Arizona DES/DDD ABA coverage (the ALTCS-DD path).

Identical to the ACC path — AMPM 320-S applies to DES/DDD by its own terms, and authorization then runs through the member's chosen DDD Health Plan (Mercy Care DD or UHCCP DD) on that plan's ABA machinery: AMPM 320-S sets no age bound of its own. Behavior Analysis Services are covered "for individuals with Autism Spectrum Disorder (ASD) and/or other diagnoses as justified by medical necessity," and the policy applies across ACC, ALTCS E/PD, DCS/CMDP, DES/DDD, the RBHA contracts and fee-for-service programs without an age criterion. In practice children reach the benefit through EPSDT, and nothing in the policy text excludes adults — screen on medical necessity, not birthday.^[11][10]

Identical to the ACC path — AMPM 320-S applies to DES/DDD by its own terms, and authorization then runs through the member's chosen DDD Health Plan (Mercy Care DD or UHCCP DD) on that plan's ABA machinery: None at the state level. AMPM 320-S imposes no recency clock on the diagnostic evaluation — and no autism diagnosis at all is strictly required. What must be current is the assessment: services are "prescribed or recommended in specific dosages, frequency, intensity, and duration by a qualified BHP as the result of an assessment of the member." Plan-level overlays can be stricter, so check the per-plan guide before telling a family an old evaluation still counts.^[11][10]

Identical to the ACC path — AMPM 320-S applies to DES/DDD by its own terms, and authorization then runs through the member's chosen DDD Health Plan (Mercy Care DD or UHCCP DD) on that plan's ABA machinery: AMPM 320-S gates on who recommends ABA, not on who diagnoses: services must be "prescribed or recommended... by a qualified BHP." A Behavioral Health Professional is defined as an individual licensed under A.R.S. Title 32, Chapter 33 whose scope allows independent behavioral health practice (or practice under direct supervision, except a licensed substance abuse technician); a psychiatrist (A.R.S. § 36-501); a psychologist (A.R.S. § 32-2061); a physician; a Behavior Analyst (A.R.S. § 32-2091); a registered nurse practitioner licensed as an adult psychiatric and mental health nurse; or a registered nurse with psychiatric-mental health certification or one year of behavioral health experience.^[11][10]

Identical to the ACC path — AMPM 320-S applies to DES/DDD by its own terms, and authorization then runs through the member's chosen DDD Health Plan (Mercy Care DD or UHCCP DD) on that plan's ABA machinery: No single instrument is mandated. "Behavior Analysis Services shall be based upon assessment(s) that include Standardized and/or Non-standardized instruments through both direct and indirect methods." Standardized examples named in the policy: the Pervasive Developmental Disabilities Behavior Inventory, the Brigance Inventory of Early Development and the Vineland Adaptive Behavior Scales. Non-standardized examples: curriculum-referenced assessments and stimulus preference assessment procedures.^[11][10]

Identical to the ACC path — AMPM 320-S applies to DES/DDD by its own terms, and authorization then runs through the member's chosen DDD Health Plan (Mercy Care DD or UHCCP DD) on that plan's ABA machinery: A prescription or recommendation from a qualified Behavioral Health Professional, based on an assessment of the member, is the referral — AMPM 320-S requires nothing else and sets no prior-authorization rules of its own, leaving PA to the Contractors. The two largest plans both skip PA on the assessment codes: Mercy Care states no PA is needed for 97151 and 97152, and Optum's Arizona orientation states "All ABA services require prior authorization except 97151 and 97152."^{[11][15][14][10]}

AMPM 320-I names DES/DDD among the Contractors it applies to, so for DDD members the rule is the AHCCCS rule: AMPM 320-I binds ACC, ALTCS and DDD Contractors by its own terms. All eight ABA CPT codes (97151–97158) are on the AHCCCS Telehealth Code Set (sheet effective 06/01/2026) for interactive audio-video with the GT modifier; none carries the audio-only FQ modifier, and 0362T and 0373T are not listed. The place of service on the claim is the originating site, where the member is (12 home, 03 school, 11 office): “AHCCCS will not be utilizing POS 02 and POS 10 for telehealth” unless another primary payer requires them. AMPM 320-S requires the treatment plan to “identify the modality by which the service will be delivered (whether in person or via telehealth, or in-group or individual setting, or combination thereof),” so name telehealth in the plan you submit for authorization. Authorization still runs through the member’s DDD Health Plan.^[7][6][11]

DDD’s own policy and the policy for its health plans (AdSS — Mercy Care DD and UHC Community Plan DD, which authorize ABA) both still read "no later than 14 Calendar Days from receipt of the request for the service regardless of whether the 14th day falls on a weekend … or Legal Holiday", 72 hours expedited, each extendable up to 14 more days. AHCCCS’s own CY2025 prior-authorization metrics report (March 2026) says that "Beginning January 1, 2026" the CMS rule requires Medicaid managed care plans to decide within "7 calendar days for standard requests (non-urgent)" and "72 hours for expedited requests (urgent)"; the federal regulation ties the 7-day ceiling to rating periods starting on or after January 1, 2026. Confirm with the DDD health plan which clock it runs. No ABA-specific decision clock or reauthorization lead time is published; AMPM 320-S requires progress reports at least every six months, which is what the reauth is built from.^{[25][26][27][28][11]}

DDD pays last and must "independently evaluate the Member's service request using its own criteria" when a third party denies; "when a Third Party has approved a service request as medically necessary" it must "Not apply a secondary prior authorization" and coordinate payment. It pays first and recovers later for preventive pediatric/EPSDT services, a list that includes "Therapies, and behavioral health exams." DDD Qualified Vendors bill the other insurer first (including high-deductible plans), obtain the EOB or denial, and bill the difference up to the contracted rate. Under federal rules TRICARE pays before Medicaid, and CHAMPVA pays first when the child is also Medicaid-eligible.^{[29][30][31][32]}

Identical to the ACC path — AMPM 320-S applies to DES/DDD by its own terms, and authorization then runs through the member's chosen DDD Health Plan (Mercy Care DD or UHCCP DD) on that plan's ABA machinery: A duty with no number attached. "Behavior Analysis Services shall be directed and overseen by Behavior Analysts and supported, where applicable, by Behavior Analysis Trainees and/or Behavior Technicians." The Behavior Analyst "is responsible for all aspects of clinical direction, supervision, and provider-level case management," for training Trainees and Technicians, for ensuring that "the extent, kind, and quality" of what they deliver matches their training and experience, and for their compliance with the policy and A.R.S. § 32-2091. A Behavior Analysis Trainee needs "direct and ongoing supervision consistent with the standards set by a nationally recognized Behavior Analyst certification board." AMPM 320-S publishes no supervision percentage and no caseload cap, so for RBT-credentialed staff the BACB floor is the operative number.^[11][10]

Identical to the ACC path — AMPM 320-S applies to DES/DDD by its own terms, and authorization then runs through the member's chosen DDD Health Plan (Mercy Care DD or UHCCP DD) on that plan's ABA machinery: The claim line has to say who actually delivered the service. AHCCCS pays credential-tiered rates through modifiers — HM below bachelor's (technician level), HN bachelor's, HO master's, HP doctoral — and AMPM 320-S points to the Behavioral Health Services Billing Matrix for "modifiers for Behavior Analysis Trainee billing." Whose NPI goes in the rendering field is set per Contractor: UnitedHealthcare Community Plan, for instance, requires the rendering provider's 10-digit NPI in box 24J, "must be an active AHCCCS registered provider (The rendering provider is the BCBA/Licensed Clinician)."^{[11][13][14][10]}

Identical to the ACC path — AMPM 320-S applies to DES/DDD by its own terms, and authorization then runs through the member's chosen DDD Health Plan (Mercy Care DD or UHCCP DD) on that plan's ABA machinery: AMPM 320-S does not address whether 97153 and 97155 may be billed for the same clock time. The policy routes every coding question elsewhere: "Refer to the Behavioral Health Services Billing Matrix and Medical Coding Resources on the AHCCCS website for more information regarding required coding information, including covered settings, modifiers for Behavior Analysis Trainee billing, or other billing/coding information."^[11][10]

Blocked on: The member's DDD Health Plan — Mercy Care DD or UnitedHealthcare Community Plan DD — plus the DDD support coordinator on the service-plan side.

Identical to the ACC path — AMPM 320-S applies to DES/DDD by its own terms, and authorization then runs through the member's chosen DDD Health Plan (Mercy Care DD or UHCCP DD) on that plan's ABA machinery: AMPM 320-S sets no per-day ceiling (services are prescribed “in specific dosages, frequency, intensity, and duration” by the recommending BHP), and the AHCCCS Behavioral Health Services Matrix it points to lists provider types, places of service and modifiers with no unit column, so the authorization is the ceiling. CMS requires the Medicaid NCCI unit edits on fee-for-service claims but calls them “desirable but optional” for managed care plans; the public Medicaid MUE for 97153 is 32 units per claim line. UnitedHealthcare Community Plan’s Arizona manual (which covers DDD) applies a “maximum daily frequency” edit without printing the numbers; Mercy Care DD’s edits could not be read.^{[11][3][4][5][2]}

Blocked on: The member’s DDD Health Plan (Mercy Care DD or UHCCP DD) — the authorization states units per code; ask whether Medicaid MUEs apply.

Identical to the ACC path — AMPM 320-S applies to DES/DDD by its own terms, and authorization then runs through the member's chosen DDD Health Plan (Mercy Care DD or UHCCP DD) on that plan's ABA machinery: AMPM 320-S sets a reporting cadence, not a signature rule. Progress reports are required "at minimum, every six months" and must include member identification; background information (family dynamics, school placement, cultural considerations, prenatal and/or developmental history, medical history, sensory, dietary and adaptive needs, sleep patterns, medications); assessment findings; outcomes (measurable objectives, progress toward goals, clinical recommendations, treatment dosage, family role and outcomes); and care coordination (transition statement and individualized discharge criteria). Who signs a session note, and within what window, is not stated.^[11][10]

Ask the plan: The member's DDD Health Plan — Mercy Care DD or UnitedHealthcare Community Plan DD — plus the DDD support coordinator on the service-plan side.

Identical to the ACC path — AMPM 320-S applies to DES/DDD by its own terms, and authorization then runs through the member's chosen DDD Health Plan (Mercy Care DD or UHCCP DD) on that plan's ABA machinery: AMPM 320-S requires the treatment plan to "specify the setting(s) in which services will be delivered" but publishes no payable-setting list, pointing instead to the Behavioral Health Services Billing Matrix "regarding required coding information, including covered settings." What is documented at the rate level is that setting changes the money: the November 2023 fixed-rate notice pays home delivery (POS 12) roughly 10% above the clinic rate on every ABA code.^[11][13][10]

Blocked on: The member's DDD Health Plan — Mercy Care DD or UnitedHealthcare Community Plan DD — plus the DDD support coordinator on the service-plan side.