---
title: "Anthem BCBS Nevada ABA coverage: the intake guide."
url: "https://carelu.com/payers/anthem-bcbs-nevada"
markdown_url: "https://carelu.com/payers/anthem-bcbs-nevada.md"
state: NV (Nevada)
payer: Anthem Blue Cross and Blue Shield Nevada
kind: Commercial insurance
description: "How Anthem Blue Cross and Blue Shield covers ABA in Nevada: the Nevada precertification list, billing rules from Anthem’s ABA resource guide, Nevada’s autism mandate (under 18, or 22 in high school; $72,000 a year cap), licensure and PA deadlines."
last_reviewed: October 2026
---

# Anthem BCBS Nevada ABA coverage: the intake guide.

_Payer Guide · Anthem BCBS · Nevada · Last updated October 2026 · 19 primary sources_

> Nevada’s Blue plan (Rocky Mountain Hospital and Medical Service / HMO Nevada): outpatient behavioral health on the NV precert list; ABA billing rules from Anthem’s resource guide.

In Nevada, Anthem Blue Cross and Blue Shield is Rocky Mountain Hospital and Medical Service, Inc., with HMO products underwritten by HMO Colorado, Inc., doing business as HMO Nevada. Two Anthem documents govern ABA: the Nevada commercial precertification list, which routes inpatient and outpatient behavioral health to Anthem Behavioral Health, and the multi-state ABA Provider Resource Guide (June 2025), which names Nevada among its states and sets coding, supervision and documentation rules. Anthem’s Nevada Medicaid plan is a separate company with its own guide.

Under both sits Nevada’s autism mandate for state-regulated plans. Establish funding type on every benefits check: self-funded employer plans administered by Anthem follow their plan documents and ERISA.

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment** _(plan-dependent)_: Likely: Anthem’s Nevada commercial precertification list (updated 07/10/2026) lists “Behavioral Health Services - Inpatient and Outpatient” with Anthem as the responsible party (“Contact Behavioral Health at 800-424-4014”) but does not list ABA codes individually [4]
  - Ask the plan: Anthem Behavioral Health, 800-424-4014, or the number on the member’s card: ask whether 97151 and 97152 need precertification on this plan.
- **Prior auth for treatment** _(plan-dependent)_: Yes for outpatient behavioral health on the Nevada list, reviewed by Anthem Behavioral Health (800-424-4014); requirements depend on the member’s product [4]
  - Ask the plan: Anthem Behavioral Health, 800-424-4014: confirm ABA treatment precertification and the review interval.
- **Autism diagnosis required?** _(plan-dependent)_: Yes under the Nevada mandate (autism spectrum disorder is the covered condition); Anthem’s own diagnostic criteria for ABA are not published in its Nevada documents [1][5]
  - Ask the plan: Anthem Behavioral Health, 800-424-4014: ask which medical necessity guideline applies and what diagnostic documentation it requires.

## At a glance

- **Covers ABA?:** Yes, for ASD, on state-regulated plans under the Nevada mandate; self-funded plans per plan document
- **Who reviews ABA:** Anthem Behavioral Health, 800-424-4014 (NV commercial precert list, 07/10/2026)
- **State mandate:** NRS 689B.0335 (group), 695C.1717 (HMO), 689C.1655 (small employer); individual plans must offer it as an option (NRS 689A.0435)
- **Mandate age:** Under 18, or until 22 if enrolled in high school
- **Mandate caps:** ABA up to the actuarial equivalent of $72,000 per year; no visit limits within it
- **Exempt from mandate:** Self-funded ERISA employer plans; individual plans only need to offer an option
- **Licensure:** Required: Nevada Board of Applied Behavior Analysis licenses behavior analysts and BCaBAs and registers RBTs (NRS 641D)
- **Fee schedule:** Not public — contracted rates; Nevada Medicaid’s PT 85 schedule is the public benchmark

## Precertification in Nevada

Anthem’s Nevada commercial precertification list (“Nevada | Anthem Blue Cross and Blue Shield and HMO Colorado, Inc. (Anthem) | Commercial,” updated 07/10/2026) lists “Behavioral Health Services - Inpatient and Outpatient” with Anthem as the responsible party and the instruction “Contact Behavioral Health at 800-424-4014.” Unlike Anthem’s lists in some other states, it does not itemize the ABA CPT codes, so confirm code-level requirements for the member’s product before the assessment. [4]

## Billing and documentation rules from the ABA resource guide

Anthem’s ABA Provider Resource Guide (June 2025) covers Nevada. 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 of the CMS claim form,” and the guide lists credential modifiers HM, HN and HO. Records need start and stop times, author identification with credentials, entries completed within 30 days with a “Signature date within 30 days of the date of service,” and a treatment plan reviewed at least every 6 months. Anthem applies NCCI MUEs to ABA codes and lists POS 12 (home), 11 (office), 99 (community), 03 (school), 10 and 02 (telehealth). [5]

## The Nevada mandate: what it guarantees

Nevada’s autism mandate is written separately into each insurance chapter. For group policies, NRS 689B.0335 says a health benefit plan “must provide coverage for screening for and diagnosis of autism spectrum disorders and for treatment of autism spectrum disorders to persons covered by the policy of group health insurance under the age of 18 years or, if enrolled in high school, until the person reaches the age of 22 years.” HMOs (NRS 695C.1717) and small-employer plans (NRS 689C.1655) carry the same text. Individual policies are different: NRS 689A.0435 only requires the plan to “provide an option of coverage,” with a maximum benefit “of not less than” the same amount. The cap is set in subsection 2: coverage is subject to “A maximum benefit of the actuarial equivalent of $72,000 per year for applied behavior analysis treatment,” plus the policy’s ordinary cost sharing. Inside that cap the insurer “shall not limit the number of visits,” may not charge higher cost sharing or impose a longer wait than for other outpatient care, and “shall accept as dispositive any diagnosis of an autism spectrum disorder that is rendered in accordance with the statewide standard” set under NRS 427A.872. Treatment “must be identified in a treatment plan” prescribed and provided by a provider acting within scope, and the insurer “may request a copy of and review a treatment plan.” The statute defines behavioral therapy as therapy “provided by a licensed psychologist, licensed behavior analyst, licensed assistant behavior analyst or registered behavior technician,” and it does not require an insurer to reimburse a school for school services. The current text was last amended in 2025 and binds policies “delivered, issued for delivery or renewed on or after January 1, 2026.” It reaches state-regulated plans only; self-funded employer plans answer to ERISA. [1][3][8][2]

## Licensure and credentialing

Nevada licenses behavior analysts. Under NRS Chapter 641D a “behavior analyst” is a person with current BCBA or BCBA-D certification “and is licensed as a behavior analyst pursuant to this chapter”; an assistant behavior analyst is a licensed BCaBA; and a registered behavior technician must be BACB-certified and “registered as such pursuant to this chapter.” The Board of Applied Behavior Analysis (NRS 641D.200) issues those credentials, and the BACB’s licensure table lists Nevada with the NV Applied Behavior Analysis Board. Practicing ABA without the license or registration is prohibited (NRS 641D.900) and is a gross misdemeanor (NRS 641D.910); exemptions cover physicians, psychologists and certain other licensed professionals, family members acting at a behavior analyst’s direction, and school-district employees serving pupils (NRS 641D.110). An assistant behavior analyst or RBT may practice only under supervision by a licensed behavior analyst or a BCBA-certified licensed psychologist (an RBT may also be supervised by a qualified licensed assistant behavior analyst), and supervisors must follow BACB supervision rules (NRS 641D.610). Expect every payer to credential against the Nevada license number, not just the BACB number. [11][13]

## Can an out-of-state BCBA treat a Nevada member, including by telehealth?

Not without a Nevada license. NRS 641D.900 bars anyone from engaging “in the practice of applied behavior analysis unless he or she is licensed or registered as required by the provisions of this chapter.” Telehealth does not get around that: NRS 629.031 counts “A behavior analyst, assistant behavior analyst or registered behavior technician” as a provider of health care, and NRS 629.515 says that before a provider at a distant site “may use telehealth to direct or manage the care or render a diagnosis of a patient who is located at an originating site in this State,” the provider “must hold a valid license or certificate to practice his or her profession in this State.” A BCBA directing a Nevada child’s program from another state is therefore treated as practicing in Nevada and is “subject to the laws and jurisdiction of the State of Nevada.” The fast path is licensure by endorsement under NRS 641D.340: a behavior analyst who holds “a corresponding valid and unrestricted license as a behavior analyst” in another state or D.C. may apply, and unless the Board denies for good cause it must issue the license within 45 days of the application or 10 days after the fingerprint background report, whichever is later. Payers add their own layer: credential the clinician with each plan before billing. [11][12]

## Claims timing and rates

Claims timing for state-regulated group policies is set by NRS 689B.255: the insurer “shall approve or deny a claim … within 21 days after the insurer receives the claim, if the claim is submitted electronically, or 30 days” on paper, and must pay an approved claim within the same period or owe interest “at a rate of 10 percent per annum.” A request for more information must come “within 20 working days” of receipt, and the clock restarts at 21 or 30 days from the additional information. A denial must state the reasons and the criteria the insurer applied. Self-funded plans follow their own documents and ERISA. Anthem publishes no Nevada ABA rate table; rates are contractual. The public benchmark is Nevada Medicaid’s 07/2026 PT 85 schedule (97153 $30.10 per 15 minutes billed by a BCBA, $13.01 by an RBT). [1][18]

## Out-of-state Blue members in Nevada (BlueCard)

If you are in Anthem’s Nevada network and the child’s card is from another Blue plan, the BlueCard program routes the claim through Anthem. Anthem’s Nevada manual says BlueCard "allows Providers and Facilities to submit Claims for Members from other Blue Plans, domestic and international, to Anthem. Anthem is the sole contact for Claims payment, adjustments, and issue resolution." Bill Anthem, not the member’s home plan. [20]

The home plan still owns the member’s benefits. Anthem lists "Medical records requested by a Member’s Blue Cross Blue Shield (BlueCard) home plan" among the reasons it may ask for records beyond the claim. Provider disputes on BlueCard claims "are filed directly to the local Blue plan (Nevada)," but when the dispute is about the member’s benefits and you appeal on the member’s behalf, "appeals are coordinated with the Member’s benefit office for final determination." [20]

Anthem’s manual does not say whose ABA prior-authorization rules apply to a BlueCard member. The detail sits in the separate BlueCard Provider Manual, which the manual says is in the Provider Manual Library. Before the first session, ask the home plan (the number on the member’s card) about its ABA precertification requirements. Do not assume Anthem’s own list applies. [20]

## Claim filing and payment rules in Nevada

Nevada sets the payment clock for state-regulated plans. A group or blanket insurer "shall approve or deny a claim ... within 21 days after the insurer receives the claim, if the claim is submitted electronically, or 30 days after the insurer receives the claim, if the claim is not submitted electronically," must pay an approved claim within the same period, and owes interest at 10 percent a year after that (NRS 689B.255; the individual-market rule, NRS 689A.410, is the same). A request for more information must come within 20 working days, and the clock restarts on receipt of it. The HMO section that used to carry the same rule (NRS 695C.185) is shown as repealed in 2025, so for an HMO product check the contract. Self-funded employer plans follow ERISA instead. Anthem’s own commercial timely-filing limit for Nevada is not in the documents read for this guide; take it from your Anthem agreement. [1][2][3]

## Intake gates

The questions that decide whether a family can start with Anthem Blue Cross and Blue Shield Nevada, and what they have to bring.

- **Referral required?**: Anthem’s Nevada documents require precertification of outpatient behavioral health through Anthem Behavioral Health, not a physician referral. For a state-regulated Nevada plan, autism treatment “must be identified in a treatment plan” and be prescribed by a provider of health care acting within scope, and the insurer “may request a copy of and review a treatment plan” (NRS 689B.0335(5)). Self-funded ERISA plans sit outside the statute. [4][1]
- **Age limit** _(plan-dependent)_: Anthem publishes no ABA age limit in its Nevada documents. For state-regulated Nevada group, small-employer and HMO plans, the mandate covers members “under the age of 18 years or, if enrolled in high school, until the person reaches the age of 22 years,” with ABA capped at the actuarial equivalent of $72,000 a year (NRS 689B.0335, 689C.1655, 695C.1717). Individual policies need only offer the coverage as an option (NRS 689A.0435). Self-funded ERISA plans are outside the statute. [4][1][3][8][2]
  - Ask the plan: Live benefits verification: establish Nevada-insured vs. self-funded, then the plan’s own age terms.
- **Telehealth** _(plan-dependent)_: Anthem lists POS 10 (telehealth in the home) and 02 (elsewhere) for ABA, subject to coverage, and refers to its Virtual Visits reimbursement policy. For a state-regulated group policy, NRS 689B.0369 requires coverage of services “provided to an insured through telehealth to the same extent as though provided in person,” bars the insurer from requiring prior authorization for a telehealth service “that is not required for that service when provided in person,” and forbids refusing coverage because of the originating site (the home counts) or the technology used; pay parity in the same amount applies to mental health treatment, including audio-only. NRS 629.515 separately requires the clinician to hold a Nevada license. Self-funded employer plans are outside the state statute. [5][1][12]
  - Ask the plan: Anthem’s Virtual Visits reimbursement policy and the member’s benefits: confirm which ABA codes are allowed by telehealth.
- **Prior-auth decision time** _(plan-dependent)_: Depends on how the plan is funded. State-regulated plans fall under Nevada’s prior-authorization statute: unless a shorter period applies, a health carrier must respond “within: (1) Two business days after it receives the request; or (2)” any longer period the CAQH CORE Prior Authorization and Referrals Operating Rules allow, and in any case “within 7 calendar days after receiving the request” (NRS 687B.970). If the carrier violates that section for a particular request, “the request shall be deemed approved” (NRS 687B.990). The procedure “may not discriminate among persons licensed to provide the covered care.” 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 Nevada-specific ABA turnaround or reauthorization lead time. [10][14]
  - Ask the plan: At benefits verification ask whether the plan is Nevada-insured or self-funded (ERISA) and the reauthorization lead time.
- **Other insurance (who pays first)** _(plan-dependent)_: For a child on two group policies, Nevada uses the birthday rule: when parents are not divorced or separated, “the primary policy is the policy of the parent whose birthday falls earlier in the year”; for divorced or separated parents the custodial parent’s policy pays first, then the custodial parent’s spouse’s, then the non-custodial parent’s, unless a court decree assigns responsibility (NRS 689B.064). A policy that does not coordinate is always primary. That rule binds state-regulated group policies; a self-funded plan sets its own order. If the child also has Nevada Medicaid, Anthem pays first: Medicaid is the payer of last resort (42 CFR 433.139), and Nevada Medicaid tells providers to “Always follow other payers’ billing requirements. If the other payer denies a claim because you did not follow their requirements, Medicaid will also deny the claim.” TRICARE pays after this plan (10 U.S.C. 1079(i)(1)). [1][15][16][17]
  - Ask the plan: Ask Anthem at benefits verification for the coordination-of-benefits order, and record every other coverage the child has.
- **Diagnosis recency** _(ask the plan)_: Not published in Anthem’s Nevada documents. [4][5]
  - Ask the plan: Anthem Behavioral Health, 800-424-4014: ask what diagnostic documentation and dates its review expects.
- **Who may diagnose** _(ask the plan)_: Not published in Anthem’s Nevada documents. Nevada’s mandate requires the insurer to accept as dispositive a diagnosis made under the state’s statewide standard (NRS 689B.0335(1)). [5][1]
  - Ask the plan: Anthem Behavioral Health, 800-424-4014.
- **Diagnostic tools required** _(ask the plan)_: The resource guide stresses standardized assessments for tracking progress but names no diagnostic instrument. [5]
  - Ask the plan: Anthem Behavioral Health, 800-424-4014.

## Delivery and billing rules

Coverage decides whether Anthem Blue Cross and Blue Shield Nevada 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**: Anthem publishes no numeric supervision ratio; it allows 97153 alongside 97155 only when the QHP and technician are both face-to-face with the patient and the QHP is directing the technician. In Nevada, BCaBAs and RBTs practice only under supervision meeting NRS 641D.610, which incorporates BACB supervision requirements. [5][11]
- **Concurrent billing (97153 + 97155)**: “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.” Supervised services billed with a QHP procedure fall under Anthem’s Incident To policy. [5]
- **Daily limits / MUEs**: No Anthem daily cap is published; “ABA codes may have associated MUE limits” under NCCI. For state-regulated Nevada plans the mandate caps ABA at the actuarial equivalent of $72,000 a year and bars visit limits within it. [5][1]
- **Session-note signature**: Each entry must identify its author (signature, electronic identifier or initials, with credentials); documentation is expected at the time of service and “should not exceed 30 days,” with a “Signature date within 30 days of the date of service.” Start and stop times are required. [5]
- **Place of service**: POS codes Anthem lists for ABA: 12 home, 11 office/clinic, 99 community, 03 school, 10 telehealth in the home, 02 telehealth elsewhere, “Subject to the member’s coverage and reviews by the plan.” Nevada’s mandate does not require reimbursing a school for school services (NRS 689B.0335(7)). [5][1]
- **Bill as provider**: “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.” [5]

## What intake should collect for Anthem Blue Cross and Blue Shield Nevada

- **Plan funding type:** Fully insured Nevada plan (mandate applies) vs. self-funded ERISA (plan document governs).
- **HMO Nevada or PPO:** Product decides precertification details; call 800-424-4014.
- **Child’s age and school status:** The mandate stops at 18, or 22 if the child is still enrolled in high school.
- **Diagnosis report:** ASD diagnosis, diagnosing clinician and date.
- **Other coverage:** Second parent’s plan (birthday rule), Medicaid or TRICARE.

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

## Common questions

### How fast must Anthem pay a clean ABA claim in Nevada?

For a state-regulated group or individual plan, within 21 days of an electronic claim (30 days on paper), with 10% annual interest after that (NRS 689B.255, 689A.410). Self-funded plans follow ERISA. Take Anthem’s own filing limit from your agreement.

### Does Anthem require prior authorization for ABA in Nevada?

Anthem’s Nevada commercial list puts inpatient and outpatient behavioral health under Anthem Behavioral Health precertification (800-424-4014), but it does not itemize ABA codes, so confirm per product.

### Does Nevada cap ABA benefits?

Yes, for state-regulated plans: ABA up to the actuarial equivalent of $72,000 a year, for children under 18 (22 if still in high school). Self-funded plans follow their own documents.

### Can a BCBA and RBT both bill Anthem for the same time?

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.

### I am in Anthem’s Nevada network. Can I treat a child with another state’s Blue plan?

Yes, through BlueCard. Submit the claim to Anthem, which is "the sole contact for Claims payment, adjustments, and issue resolution." The member’s home plan still sets the benefits and may ask for records. Check the home plan’s ABA prior-authorization rules before starting.

## Primary sources

1. [NRS 689B.255 — Group health insurance: approval or denial of claims, payment and interest](https://www.leg.state.nv.us/NRS/NRS-689B.html)
2. [NRS 689A.410 — Individual health insurance: approval or denial of claims, payment and interest](https://www.leg.state.nv.us/NRS/NRS-689A.html)
3. [NRS chapter 695C — Health maintenance organizations (NRS 695C.185 shown as repealed by ch. 366, Statutes of Nevada 2025)](https://www.leg.state.nv.us/NRS/NRS-695C.html)
4. [Anthem Blue Cross and Blue Shield / HMO Nevada — Nevada Commercial Precertification List (updated 07/10/2026)](https://www.anthem.com/content/dam/digital/docs/provider/commercial/guides/NV_PA_List.pdf)
5. [Anthem BCBS — Applied Behavior Analysis Provider Resource Guide (multi-state incl. Nevada, June 2025)](https://www.anthem.com/content/dam/digital/docs/provider/commercial/guides/aba-provider-resource-guide-abcbs.pdf)
6. [NRS Chapter 689B — Group health insurance (689B.0335 autism, 689B.0369 telehealth, 689B.064 order of benefits, 689B.255 claims)](https://www.leg.state.nv.us/NRS/NRS-689B.html)
7. [NRS 695C.1717 — Health maintenance organizations: coverage for autism spectrum disorders](https://www.leg.state.nv.us/NRS/NRS-695C.html)
8. [NRS 689C.1655 — Small employer health benefit plans: coverage for autism spectrum disorders](https://www.leg.state.nv.us/NRS/NRS-689C.html)
9. [NRS 689A.0435 — Individual health insurance: option of coverage for autism spectrum disorders](https://www.leg.state.nv.us/NRS/NRS-689A.html)
10. [NRS 687B.900–687B.990 — Prior authorization (response deadlines; violation deems request approved)](https://www.leg.state.nv.us/NRS/NRS-687B.html)
11. [NRS Chapter 641D — Applied Behavior Analysis (licensure, endorsement, supervision, prohibited acts)](https://www.leg.state.nv.us/NRS/NRS-641D.html)
12. [NRS 629.031 and 629.515 — Provider of health care defined; Nevada license required for telehealth to a patient in Nevada](https://www.leg.state.nv.us/NRS/NRS-629.html)
13. [BACB — U.S. Licensure of Behavior Analysts (Nevada: NV Applied Behavior Analysis Board)](https://www.bacb.com/u-s-licensure-of-behavior-analysts/)
14. [29 CFR 2560.503-1 — ERISA claims procedure (eCFR)](https://www.ecfr.gov/current/title-29/section-2560.503-1)
15. [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)
16. [Nevada Medicaid and Nevada Check Up Billing Manual (updated July 10, 2026)](https://www.medicaid.nv.gov/Downloads/provider/nv_billing_general.pdf)
17. [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)
18. [Nevada Medicaid — Provider Type 85 ABA Reimbursement Schedule (rate data as of 07/2026)](https://www.nevadamedicaid.nv.gov/siteassets/content/resources/rates/pt-85-fee-schedule-072026.xlsx)
19. [Anthem Nevada — Provider News (index of articles)](https://providernews.anthem.com/nevada)
20. [Anthem Blue Cross and Blue Shield Nevada Provider and Facility Manual (effective October 1, 2026): BlueCard Program Overview, medical records, provider disputes](https://www.anthem.com/content/dam/digital/docs/provider/commercial/manuals/PM_NV_00015.pdf)

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.