---
title: "Aetna ABA coverage in New Hampshire: the intake guide."
url: "https://carelu.com/payers/aetna-new-hampshire"
markdown_url: "https://carelu.com/payers/aetna-new-hampshire.md"
state: NH (New Hampshire)
payer: Aetna in New Hampshire
kind: Commercial insurance
description: "How Aetna covers ABA for New Hampshire families: the national clinical policy, precertification, New Hampshire’s RSA 417-E autism mandate (no current age or dollar caps), credentialing without a state license, and what intake should verify."
last_reviewed: September 2026
---

# Aetna ABA coverage in New Hampshire: the intake guide.

_Payer Guide · Aetna · New Hampshire · Last updated September 2026 · 11 primary sources_

> CPB 0554 (ABA) + CPB 0648 (ASD) + New Hampshire’s RSA 417-E mandate layer.

For an intake team in New Hampshire, an Aetna card means three layers: Aetna’s national clinical policy, New Hampshire’s autism mandate in RSA 417-E, and the plan’s funding type, which decides whether the mandate applies at all. This guide stacks them in order.

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Required: all ten ABA codes, 97151 included, are on Aetna’s behavioral health precertification list (eff. 8/1/2024); CPB 0554 itself sets no precertification rule [4][1]
- **Prior auth for treatment** _(plan-dependent)_: Required: precertification on form GR-69017-4 via Availity or phone; the reauthorization interval is set by the plan [4]
  - Ask the plan: The member’s Aetna plan (benefits line on the card): ask whether the group carries ABA precertification and what reauthorization interval it uses.
- **Autism diagnosis required?**: Yes: ASD only (F84.0, F84.3–F84.9); ABA for other diagnoses is considered experimental [1][3]

## At a glance

- **Covers ABA?:** Yes, for ASD, per the national Aetna policy
- **State mandate:** RSA 417-E:1, III(h) + RSA 417-E:2 (HB 569, Laws 2010 ch. 363)
- **Mandate age:** No age limit in the current statute (the 2010 law let plans cap ABA by age band, 0–12 and 13–21; that paragraph is gone)
- **Mandate caps:** None in the current text; the 2010 caps ($36,000/yr ages 0–12, $27,000/yr ages 13–21) no longer appear in RSA 417-E:2
- **Exempt from mandate:** Self-funded ERISA employer plans (outside state insurance law)
- **Licensure:** None: NH does not license behavior analysts; the mandate requires BACB certification or BACB-certificant supervision

## The national policy, applied in New Hampshire

Aetna covers ABA for autism spectrum disorder under CPB 0554 (with CPB 0648 for ASD) and considers ABA experimental for other diagnoses. Its behavioral health precertification list names all ten ABA codes, 97151 through 97158, 0362T and 0373T, and ABA precertification runs on form GR-69017-4 through Availity or the number on the card. We checked Aetna’s ABA medical necessity guide: its state exhibits do not include New Hampshire, so the national criteria apply unchanged. Aetna runs no New Hampshire Medicaid plan. [1][2][4][3]

## The New Hampshire mandate: what it guarantees

New Hampshire’s autism mandate sits inside its mental-illness parity statute. RSA 417-E:1 requires every insurer, nonprofit health service corporation and HMO issuing or renewing accident or health coverage in the state to cover "pervasive developmental disorder or autism" on terms "no less extensive than the coverage provided for any other type of health care for physical illness." RSA 417-E:2 then defines the treatment: "applied behavioral analysis, necessary to produce socially significant improvements in human behavior or to prevent loss of attained skill or function," plus pharmaceuticals, psychiatric, APRN, psychologist and social-work services, and speech, occupational and physical therapy. Two conditions bind ABA specifically. It "must be provided by a person professionally certified by the national Behavior Analyst Certification Board or performed under the supervision of" one. And the insurer "may require submission of a treatment plan, including the frequency and duration of treatment," signed by the primary care provider or a listed specialist (child psychiatrist, developmental-behavioral pediatrician, child neurologist, or a psychologist trained in child psychology), updated "no more frequently than on a semi-annual basis." Coverage "shall not be denied on the basis that services are habilitative in nature." The age and dollar question has changed since enactment: HB 569 as passed in 2010 let a policy "limit coverage for applied behavior analysis to $36,000 per year for children 0 to 12 years of age, and $27,000 from ages 13 to 21." That paragraph does not appear in the current RSA 417-E:2, whose source note lists amendments in 2011 and 2022, and no other age or dollar limit appears in the section. Autism Speaks’ New Hampshire summary (last updated December 2019) still describes the caps, so expect some plan documents and benefit summaries to lag. The mandate reaches fully insured plans only; self-funded employer plans answer to ERISA and federal parity. [6][7]

## Credentialing, licensure and rates

New Hampshire does not license behavior analysts. The BACB’s state licensure table (updated 2026) lists no New Hampshire law or board, and the practical credential is therefore BACB certification, which the mandate itself requires. That shapes credentialing in two ways. First, carriers credential BCBAs on certification rather than a state license number, even where a form asks for one (WellSense’s New Hampshire ABA form has a "BCBA license #" field). Second, the state credentialing clock in RSA 420-J:4 does help: a carrier must tell you an application is incomplete within 15 business days and must "act upon and finalize the credentialing process within 30 calendar days" of a clean and complete application for primary care physicians and mental health providers (45 days for specialists). The statute does not say which bucket a BCBA falls in, so ask. The provisional-pay rule in RSA 420-J:8-c is keyed to "a valid license from the respective state licensing board," which New Hampshire BCBAs do not hold, so do not plan on being paid before credentialing completes. On rates: commercial ABA rates are negotiated and unpublished. RSA 417-E:1, V-b requires carriers’ contracts to pay mental health and substance use treatment services, on average, at least as favorably as non-hospital primary care, measured against relative Medicare reimbursement; the statute does not say whether ABA codes are in that comparison. The public benchmark is the NH Medicaid fee-for-service schedule, which is low (97153 $17.79 and 97155 $16.43 per 15-minute unit). [10][8][6][12][13]

## Intake gates

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

- **Diagnosis recency**: No expiry on the ASD diagnosis itself, but medical necessity requires functional impairment shown on a standardized scale administered in the past 12 months (at least one standard deviation below the mean) or a significant risk of harm. [3]
- **Who may diagnose**: A DSM-5 ASD diagnosis by an appropriate provider: a licensed psychologist or psychiatrist, a physician, or another professional qualified to diagnose within scope. CPB 0648 lists the professionals appropriate to an ASD evaluation, from developmental pediatricians and neurologists to psychologists and speech-language pathologists. [3][2]
- **Diagnostic tools required**: CPB 0648 names ADI-R, ADOS-2, CARS-2 and the Asperger Syndrome Diagnostic Scale. The ABA guide requires a standardized functional measure from the past 12 months (Vineland-3, ABAS, VB-MAPP or ABLLS as examples). [2][3]
- **Referral required?**: Aetna’s national ABA policies require no physician referral or prescription; what they require is precertification of all ten ABA codes, on form GR-69017-4 through Availity or the number on the card. For a fully insured New Hampshire plan, RSA 417-E:2, II lets the insurer require a treatment plan, with frequency and duration, signed by the primary care provider or a listed specialist, updated no more than every six months. Self-funded ERISA plans sit outside the statute. [4][3][6]
- **Age limit** _(plan-dependent)_: Aetna’s national ABA policies set no age cap; the guide describes typical, not limiting, age ranges. For fully insured New Hampshire plans, the current RSA 417-E:2 carries no age or dollar limit on ABA (the 2010 caps of $36,000 a year for ages 0–12 and $27,000 for 13–21 are no longer in the text). Self-funded ERISA plans are outside the statute, so plan funding type decides whether that binds. [3][6][7]
  - Ask the plan: Live benefits verification on the member ID: establish fully insured vs. self-funded ERISA, then the plan’s own age terms.
- **Prior-auth decision time** _(plan-dependent)_: Depends on how the plan is funded. Fully insured New Hampshire plans fall under RSA 420-J:6. For requests sent through the carrier’s electronic prior-authorization process, a non-urgent decision is due "within 7 calendar days of obtaining all information necessary to make the determination"; for paper or fax requests the limit is 14 calendar days; urgent requests are decided within 72 hours. Any request for more information must come within 7 calendar days of the request date, and information supplied in a peer-to-peer counts. A missed deadline means the request "shall be considered approved." Once approved, the carrier may not revoke or limit it "if care is provided within 60 business days" of the approval, and a peer-to-peer must be offered within 2 business days of a request. Self-funded employer (ERISA) plans follow 29 CFR 2560.503-1 instead: pre-service decisions "not later than 15 days after receipt of the claim," one 15-day extension, urgent care within 72 hours. Aetna publishes no New Hampshire-specific ABA turnaround or reauthorization lead time. [8][11]
  - Ask the plan: At benefits verification ask whether the plan is fully insured (New Hampshire-regulated) or self-funded (ERISA), whether you are submitting electronically, and what reauthorization lead time Aetna expects.
- **Other insurance (who pays first)** _(plan-dependent)_: For a child on two group plans, New Hampshire follows the birthday rule: when parents are married or living together, "the plan of the parent whose birthday falls earlier in the calendar year is the primary plan" (Ins 1904.05(d)(2)); for separated parents a court decree controls, and otherwise the custodial parent’s plan pays first. That rule binds group plans regulated by the state; a self-funded plan sets its own order. When both plans require precertification, RSA 420-J:3-b says the member "shall obtain pre-certification from the primary plan," and the secondary plan "shall not refuse payment for such services solely on the basis that the services were not pre-certified by the secondary plan" (it can still apply its own criteria). If the child also has NH Medicaid, Aetna pays first: Medicaid is payer of last resort (42 CFR 433.139), and NH Medicaid will not pay a balance the primary denied for "incorrect billing, non-eligible provider, or lack of medical necessity." TRICARE pays after this plan (10 U.S.C. 1079(i)(1)); CHAMPVA is the last payer (38 CFR 17.270). [9][8][14][15][16][17]
  - Ask the plan: Ask Aetna at benefits verification for the member’s coordination-of-benefits order (and whether a self-funded plan uses the birthday rule), and record every other coverage the child has.
- **Telehealth** _(ask the plan)_: Not addressed in CPB 0554, CPB 0648 or the ABA medical necessity guide. [1][3]
  - Ask the plan: Availity or the precertification line on the card: ask which ABA codes Aetna pays by telehealth on this plan, with which POS and modifier.

## Delivery and billing rules

Coverage decides whether Aetna in New Hampshire 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 licensure laws), board-certified behavior analysts, or licensed psychologists where ABA is within scope, unless mandates, plan documents or contracts say otherwise; where others deliver services, there must be supervision "in line with practice standards." Aetna publishes no numeric ratio. The NH mandate requires ABA to be provided by, or supervised by, a BACB certificant. [3][6]
- **Daily limits / MUEs**: No per-day or per-week cap is published. Hours come from the guide’s severity assessment, with typical intensities of 10–25 hours a week for comprehensive and 1–20 for focused programs (typical, not caps). Progress is re-evaluated every six months. [3]
- **Place of service**: Outpatient ABA is setting-neutral in Aetna’s guide; inpatient, residential or partial hospitalization settings use that level of care’s criteria. Aetna expects coordination with the school and is not required to provide services under an IEP. RSA 417-E:2 likewise leaves school districts’ IEP obligations untouched. [3][6]
- **Bill as provider**: Services must be provided directly or billed by the appropriately licensed or certified provider (licensed behavior analyst where a state licenses them, BCBA, or licensed psychologist where in scope), unless mandates, plan documents or contracts say otherwise. New Hampshire has no behavior-analyst license, so the BCBA is the billing credential. [3][10]
- **Concurrent billing (97153 + 97155)** _(ask the plan)_: Not addressed in Aetna’s published ABA policies (CPB 0554, CPB 0648, the medical necessity guide). [1][3]
  - Ask the plan: Aetna provider services, the participating-provider agreement, or a written coding determination from Aetna Behavioral Health.
- **Session-note signature** _(ask the plan)_: Not addressed. Aetna sets treatment-plan content requirements but not who signs a session note or by when. [3][5]
  - Ask the plan: The participating-provider agreement and the Aetna Behavioral Health Provider Manual section on documentation.

## What intake should collect for Aetna in New Hampshire

- **Plan funding type:** Fully insured (RSA 417-E applies) vs. self-funded ERISA (plan document governs). Ask for the employer and check the card.
- **Member ID + card photo:** Enough to run a live benefits verification.
- **Diagnosis report:** DSM-5 ASD diagnosis, diagnosing provider and credentials, evaluation date. Aetna’s policy is ASD-only.
- **Standardized functional measure:** Aetna wants one from the past 12 months (for example Vineland-3).
- **Signed treatment plan:** RSA 417-E:2 lets the insurer require one signed by the PCP or a listed specialist.

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

## Common questions

### Does Aetna cover ABA therapy in New Hampshire?

Yes, under its national policy for ASD, with New Hampshire’s RSA 417-E mandate layered on for fully insured plans. Self-funded employer plans follow their own documents.

### What does the New Hampshire autism mandate require?

Coverage of autism treatment including ABA by or under a BACB-certified provider, on terms no less extensive than physical illness, without denial because services are habilitative. The current statute carries no age or dollar cap.

### What does Aetna pay for ABA in New Hampshire?

Commercial rates are negotiated and not published. The only public benchmark is NH Medicaid’s fee-for-service schedule (97153 $17.79 per 15 minutes).

## Primary sources

1. [Aetna CPB 0554 — Applied Behavior Analysis](https://www.aetna.com/cpb/medical/data/500_599/0554.html)
2. [Aetna CPB 0648 — Autism Spectrum Disorders](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. [RSA 417-E:1–2 — Coverage for biologically-based mental illnesses; treatment of pervasive developmental disorder or autism](https://www.gencourt.state.nh.us/rsa/html/XXXVII/417-E/417-E-mrg.htm)
7. [HB 569 (2010), Laws 2010 ch. 363 — as enacted, with the original ABA dollar caps](https://gc.nh.gov/legislation/2010/HB0569.html)
8. [RSA 420-J — Managed Care Law (420-J:3-b, 420-J:4 credentialing, 420-J:6 utilization review, 420-J:8-c)](https://www.gencourt.state.nh.us/rsa/html/XXXVII/420-J/420-J-mrg.htm)
9. [N.H. Admin. Rules Ins 1904 — Group Coordination of Benefits (Ins 1904.05 order of benefits)](https://www.gencourt.state.nh.us/rules/state_agencies/ins1900.html)
10. [BACB — U.S. Licensure of Behavior Analysts (New Hampshire not listed)](https://www.bacb.com/u-s-licensure-of-behavior-analysts/)
11. [29 CFR 2560.503-1 — ERISA claims procedure (eCFR)](https://www.ecfr.gov/current/title-29/section-2560.503-1)
12. [NH MMIS — 2026 Fee Schedule, Covered Procedures Report with SA Requirements (as of 07-24-2026)](https://nhmmis.nh.gov/portals/wps/wcm/connect/4a6d9e2c-f8af-407e-86f8-6378c7e79ad8/2026+Fee+Schedule+-+Covered+Procedures+Report+with+SA+Requirements+as+of+07-24-2026.pdf?MOD=AJPERES&CVID=p.9ZszB)
13. [WellSense — Applied Behavioral Analysis Prior Authorization Form, New Hampshire (updated 11/14/2025)](https://www.wellsense.org/hubfs/Forms/Provider_Forms/Applied_Behavioral_Analysis_Prior_Authorization_Form_NH.pdf)
14. [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)
15. [NH Medicaid — Non-Primary Payer Claim Billing Requirements (updated May 23, 2023)](https://nhmmis.nh.gov/portals/wps/wcm/connect/9d07a0a4-82af-46c4-b758-d1a911bd9753/NH+Medicaid+Non-Primary+Claim+Billing+Requirements.pdf?MOD=AJPERES&CVID=oywGTyK)
16. [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)
17. [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 September 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.