In Connecticut, Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans, Inc. Two Anthem documents govern ABA here. The Connecticut precertification list puts ABA under Anthem’s own behavioral health review. The multi-state ABA Provider Resource Guide names Connecticut among its states and sets the coding, supervision and documentation rules.
Under both sits Connecticut’s autism mandate for fully insured plans. Check funding type on every benefits verification: self-funded employer plans administered by Anthem follow their plan documents and ERISA, not § 38a-514b. National Account members follow the number on the card.
Anthem’s Connecticut Precertification/Prior Authorization List (Commercial, September 2026) applies to “Anthem products issued and delivered by Anthem in Connecticut.” Its behavioral health row lists “Applied behavior analysis (ABA)” with partial hospital, IOP, intensive in-home services and other levels of care. The responsible party is “Anthem,” and the instruction is “Contact Behavioral Health at 800-934-0331.” The list names no CPT codes and no criteria set for ABA. For National Accounts, Anthem says to call the number on the member’s card.[1]
Anthem’s commercial ABA Provider Resource Guide (June 2025) lists Connecticut among its states. Approved providers include psychiatrists, psychologists, LCSWs, LPCs and LMFTs with ABA training, BCBAs and BCBA-Ds, “providers practicing under the direction and supervision of the BCBA,” and other mental health providers “licensed or authorized by the state in which they practice.” A QHP billing 97155 “can only add code 97153 if both the technician and QHP are face-to-face with the patient at the same time and the QHP is directing the technician.” Technician services “must show the supervising BCBA or other QHP in box 31.” Record start and stop times, sign within 30 days of the service date, and update the treatment plan at least every 6 months. Anthem applies NCCI medically unlikely edits to ABA codes and lists POS 12 (home), 11 (office), 99 (community), 03 (school), and 10 and 02 (telehealth).[2]
Connecticut’s autism mandate is two parallel statutes: § 38a-514b for group policies and § 38a-488b for individual policies. Each requires coverage “for the diagnosis and treatment of autism spectrum disorder,” which the law treats as an illness. Covered treatments must be medically necessary and “identified and ordered by a licensed physician, licensed psychologist or licensed clinical social worker,” following a treatment plan written by a licensed behavior analyst, physician, psychologist or licensed clinical social worker after a comprehensive evaluation or reevaluation. “Behavioral therapy,” which expressly includes applied behavior analysis, is covered when it is “Provided to children less than twenty-one years of age” and “provided or supervised by (i) a licensed behavior analyst, (ii) a licensed physician, or (iii) a licensed psychologist.” Supervision is defined as “at least one hour of face-to-face supervision” for every ten hours of behavioral therapy. From January 1, 2027, the age limit rises: Public Act 25-3 of the November 2025 special session changes the text to individuals “under twenty-six years of age.” The statute bans visit limits “on any basis other than a lack of medical necessity” and cost-sharing heavier than for other medical conditions. The 2015 amendment (June Sp. Sess. P.A. 15-5) deleted the old coverage limit, so no dollar cap remains. Two utilization-review protections help intake: outside inpatient care, the carrier may review the treatment plan “not more than once every six months” unless the treating clinician agrees or changes the plan, and “the results of a diagnosis shall be valid for a period of not less than twelve months.” Coverage can still carry the policy’s ordinary terms (coordination of benefits, network rules, limits on services by family or household members). Nothing in the statute requires a plan to pay for special education under an IEP. The mandate binds fully insured policies issued in Connecticut. Self-funded employer plans fall under ERISA instead.[3][4]
Yes. Connecticut licenses behavior analysts, and the license is required to practice. Conn. Gen. Stat. § 20-185j(a) says: “No person may practice behavior analysis unless licensed pursuant to section 20-185k or 20-185l.” Licensure began July 1, 2018 and is run by the Department of Public Health. The route is simple for a current BCBA. Under § 20-185k, DPH “shall grant a license as a behavior analyst to any applicant who furnishes evidence satisfactory to the commissioner that such applicant is certified as a behavior analyst by the Behavior Analyst Certification Board.” The application is online only and costs $350. DPH verifies the BCBA online and requires verification of every other state license you hold or have held. The license renews every year for $180, with current BACB certification and a one-time two hours of training on PTSD, suicide-risk, depression and grief screening and suicide prevention, then repeated every six years. Section 20-185l adds licensure by endorsement for people licensed in a state with substantially similar or higher requirements. Several people do not need the license (§ 20-185j(c)): a BCaBA “working under the supervision of a behavior analyst” under BACB standards; anyone who “implements an intervention based on behavior analysis under the supervision of a behavior analyst” (RBTs and technicians); students in an accredited program under direct supervision; course instructors; family members carrying out a plan; and other licensees acting within their own scope who do not call themselves behavior analysts. The license matters for payment too. The commercial mandate covers behavioral therapy only when it is provided or supervised by a licensed behavior analyst, physician or psychologist, so a BCBA without a Connecticut license cannot be the supervising clinician on a fully insured Connecticut plan.[8][9][10][11][3]
Telehealth from another state does not get around the license. Under § 19a-906(a)(12)(A), a “telehealth provider” means a provider “licensed pursuant to title 20,” the title that contains the behavior analyst chapter. A separate route let behavior analysts licensed in another state treat Connecticut patients by telehealth after registering with DPH and applying for a Connecticut license. In the 2026 Supplement that route applies only “on or before June 30, 2025.” Section 19a-906(j) lets a telehealth provider serve a patient “from any location to a patient in any location,” but only “subject to compliance with … state licensing standards.” A Connecticut agency that contracts with an out-of-state telehealth provider who has no DPH license must check that provider’s DPH registration (§ 19a-906(k)). Our reading, as of the 2026 Supplement: a BCBA must hold a Connecticut license to treat a member located in Connecticut, in person or by telehealth. We did not review 2026-session public acts. Confirm with DPH (dph.counselorsteam@ct.gov) before relying on any exception.[8][9][10][11][3]
Connecticut’s prompt-pay rule is in its unfair claim settlement statute, § 38a-816(15). An insurer must pay a claim within 60 days of receipt if filed on paper and within 20 days if filed electronically. If information is missing, it must list every deficiency within 30 days (paper) or 10 days (electronic), then pay within 30 or 10 days of receiving what it asked for. A late claim carries interest “at the rate of fifteen per cent per annum.” The statute defines “health care provider” to include anyone licensed under chapters 375 to 383c, a range that takes in licensed behavior analysts (chapter 382a). It applies to insured policies. Self-funded ERISA plans follow federal claim rules instead. Anthem publishes no ABA rate table. For a public benchmark, Connecticut Medicaid’s ASD fee schedule (rates effective January 1, 2026) pays 97153 at $14.00 per 15 minutes. Commercial contracts are negotiated separately.[7][17]
A child whose card comes from another state’s Blue plan is a BlueCard member, and Anthem is the local plan. Anthem’s Connecticut provider manual says that "If the Member’s home plan is not with Anthem, the applicable home plan will determine prior authorization requirements". Anthem’s prefix lookup tool identifies the home plan from the three-character prefix on the ID card. For medical policy and prior authorization rules, use Resources > Prior Authorization > "Medical Policy and Prior Authorization for Blue Plans" and enter the prefix. So an out-of-state child’s ABA assessment and treatment are authorized under the home plan’s ABA policy, not Anthem’s.[18]
On utilization-management appeals the manual says decisions "involving Pre-certification/Pre-authorization are the responsibility of the Blue Plan, insuring or administering benefits for non-Anthem Members (the Member’s Home Plan)". It also says that "Technically, the Member, not the Provider or Facility, is responsible for obtaining the necessary authorization prior to the delivery of non-inpatient admission services". In practice the ABA provider requests it on the family’s behalf. A claim-denial appeal goes to the local Anthem plan as a Claim Payment Dispute.[18]
The questions that decide whether a family can start with Anthem Blue Cross and Blue Shield (Connecticut), and what they have to bring. Each maps onto something intake should ask on the first call.
Anthem’s Connecticut list requires precertification through Anthem Behavioral Health, not a physician referral. For a fully insured Connecticut plan, §§ 38a-514b(c) and 38a-488b(c) cover ABA only when it is “identified and ordered by a licensed physician, licensed psychologist or licensed clinical social worker” and follows a treatment plan by a licensed behavior analyst, physician, psychologist or LCSW. Get that order before the first request. Self-funded ERISA plans are outside the statute.[1][3]
Anthem’s Connecticut documents publish no ABA age limit. For fully insured Connecticut plans, the mandate covers behavioral therapy for children under 21 today and for individuals under 26 from January 1, 2027 (Nov. Sp. Sess. P.A. 25-3). It has no dollar cap. Self-funded ERISA plans are outside the statute, so the plan’s funding type decides whether this applies.[1][3][4]
Ask the plan: Live benefits verification: establish fully insured vs. self-funded, then the plan’s own age terms.
Anthem publishes no recency rule. For insured plans, the statute says diagnosis results “shall be valid for a period of not less than twelve months” unless the treating clinician sets a shorter period.[3][1]
Ask the plan: Anthem Behavioral Health, 800-934-0331: ask what diagnostic documentation and dates the review expects.
Anthem publishes no rule. On insured plans, the statute defines diagnosis as assessment “performed by a licensed physician, licensed psychologist or licensed clinical social worker.”[3]
Ask the plan: Anthem Behavioral Health, 800-934-0331.
Anthem lists POS 10 (telehealth at home) and 02 (telehealth elsewhere) for ABA, subject to coverage, and points to its virtual-services reimbursement policy for eligible codes. For a fully insured Connecticut plan, § 38a-526a (group; § 38a-499a for individual policies) requires coverage of care “provided through telehealth, to the extent coverage is provided for such advice, diagnosis, care or treatment when provided through in-person consultation between the insured and a health care provider licensed in the state.” A plan may not exclude a service “solely because such service is provided only through telehealth … provided telehealth is appropriate for the provision of such service,” and any utilization review must use the same criteria as for in-person care. The section’s own list of “telehealth provider” professions does not name behavior analysts (chapter 382a), so ask the carrier how it treats ABA under it. Self-funded employer plans are outside the statute.[2][5]
Ask the plan: Anthem Behavioral Health, 800-934-0331: confirm which ABA codes it pays by telehealth on this member’s plan.
Depends on how the plan is funded. Fully insured Connecticut plans fall under § 38a-591d. For a non-urgent prospective or concurrent request, the carrier must decide “not later than seven calendar days after the date the health carrier receives such request.” It may extend once by up to five calendar days for circumstances beyond its control, or by up to fifteen if the clinician says the service will not start for at least three months. Retrospective requests get 30 days. Urgent requests are decided within 24 hours. A concurrent urgent request to extend a course of treatment counts only if made at least 24 hours before the current authorization ends. After a medical-necessity denial, the carrier must offer your clinician a conference with a clinical peer, who has authority to reverse the denial. 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. Anthem publishes no Connecticut-specific ABA turnaround.[6][12]
Ask the plan: At benefits verification ask whether the plan is fully insured (Connecticut-regulated) or self-funded (ERISA), and what reauthorization lead time Anthem expects.
Anthem is primary to Connecticut Medicaid. HUSKY Health is “the payer of last resort,” and if a member has third-party coverage “the benefits of these policies must be fully exhausted prior to claim submission” to Medicaid (42 CFR 433.139). So be in the commercial network and get its authorization as well as the Carelon BH CT authorization. TRICARE pays after this plan (10 U.S.C. 1079(i)(1)). CHAMPVA is “the last payer” (38 CFR 17.270). Connecticut’s autism statutes let insured coverage carry the policy’s ordinary coordination-of-benefits terms (§ 38a-514b(f)). We did not read Connecticut’s coordination-of-benefits regulation, so get the order between two parents’ plans from the carriers.[13][14][15][16][3]
Ask the plan: Ask Anthem at benefits verification for the member’s coordination-of-benefits order between both parents’ plans, and record every other coverage the child has (HUSKY, TRICARE, CHAMPVA).
The resource guide stresses “standardized assessments and current clinical information” to track progress but names no diagnostic instrument.[2]
Blocked on: Anthem Behavioral Health, 800-934-0331.
Coverage decides whether Anthem Blue Cross and Blue Shield (Connecticut) 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.
Anthem recognizes “providers practicing under the direction and supervision of the BCBA” and publishes no ratio of its own. For fully insured Connecticut plans, the mandate defines supervised behavioral therapy as “at least one hour of face-to-face supervision … for each ten hours of behavioral therapy,” by a licensed behavior analyst, physician or psychologist.[2][3]
“A physician or other QHP billing for 97155 can only add code 97153 if both the technician and QHP are face-to-face with the patient at the same time and the QHP is directing the technician.”[2]
No Anthem-specific daily cap. “ABA codes may have associated MUE limits,” and Anthem applies NCCI edits as CMS updates them. Authorized hours are set per precertification. The mandate bars visit limits other than for lack of medical necessity on insured plans.[2][3]
Each entry identifies its author (signature, electronic identifier or initials, with credentials). Documentation is due “at the time of service, or shortly thereafter and should not exceed 30 days,” with a “Signature date within 30 days of the date of service.” Start and stop times are required.[2]
POS codes Anthem lists for ABA: 12 home, 11 office or clinic, 99 community, 03 school, 10 telehealth at home, 02 telehealth elsewhere, all “Subject to the member’s coverage and reviews by the plan.” The Connecticut mandate does not make insured plans pay for special education under an IEP.[2][3]
“ABA therapy performed by therapy assistants/behavioral technicians/paraprofessionals must show the supervising BCBA or other QHP in box 31 of the CMS claim form.”[2]
Yes. ABA is on Anthem’s Connecticut precertification list, reviewed by Anthem Behavioral Health at 800-934-0331. The list names no codes, so ask whether the assessment itself needs approval.
No dollar cap. Insured plans cover behavioral therapy for children under 21, rising to under 26 on January 1, 2027, with no visit limits other than for medical necessity. Self-funded plans follow their own documents.
Yes, 97155 with 97153, but only when both are face-to-face with the patient at the same time and the BCBA is directing the technician.
Yes. Conn. Gen. Stat. § 20-185j says “No person may practice behavior analysis unless licensed.” A current BCBA gets the license from DPH by showing BACB certification ($350, renewed yearly), and § 20-185l offers licensure by endorsement. RBTs, technicians and BCaBAs working under a licensed behavior analyst’s supervision do not need their own license. Telehealth into Connecticut also requires the Connecticut license: the telehealth statute (§ 19a-906) defines a telehealth provider as someone licensed under title 20, and its temporary route for out-of-state behavior analysts applied only on or before June 30, 2025 (2026 Supplement text). On a fully insured plan, the autism mandate covers behavioral therapy only when it is provided or supervised by a licensed behavior analyst, physician or psychologist.
The child’s home plan. Anthem’s manual says that when the member’s home plan is not Anthem, "the applicable home plan will determine prior authorization requirements." Look the prefix up under Medical Policy and Prior Authorization for Blue Plans on Anthem’s provider site, request authorization from the home plan, and file the claim with Anthem as the local plan.
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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