply requested information the same 30- or 15-day clock applies, and late payments carry interest "at a rate of fifteen per cent a year," added automatically once it reaches $2. Before recouping a payment the plan must give 30 days’ written notice, and you have 60 days from that notice to appeal (HRS § 431:13-108). Self-funded employer plans are not covered by the statute. [15][18]

Aetna’s provider manual (edition 6/26) publishes no numeric filing deadline: a clean claim is one "received in a timely manner," so the operative limit is the one in your Aetna agreement or state law. The manual says a clean claim "Doesn’t involve coordination of benefits," and that COB, corrected and voided claims can all be submitted through Availity at no charge; it sets no separate deadline for corrected or secondary claims and publishes no weekly payment cycle or submission cutoff. [15][18]

## Does Aetna need a referring provider on the ABA claim?

Aetna publishes no requirement to report a referring or ordering provider on an ABA claim. Its office manual defines a clean claim as including “A corresponding referral (whether in paper or electronic format), if required for the applicable claim” plus “All the data elements of the UB-04 or CMS-1500 (or successor standard) forms (including but not limited to member identification number, National Provider Identifier (NPI), date(s) of service, and a complete and accurate breakdown of services).” [15][5]

A referral matters only on plans that require PCP referrals for specialist care. Those referrals must be issued before the visit (“Referrals should not be retroactive”), and “In Aetna Open Access® plans, referrals also are not necessary.” Aetna’s behavioral health manual lists direct access as the first way into care: members may reach behavioral health “Through direct access to the behavioral health provider,” through a recommendation from their PCP or another treating provider, or through an EAP referral. [15][5]

## What goes in an Aetna ABA precertification request?

Since August 1, 2026, one Aetna form — “Outpatient Behavioral Health (BH) – ABA Treatment Request: Required Information for Precertification” (GR-69017-4) — “replaces all other” ABA precertification information forms. It does not start a request. Start the request on Availity (Authorization Add) or by phone, then attach the form and the records to the case, or fax them to FaxHub 833-596-0339 with the reference number. [19]

Section 1 asks for the member and provider group details; the current DSM-5 diagnosis code(s); the diagnosing provider’s name and credentials; hours per authorization period for the assessment codes 97151, 97152 and 0362T; hours per week for 97153–97158 and 0373T; and whether any hours fall during class. Section 2 asks who supervises the ABA services, and whether the child also gets PT, OT, speech, mental health or school services and whether you coordinate with those providers. It also asks for current impairment areas with supporting severity data. [19]

Attach the results of a standardized assessment (“i.e. Vineland, ABAS, VB-MAPP”) completed within the past 12 months. Also attach a time-limited, individualized treatment plan with baselines and measurable progress criteria, caregiver goals, titration and discharge criteria with an aftercare plan, and baseline, interim and current data for every goal. The form names CPB 0648 and the ABA Medical Necessity Guide as the review criteria. [19]

## What must an Aetna ABA reauthorization request contain, and are graphs required?

Aetna’s ABA medical necessity guide (©2026) says "A member's progress is to be evaluated every six months," and a member not making progress "will be transitioned to other appropriate services"; coverage ends when medical necessity is no longer met or when standardized improvement thresholds (for example, two or more standard deviations in multiple domains) are reached. The guide does not specify a graph or data-presentation format for the reassessment; send the updated treatment plan with measurable progress against each goal and the standardized scores the termination criteria are tested against. [3]

## Network participation, out-of-network referrals and disputes (Aetna)

Joining the network: Aetna's participation criteria for ABA providers require services "provided directly or supervised by individuals licensed by the state or certified by the Behavior Analyst Certification Board as board-certified behavior analysts (BCBAs)"; a BCaBA or paraprofessional works under supervision, BCBAs must meet Aetna credentialing standards, and "All BCBAs, BCaBAs and paraprofessionals must meet state requirements." The criteria do not say the ABA network is open or closed in a given state. [14][5][15]

Out-of-network care and single case agreements: Aetna does not use the term "single case agreement" in these documents. Its behavioral health manual describes a "nonparticipating referral" — "a written or verbal request that we review" — that may be approved when a preferred clinician "isn't available in network (and the member's plan provides coverage for out-of-network services)," when the member is continuing or returning to treatment with a nonparticipating clinician "in certain circumstances," or when the PCP identifies a nonparticipating expert. Plans without referral requirements let members self-refer to participating or nonparticipating providers, paying their cost share; Aetna Open Access plans let members self-refer to any participating provider. [14][5][15]

Disputes: payment disputes on a finalized claim go through the Availity provider portal ("Dispute Claim" from Claim Status, then the Appeals dashboard, up to five 32 MB attachments) or the Disputes and Appeals page on Aetna.com. The behavioral health manual describes "One level of appeal" for payment decisions; pre-service and concurrent medical-necessity denials go through the member appeal process, and a provider appeal counts as "on behalf of the member" only with the member's written authorization. State rules may change the process. [14][5][15]

Authorizations and changing agencies: none of these Aetna documents says whether an ABA precertification is issued to the rendering NPI, the group or the TIN, or whether it moves with the child to a new agency; ask the precertification line on the member's card before the first session with the new agency. [14][5][15]

## Intake gates

The questions that decide whether a family can start with Aetna in Hawaii, and what they have to bring.

- **Diagnosis recency**: No expiry on the diagnosis, but functional impairment must be shown on a standardized scale "in the past 12 months," and progress is re-evaluated every six months. Luke’s Law lets a carrier ask for a repeat evaluation when a new DSM edition is published. [3][6]
- **Who may diagnose**: DSM-5 ASD "obtained by an appropriate provider (i.e. licensed psychologist/psychiatrist, physician or other health care professional qualified to diagnose mental health conditions within their scope of practice)." CPB 0648 lists professionals appropriate for ASD evaluation, from developmental pediatricians and neurologists to psychologists and SLPs. LCSW: yes — Aetna accepts an "other health care professional qualified to diagnose mental health conditions within their scope of practice," and Hawaii puts "Clinical diagnosis" inside the LCSW scope (HRS § 467E-1(8)). Hawaii scope rule: the practice of social work includes "(8) Clinical diagnosis or psychotherapy, or both, provided by a licensed clinical social worker" (HRS § 467E-1), and Luke's Law covers autism treatment "prescribed or ordered" by a licensed physician, psychiatrist, psychologist, licensed clinical social worker or registered nurse practitioner (HRS § 431:10A-133). [3][2][13][6]
- **Diagnostic tools required**: CPB 0648 names ADI-R, ADOS-2, CARS-2 and the Asperger Syndrome Diagnostic Scale for the diagnosis; the ABA guide requires a standardized functioning measure (Vineland-3, ABAS, VB-MAPP or ABLLS) within 12 months showing impairment at least one standard deviation below the mean, or significant risk of harm. [2][3]
- **Referral required?**: Aetna’s national policies need no physician referral; they need precertification on all ABA codes. For fully insured Hawaii plans, Luke’s Law covers treatment "prescribed or ordered" by a licensed physician, psychiatrist, psychologist, LCSW or registered nurse practitioner, and each request must include a treatment plan. [4][3][6]
- **Telehealth**: Aetna's Telemedicine and Direct Patient Contact Payment Policy lists the ABA codes it pays by telehealth, by line of business. On commercial plans the eligible codes are 97151 (the assessment), 97153, 97155 (protocol modification, the code for BCBA direction of the technician), 97156 and 97157, billed with modifier GT, 95 or FR; 97152, 97154 and 97158 are checked for Medicare Advantage only. The posted policy shows a last review of June 2021, so treat the list as perishable. [20]
  - Ask the plan: Aetna provider services or Availity — confirm the payment policy is still current and that the member's plan carries a telehealth benefit before scheduling remote hours.
- **Age limit** _(plan-dependent)_: Aetna’s policies set no age cap. Luke’s Law requires coverage only for "individuals under fourteen years of age" on fully insured plans; beyond 13, coverage depends on the plan. Self-funded plans are outside the statute. [3][6]
  - Ask the plan: Benefits verification on the member ID — funding type, then the plan’s own ABA age terms.
- **Prior-auth decision time** _(plan-dependent)_: Depends on funding. Group plans (fully insured through 45 CFR 147.136, self-funded directly) follow 29 CFR 2560.503-1: pre-service decisions "not later than 15 days," one 15-day extension, urgent within 72 hours. We found no Hawaii statute setting a shorter initial-decision deadline for fully insured plans; HRS § 432E-5 sets internal appeals at 72 hours expedited and 60 days. [10][11][12]
  - Ask the plan: Ask Aetna at benefits verification for its precertification turnaround and continuation lead time for this plan.
- **Other insurance (who pays first)** _(plan-dependent)_: Order is set by the plans’ COB provisions; we found no Hawaii rule fixing it, so ask Aetna which plan is primary (and whether the birthday rule applies). If the child also has QUEST, Aetna pays first and Medicaid last — get Aetna precertification even so. TRICARE pays after this plan; CHAMPVA pays last. [17][21][22][23]
  - Ask the plan: Aetna benefits verification — record every other coverage the child has.

## Delivery and billing rules

Coverage decides whether Aetna in Hawaii 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.

- **Supervision**: Services must be "provided directly or billed by licensed behavior analysts (in states with behavior analyst licensure laws), board-certified behavior analysts, or licensed psychologists" where ABA is in scope, unless state mandates, plan documents or contracts say otherwise; where others deliver services, "there must be supervision and direction" in line with practice standards. Aetna publishes no numeric ratio. In Hawaii, RBTs and BCaBAs may practice only under a licensed behavior analyst’s direction (HRS § 465D-7). [3][8]
- **Daily limits / MUEs**: No per-day or per-week unit cap. The guide gives typical intensities — comprehensive ABA 10–25 hours a week, focused ABA 1–20 hours a week — as typical, not limits. On fully insured Hawaii plans Luke’s Law caps ABA at $25,000 a year for children 13 and under. [3][6]
- **Session-note signature**: Aetna has a general rule, not an ABA-specific one. Its medical-record standards apply to "all participating practitioners," who "agree to maintain medical records in a current, detailed, organized, and comprehensive manner." The core components are: "All entries are dated," "All entries are legible to someone other than the writer," and "All entries in the record must contain the provider's signature/initials or electronic identifier." Aetna audits records against these at least every two years, with an 85% performance goal. Aetna's ABA documents do not say whether the technician, the supervising BCBA or both sign a session note, or how soon after the session it must be signed. Each person who writes an entry should sign or e-sign and date it. [15][3]
- **Place of service**: Outpatient ABA is setting-agnostic in Aetna’s guide, which expects coordination with the school district as applicable. Luke’s Law excludes "services provided outside of the State" and does not reduce IEP or IFSP obligations. [3][6]
- **Bill as provider**: Services must be "provided directly or billed by the appropriately licensed provider" — licensed behavior analysts in licensure states, BCBAs, or licensed psychologists in scope. Hawaii licenses behavior analysts (HRS ch. 465D), and Luke’s Law covers treatment only from a provider "licensed by a state licensure board." [3][9][6]
- **Concurrent billing (97153 + 97155)** _(ask the plan)_: Not addressed in CPB 0554, CPB 0648 or the ABA medical necessity guide. [1][3]
  - Ask the plan: Aetna provider services or your participating-provider agreement.

## What intake should collect for Aetna in Hawaii

- **Plan funding type:** Fully insured (Luke’s Law applies) or self-funded employer plan (exempt). Get the employer and group number.
- **Child’s age:** Luke’s Law covers children under 14, with ABA capped at $25,000 a year for ages 13 and under. Older children depend on the plan.
- **Diagnosis report:** DSM-5 ASD diagnosis, who made it, and date — Aetna covers ABA for ASD only.
- **Recent standardized functioning measure:** Aetna wants impairment on a standardized scale (Vineland-3, ABAS, VB-MAPP or ABLLS) within the past 12 months.
- **Treatment order:** Luke’s Law covers treatment prescribed or ordered by a physician, psychiatrist, psychologist, LCSW or registered nurse practitioner.

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

## Common questions

### Will Aetna approve an out-of-network ABA provider?

Possibly, through a "nonparticipating referral" that Aetna reviews — for example when the needed clinician "isn't available in network (and the member's plan provides coverage for out-of-network services)" or the child is continuing treatment with a nonparticipating clinician. Aetna's manuals do not describe a single case agreement program by name.

### Does Aetna require graphs for ABA reassessments?

Aetna’s guide requires a progress evaluation every six months but does not prescribe graphs; send measurable progress against each goal and the standardized scores its termination criteria use.

### What is Aetna’s timely filing limit for ABA claims, and when does it pay?

Aetna publishes no numeric filing limit; it comes from your Aetna agreement or state law. COB, corrected and voided claims go through Availity; no weekly payment cutoff is published.

### Does Aetna cover ABA therapy in Hawaii?

Yes — for ASD under Aetna’s national policy, with precertification on every ABA code. Fully insured Hawaii plans also carry Luke’s Law: coverage for children under 14, with ABA capped at $25,000 a year for ages 13 and under.

### What does Hawaii’s autism mandate require?

Luke’s Law (HRS § 431:10A-133) requires state-regulated plans to cover autism diagnosis and treatment for individuals under 14, with ABA subject to a $25,000 annual maximum for children 13 and under. Self-funded employer plans are exempt.

### What does Aetna pay for ABA in Hawaii?

Commercial rates are negotiated in your provider agreement and not published.

### Does Aetna require a referring provider (box 17) on ABA claims?

Aetna publishes no such requirement for ABA. A referral has to accompany a claim only when the member’s plan requires PCP referrals for specialist care. Behavioral health is a direct-access benefit in Aetna’s behavioral health manual.

### Which form does Aetna want with an ABA prior-authorization request?

Since August 1, 2026, use form GR-69017-4, “ABA Treatment Request: Required Information for Precertification.” Start the request on Availity or by phone first, then attach the completed form plus a standardized assessment from the past 12 months and the treatment plan.

## Primary sources

1. [Aetna CPB 0554 — Applied Behavior Analysis (last review 10/14/2026)](https://www.aetna.com/cpb/medical/data/500_599/0554.html)
2. [Aetna CPB 0648 — Autism Spectrum Disorders (last review 10/20/2026)](https://www.aetna.com/cpb/medical/data/600_699/0648.html)
3. [Aetna — Applied behavior analysis medical necessity guide (©2026)](https://www.aetna.com/content/dam/aetna/pdfs/health-care-professionals/applied-behavioral-analysis-necessity-guide.pdf)
4. [Aetna — Participating provider behavioral health precertification list (eff. 8/1/2024)](https://www.aetna.com/content/dam/aetna/pdfs/aetnacom/healthcare-professionals/documents-forms/bh_precert_list.pdf)
5. [Aetna — Behavioral Health Provider Manual](https://www.aetna.com/content/dam/aetna/pdfs/aetnacom/healthcare-professionals/documents-forms/bh-provider-manual.pdf)
6. [HRS § 431:10A-133 — Autism benefits and coverage; notice; definitions (Luke’s Law; current text, archived 8/10/2026)](https://www.capitol.hawaii.gov/hrscurrent/Vol09_Ch0431-0435H/HRS0431/HRS_0431-0010A-0133.htm)
7. [S.B. 791 C.D. 1 (2015), enacted as Act 235 — Luke’s Law: §§ 3–6 add the insurer, mutual-benefit-society and HMO autism sections](https://www.capitol.hawaii.gov/session2015/bills/SB791_CD1_.htm)
8. [HRS § 465D-7 — Behavior analysts: exemptions (am. L 2023, c 167)](https://www.capitol.hawaii.gov/hrscurrent/Vol10_Ch0436-0474/HRS0465D/HRS_0465D-0007.htm)
9. [HRS § 465D-8 — Behavior analysts: application for licensure](https://www.capitol.hawaii.gov/hrscurrent/Vol10_Ch0436-0474/HRS0465D/HRS_0465D-0008.htm)
10. [29 CFR 2560.503-1 — ERISA claims procedure (eCFR)](https://www.ecfr.gov/current/title-29/section-2560.503-1)
11. [45 CFR 147.136 — Internal claims and appeals for group and individual coverage (eCFR)](https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-B/part-147/section-147.136)
12. [HRS § 432E-5 — Complaints and appeals procedure for enrollees](https://www.capitol.hawaii.gov/hrscurrent/Vol09_Ch0431-0435H/HRS0432E/HRS_0432E-0005.htm)
13. [HRS § 467E-1 — Social workers: definitions (practice of social work incl. "(8) Clinical diagnosis or psychotherapy, or both, provided by a licensed clinical social worker")](https://www.capitol.hawaii.gov/hrscurrent/Vol10_Ch0436-0474/HRS0467E/HRS_0467E-0001.htm)
14. [Aetna — Provider and facility participation criteria (Applied behavior analyst (ABA) services provider additional criteria; May 2026)](https://www.aetna.com/content/dam/aetna/pdfs/aetnacom/healthcare-professionals/documents-forms/network-participation-criteria-document.pdf)
15. [Aetna Health Care Professional Toolkit / provider manual (8102800-01-01, 6/26): Referral policies; Claim disputes and appeals](https://www.aetna.com/content/dam/aetna/pdfs/aetnacom/health-care-professionals/office_manual_hcp.pdf)
16. [HRS § 465D-2 — Behavior analysts: definitions](https://www.capitol.hawaii.gov/hrscurrent/Vol10_Ch0436-0474/HRS0465D/HRS_0465D-0002.htm)
17. [Med-QUEST memo QI-2431 / FFS 24-13 (Dec 31, 2024) — Coverage of IBT for children under 21 with ASD: Guidelines for ABA (Attachments A–C)](https://medquest.hawaii.gov/content/dam/formsanddocuments/provider-memos/qi-memos/qi-memos-2024/QI-2431,%20FFS%2024-13%20Replaces%20QI-2301,%20FFS%2023-01%20Coverage%20of%20IBT%20for%20treatment%20of%20children%20under%2021%20years%20of%20age%20with%20ASD_Guidelines%20for%20ABA._FINAL%20(part%201)%20-%20signed.pdf)
18. [HRS § 431:13-108 — Reimbursement for accident and health or sickness insurance benefits (Hawaii Revised Statutes)](https://www.capitol.hawaii.gov/hrscurrent/Vol09_Ch0431-0435H/HRS0431/HRS_0431-0013-0108.htm)
19. [Aetna — Outpatient Behavioral Health (BH) – ABA Treatment Request: Required Information for Precertification (GR-69017-4, 7-26; effective August 1, 2026)](https://www.aetna.com/content/dam/aetna/pdfs/aetnacom/pharmacy-insurance/healthcare-professional/documents/outpatient-behavioral-health-BH-ABA-assessment-precert.pdf)
20. [Aetna — Telemedicine and Direct Patient Contact Payment Policy (ABA code table: Commercial vs. Medicare columns; posted policy shows last review June 2021)](https://www.aetna.com/content/dam/aetna/pdfs/aetnacom/pdf/telemedicine.pdf)
21. [42 CFR 433.139 — Medicaid payment of claims involving third-party liability (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-433/subpart-D/section-433.139)
22. [10 U.S.C. 1079(i)(1) — TRICARE pays after other coverage except Medicaid](https://www.govinfo.gov/content/pkg/USCODE-2023-title10/html/USCODE-2023-title10-subtitleA-partII-chap55-sec1079.htm)
23. [38 CFR 17.270 — CHAMPVA is the last payer](https://www.ecfr.gov/current/title-38/section-17.270)

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.