For an intake team in Wyoming, an Aetna card means three layers: Aetna’s national ABA policy, Wyoming’s parity-based autism coverage (Insurance Department Bulletin 01-2019, since Wyoming has no autism statute), and the plan’s funding type, which decides whether the bulletin applies at all. Wyoming Medicaid has no managed care plans, so an Aetna card here is commercial or Medicare.
Aetna covers ABA for autism spectrum disorder under its ABA medical necessity guide and CPB 0648, and CPB 0554 (last reviewed October 14, 2026) calls ABA "experimental, investigational, or unproven" for non-ASD indications. The behavioral health precertification list (effective August 1, 2024) names all ten ABA codes, 97151 through 97158, 0362T and 0373T, submitted through Availity. The guide’s only state exhibit is Maryland’s; Wyoming has none, so the national criteria apply unchanged. Note that Wyoming’s Bulletin 01-2019 forbids denying ABA for a child with autism "on the basis that ABA therapy is experimental or investigational," which Aetna’s ASD criteria do not do.[1][2][3][4][8]
Aetna’s guide requires services "provided directly or billed by licensed behavior analysts (in states with behavior analyst licensure laws)," BCBAs, or psychologists in scope. Wyoming is a licensure state, so the BCBA billing Aetna for a Wyoming child should hold the Wyoming license.[1][2][3][4][8]
Wyoming has no autism insurance statute, and intake should say so plainly. The state’s autism coverage comes from mental-health parity. W.S. 26-20-701 (the Mental Health and Substance Use Disorder Insurance Parity Act, House Enrolled Act 89, signed February 27, 2019) requires individual and group health insurance policies, nonprofit service contracts and HMO contracts to meet the federal Mental Health Parity and Addiction Equity Act. On April 19, 2019 the Insurance Department issued Bulletin No. 01-2019 applying it to autism: "treatments for Autism Spectrum Disorder cannot be excluded from the mental health services in an insurance policy," for "all individual and group health insurance policies that offer mental health benefits and are under the jurisdiction of the Department," effective "no later than July 1, 2019." Three lines matter most for ABA. "Exclusion of Applied Behavior Analysis (ABA) therapy to treat children with autism spectrum disorder on the basis that ABA therapy is experimental or investigational treatment will not be allowed." Autism benefits "may not be subject to any separate cost-sharing requirements or treatment limitation that only apply to mental health/substance use disorder benefits," and any quantitative or non-quantitative limit (including preauthorization and medical-necessity rules) must match what applies to medical/surgical benefits in the same classification. And carriers may still review medical necessity, including periodic review of continuing treatment, if the review is no more stringent than for medical/surgical care. The bulletin defines treatment as "evidence-based care and related equipment prescribed or ordered for an individual diagnosed with an autism spectrum disorder by a licensed physician or a licensed psychologist who determines the care to be medically necessary, including but not limited to behavioral health treatment." It sets no age limit and no dollar cap. Its limits: a bulletin is weaker than a statute; it reaches only policies that include mental health coverage; and self-funded employer plans regulated by ERISA are outside the Department’s jurisdiction.[8][9][10]
Wyoming licenses behavior analysts. Since 2022 (HB0110, Enrolled Act 18) the State Board of Psychology "shall issue a license as a behavior analyst or an assistant behavior analyst" to an applicant who "holds a current certification as a board certified behavior analyst" (or BCaBA) verified with the certifying entity (W.S. 33-27-124(a)); the Board’s rules name "The BACB" as "the sole certifying entity recognized by the Board" and require BACB verification, license verification from every other state, proof of lawful presence and fingerprint cards (Rules ch. 4, § 4-3). A licensed assistant behavior analyst practices "only under the supervision of a licensed behavior analyst or licensed psychologist" (33-27-124(c)); the Board’s rule requires that supervision to be "at least two percent (2%) of the total behavior-analytic service hours provided per month," with at least one meeting a month (Board Rules ch. 14, § 14-5). Behavior technicians are not licensed: 33-27-125(a)(viii) exempts a technician "under the supervision of a licensed behavior analyst or licensed assistant behavior analyst," who may not design assessment or intervention plans, and (ix) exempts a caregiver working under that analyst’s direction. Representing yourself as a behavior analyst and practicing without a license or an exemption is a misdemeanor (33-27-119(b)). For a BCBA licensed in another state there is no shortcut written down for behavior analysts: 33-27-124(b) lets the Board license someone "currently licensed as a behavior analyst … in good standing in another jurisdiction that has licensure requirements comparable to" Wyoming’s, but that is still a Wyoming license, and the Board’s temporary 30-day license (Rules ch. 3, § 3-1) is written only for psychologists. Payers add their own floor: Wyoming Medicaid says a telehealth provider "must be licensed by, or otherwise under the jurisdiction of, the appropriate State of Wyoming licensing board," and BCBSWY says telemedicine providers "must be licensed in Wyoming." Plan on a Wyoming license for any BCBA treating a Wyoming child, including by telehealth. Credentialing has a state clock: under W.S. 26-56-102 a carrier must acknowledge an application within 7 calendar days, flag an incomplete one within 30, and "conclude the process of credentialing … within sixty (60) calendar days," and once you are credentialed with a contract in effect it must pay covered services "beginning with the date the health carrier received a completed credentialing application." Commercial ABA rates are negotiated and unpublished; the only public benchmark is the Wyoming Medicaid fee schedule (97153 $12.30 and 97155 $24.60 per 15-minute unit from July 1, 2026).[12][13][14][23][24][15][25][26][10][20]
Wyoming’s insurance code sets three clocks that apply to fully insured plans. Claims: "Claims for benefits under a life, accident or health insurance policy shall be rejected or accepted and paid by the insurer … within forty-five (45) days after receipt of the proofs of loss and supporting evidence" (W.S. 26-15-124(a)); a court can add attorney’s fees and 10% interest when a refusal to pay is unreasonable. Prior authorization: the Ensuring Transparency in Prior Authorization Act (W.S. 26-55, effective July 1, 2024) requires a decision on a non-urgent request "within five (5) calendar days of obtaining all necessary information" and on an urgent one within 72 hours, after which an urgent request "shall be considered authorized"; it defines urgent services to "include mental and behavioral health care services." Outpatient authorizations must be valid for "not less than one (1) year," an approval cannot be revoked if the service is delivered within 45 business days, a new plan must honor a prior plan’s authorization for at least 90 days, a peer-to-peer must be offered within 5 business days of a denial, and since January 1, 2026 a provider whose requests for a service were at least 90% approved (minimum five requests) in the past 12 months is exempt from PA for that service for a year (26-55-112). Telehealth: a policy covering mental health may not deny coverage for a service "delivered using remote audio or audio-visual delivery systems" if it would cover it in person, may not charge higher cost-sharing, and may not pay the provider less than in person (W.S. 26-20-701(b)). Autism treatment counts as mental health under the Department’s Bulletin 01-2019. Whether a given ABA code is "covered in person" is still the plan’s call, and self-funded ERISA plans sit outside all three statutes.[10][11][8][2][7][6][1][5]
Billing details from Aetna’s own documents. Codes: Aetna’s ABA policy (CPB 0554) lists only CPT 97151–97158, 0362T and 0373T and no HCPCS code, so H0031, H0032 or H2019 are not ABA codes at Aetna. Telehealth: its Telemedicine and Direct Patient Contact Payment Policy names modifiers GT, 95 and FR but no place-of-service code, and none of Aetna’s documents says the precertification must flag telehealth; ask which POS (02 or 10) it wants when you precertify. Filing: the Health Care Professional Toolkit (6/26) prints no timely-filing deadline, so your agreement sets it, and its definition of a clean claim excludes any claim that involves coordination of benefits. Reauthorization: the ABA medical necessity guide calls for "Repeated measurement with standardized measures to assess progress" and says "A member’s progress is to be evaluated every six months"; it does not mention graphs. Supervision: the Network Participation Criteria set one hour of face-to-face supervision per 10 hours of paraprofessional ABA and publish no cap on technicians per BCBA.[10][11][8][2][7][6][1][5]
Aetna publishes no ABA rate table. Its provider manual (6/26) treats payment as a contract term: "The rates and compensation under your agreement are subject to the Aetna coding/claim edit policies," and where a provider has both an intermediary contract and a direct agreement, "your direct Aetna rates will apply unless we specifically notify you otherwise." When a member’s benefits run out, the provider "cannot charge them more than the contracted rate." Get the rates from your Aetna agreement. For a public benchmark, Wyoming Medicaid pays 97153 at $12.30 and 97155 at $24.60 per 15 minutes from July 1, 2026; commercial contracts are negotiated separately.[6][20]
The questions that decide whether a family can start with Aetna in Wyoming, and what they have to bring. Each maps onto something intake should ask on the first call.
No expiry on the ASD diagnosis itself, but medical necessity requires "functional impairment on a standardized scale of functioning in the past 12 months," at least one standard deviation below the mean, or a significant risk of harm.[1]
A DSM-5 ASD diagnosis "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)." Wyoming’s bulletin defines covered treatment as care for a child diagnosed "by a licensed physician or a licensed psychologist."[1][8]
CPB 0648 names ADI-R, ADOS-2, CARS-2 and the Asperger Syndrome Diagnostic Scale as tools used with clinical assessment. The ABA guide requires a standardized functional measure from the past 12 months (Vineland-3, ABAS, VB-MAPP or ABLLS as examples).[3][1]
Aetna’s national ABA policies require no physician referral; what they require is precertification of all ten ABA codes through Availity. Wyoming’s Bulletin 01-2019 defines covered autism treatment as care "prescribed or ordered for an individual diagnosed with an autism spectrum disorder by a licensed physician or a licensed psychologist," so keep that prescription or order on file for a fully insured plan. Self-funded ERISA plans sit outside the bulletin.[4][1][8]
Aetna’s national ABA guide sets no age cap; its age ranges are typical, not limiting. For fully insured Wyoming plans that include mental health coverage, Bulletin 01-2019 sets no age limit and no dollar cap, and bars autism-only limits that do not apply to medical/surgical benefits. Self-funded ERISA plans are outside it, so plan funding type decides whether that binds.[1][8]
Ask the plan: Live benefits verification on the member ID: establish fully insured vs. self-funded ERISA, then the plan’s own age terms.
Aetna’s Telemedicine and Direct Patient Contact Payment Policy lists the ABA codes it pays by telehealth: on commercial plans 97151, 97153, 97155, 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. Aetna’s provider manual (6/26) says Aetna Behavioral Health "offers telehealth services to all commercial fully insured members and to all commercial self-insured plan sponsors, unless those self-insured plan sponsors opt out," and providers must "ensure that they have the proper licensure based on state requirements," which in Wyoming means a Wyoming behavior-analyst license. For fully insured Wyoming plans, W.S. 26-20-701(b) bars denying a covered mental health service because it is delivered by remote audio or audio-visual means. Aetna’s Telemedicine and Direct Patient Contact Payment Policy (posted policy shows last review June 2021) marks 97151, 97153, 97155, 97156 and 97157 as telehealth-eligible on commercial plans with modifier GT, 95 or FR; neither it nor the provider toolkit names a telehealth place-of-service code or says the precertification must flag telehealth.[7][6][10][12]
Ask the plan: Availity or the precertification line on the card: ask whether the plan is fully insured in Wyoming or self-funded (and opted out of telehealth), and which ABA codes, POS and modifier Aetna pays by telehealth.
Depends on how the plan is funded. Fully insured plans fall under W.S. 26-55: a non-urgent prior-authorization decision is due "within five (5) calendar days of obtaining all necessary information to complete the review," and an urgent one within 72 hours, after which it "shall be considered authorized." The Act defines urgent health care services to "include mental and behavioral health care services," which read literally puts behavioral health requests, ABA included, on the 72-hour clock; ask the carrier how it applies that. An outpatient authorization must be valid for "not less than one (1) year" (one year for a chronic condition), and a peer-to-peer must be offered within 5 business days of an adverse determination. Self-funded employer (ERISA) plans follow 29 CFR 2560.503-1: 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 Wyoming-specific ABA turnaround or reauthorization lead time.[10][11][16]
Ask the plan: At benefits verification ask whether the plan is fully insured (Wyoming-regulated) or self-funded (ERISA), whether Aetna treats ABA as an urgent behavioral health service under W.S. 26-55-102(a)(x), and what authorization length and reauthorization lead time it will use.
Wyoming’s Insurance Department rule on coordination of benefits (Rules ch. 10, § 10-3, amended effective 9/13/2023) sets the order: the plan covering the person "other than as a dependent" is primary; for a child whose parents "are married or are living together," "The plan of the parent whose birthday falls earlier in the calendar year is the primary plan" (same birthday: the plan that has covered a parent longest). For divorced or separated parents a court decree assigning health coverage decides; with none, the custodial parent’s plan pays first, then the custodial parent’s spouse’s, then the non-custodial parent’s, then that parent’s spouse’s. If the plans cannot agree within 45 calendar days after receiving everything needed to pay, they pay in equal shares. Self-funded ERISA plans are not bound by the rule and follow their plan documents. If the child also has Wyoming Medicaid, Aetna pays first: Medicaid "is the payer of last resort" and pays no more than the remaining patient responsibility (42 CFR 433.139; Wyoming Medicaid CMS-1500 manual ch. 7). TRICARE pays after this plan (10 U.S.C. 1079(i)(1)); CHAMPVA is the last payer (38 CFR 17.270).[21][22][10][17][25][18][19]
Ask the plan: Ask Aetna at benefits verification for the member’s coordination-of-benefits order (and whether the plan uses the birthday rule), and record every other coverage the child has.
Coverage decides whether Aetna in Wyoming 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.
Aetna’s guide: where others deliver services, there must be supervision "in line with practice standards," and it may authorize QHP protocol modification and direction "at 1 to 2 hours per 10 hours of treatment by protocol." Aetna’s Network Participation Criteria (5/26) require "A minimum of one hour of face-to-face supervision" of a paraprofessional "for each 10 hours of applied behavior analysis," plus the supervisor "onsite with the child at least one hour a month," and "All BCBAs, BCaBAs and paraprofessionals must meet state requirements." In Wyoming that means technicians work under a licensed behavior analyst or licensed assistant (W.S. 33-27-125(a)(viii)). Aetna’s guide and Network Participation Criteria publish no cap on the number of technicians one BCBA may supervise.[1][5][12]
No per-day or per-week cap is published. Hours follow the guide’s severity table, with typical intensities of 10–25 hours a week for comprehensive and 1–20 for focused programs (typical, not caps), and progress is evaluated every six months. On fully insured Wyoming plans, Bulletin 01-2019 bars autism-only limits that do not apply to medical/surgical benefits.[1][8]
Aetna’s guide is setting-neutral for outpatient ABA and expects "collaboration and coordination with existing providers and/or the school district." Its only school carve-out language (no obligation to provide services under an IEP or IDEA) appears in the Maryland exhibit, not as a national rule. No Wyoming rule restricts ABA settings for commercial plans.[1]
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 behavior analysis is within their scope," unless mandates, plan documents or contracts say otherwise. Wyoming licenses behavior analysts (W.S. 33-27-124), so the billing BCBA should hold the Wyoming license.[1][12]
No. Aetna’s ABA policy lists only CPT 97151–97158, 0362T and 0373T.
Its ABA guide asks for repeated measurement with standardized measures and a progress evaluation every six months; it does not mention graphs.
Aetna’s provider toolkit (6/26) does not print one; the filing limit is in your Aetna agreement.
Yes, under its national policy for ASD. Fully insured Wyoming plans with mental health coverage are also bound by Bulletin 01-2019, which bars autism exclusions and ABA-is-experimental denials. Self-funded employer plans follow their own documents.
Yes. All ten ABA codes, including the 97151 assessment, are on Aetna’s behavioral health precertification list.
Plan on it. Wyoming licenses behavior analysts (W.S. 33-27-124), and Aetna’s guide requires services to be provided or billed by licensed behavior analysts in licensure states and expects telehealth providers to hold the licensure their state requires.
Aetna publishes no ABA rates; payment follows your Aetna participation agreement. The only public benchmark is Wyoming Medicaid (97153 $12.30 and 97155 $24.60 per 15 minutes from July 1, 2026).
Aetna’s network criteria do not require the RBT credential by name: technicians may be paraprofessionals supervised by a BCBA or licensed provider, with at least 1 hour of face-to-face supervision per 10 hours of ABA and the supervisor onsite at least 1 hour a month. Technicians must meet state requirements; Wyoming exempts technicians from licensure when supervised by a licensed behavior analyst or assistant.
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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