---
title: Arizona DES/DDD ABA coverage (the ALTCS-DD path).
url: "https://carelu.com/payers/arizona-ddd"
markdown_url: "https://carelu.com/payers/arizona-ddd.md"
state: AZ (Arizona)
payer: DES/DDD (Arizona Division of Developmental Disabilities)
kind: Medicaid managed care plan (MCO)
parent_program: AHCCCS (Arizona Medicaid)
description: "How ALTCS-DD members get ABA in Arizona — the DES/DDD second funnel, the two statewide DDD Health Plans (Mercy Care DD and UHCCP DD), the over-age-3 ALTCS gate, and the bundled habilitation/respite conversation."
last_reviewed: October 2026
vob_data_updated: 2026-10-15
---

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

_Payer Guide · Arizona DES/DDD · Last updated October 2026 · 24 primary sources_

> The second funnel: ALTCS-DD members get ABA via Mercy Care DD or UHCCP DD, statewide.

The Division of Developmental Disabilities (DES/DDD) is Arizona's second ABA funnel: ALTCS-eligible members with developmental disabilities get their physical and behavioral health — including ABA — not through an ACC plan but through one of two statewide DDD Health Plans, Mercy Care DD or UnitedHealthcare Community Plan DD (both effective October 2019). Clinically nothing changes — AMPM 320-S governs DES/DDD by its own terms — but structurally this is a separate eligibility gate and plan-choice flow, and routing a DDD family down the ACC path (or vice versa) burns weeks. Intake teams that ask the DDD question first route correctly.

This plan administers the **AHCCCS (Arizona Medicaid)** ABA benefit: the state rules are the floor, and this page covers what the plan layers on top. Read it together with the [AHCCCS (Arizona Medicaid) guide](https://carelu.com/payers/arizona-ahcccs).

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Follows the member's DDD Health Plan — Mercy Care DD and UHCCP DD both skip PA on 97151/97152 [10][15][14]
- **Prior auth for treatment**: Through the member's DDD Health Plan (Mercy Care DD or UHCCP DD), on the same ABA PA machinery as their ACC lines [10][15][14]
- **Autism diagnosis required?**: No — AMPM 320-S applies; autism is a DDD qualifying-condition category, but ABA rides on medical necessity [11][10]

## At a glance

- **What it is:** The ALTCS-DD path — DDD subcontracts health care to two statewide DDD Health Plans
- **The plans:** Mercy Care DD and UHCCP DD ("DD by UHCCP") — member chooses; both statewide
- **Clinical rules:** AMPM 320-S — identical to the ACC path
- **Eligibility gate:** Over age 3, ALTCS approval is the gate to DDD-funded services; autism is a qualifying-condition category
- **Assessment PA:** None at either DDD plan — same 97151/97152 rule as their ACC lines
- **Bundled services:** DDD members also get habilitation and respite (HCBS) alongside ABA
- **Fee schedule:** Contract rate — AHCCCS’s fixed ABA rates are fee-for-service only; plans and providers negotiate

## The dual path, from the DDD side

Children under 21 can get ABA either through their ACC plan under EPSDT or — if ALTCS/DDD-eligible — through a DDD Health Plan. Autism is a DDD qualifying-condition category, and over age 3 ALTCS approval is the gate to DDD-funded services (habilitation, respite, ABA). Once eligible, the family chooses between Mercy Care DD and UHCCP DD, and unlike the ACC side, both DDD Health Plans are statewide — county doesn't restrict DDD members the way ACC geographic service areas do. Authorization then runs through the chosen plan's ABA machinery, identical to its ACC line: no PA on 97151/97152 at either plan, treatment PA on their respective forms (Mercy Care's ABA PA form with 6-month auths; Optum's Provider Express Treatment Form for UHCCP DD). DDD ALTCS also maintains its own service-approval matrix on the LTSS side. [10][11][12]

## Why the DDD conversation is different at intake

A DDD family isn't just an ABA inquiry — DDD members also receive habilitation and respite through home- and community-based services alongside ABA, a bundled-service conversation ACC-only families never have. Intake that recognizes a DDD card (UHCCP DD cards read "DDD Health Plan by UHCCP," Group AZDDD; Mercy Care DD is branded accordingly) can coordinate the ABA request with the family's DDD support coordinator instead of working blind. For families who look DDD-eligible but aren't enrolled, the ALTCS application is the long pole — flag it early, and run the ACC path in parallel where EPSDT coverage already exists. [10][14]

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

Arizona licenses the practice: “A person who wishes to practice as a behavior analyst must be licensed pursuant to this article” (A.R.S. § 32-2091.02, Board of Psychologist Examiners), and practicing unlicensed is a class 2 misdemeanor (§ 32-2091.12). Arizona is unusual in giving out-of-state clinicians a telehealth-only route: under A.R.S. § 36-3606 a health care provider “who is not licensed in this state may provide telehealth services to a person located in this state” after registering with the board that licenses the comparable profession, holding “a current, valid and unrestricted license to practice in another state that is substantially similar,” carrying malpractice coverage that includes Arizona telehealth, and following Arizona’s scope and standard-of-care rules. Behavior analysts are licensed under Title 32, chapter 19.1, which § 36-3601 includes in the definition of “health care provider.” A registered provider may not open an Arizona office (except within a multistate group that includes an Arizona-licensed provider) or see Arizona patients in person without an Arizona license. Fewer than ten telehealth encounters a year, or care in consultation with an Arizona-licensed provider who keeps ultimate authority, is exempt from registration. [17][18][19][20][11][21]

AHCCCS ties ABA to the Arizona license: AMPM Policy 320-S defines a Behavior Analyst as “A person who is licensed pursuant to A.R.S §32-2091,” and A.R.S. § 32-2091.14 directs AHCCCS to recognize “a behavior analyst who is licensed pursuant to this article” as a behavioral health professional eligible for reimbursement. A § 36-3606 telehealth registration is not that license, so for AHCCCS work plan on full Arizona licensure. [17][18][19][20][11][21]

## Does EVV apply to ABA for DDD members?

EVV. AMPM 540 (revised effective 08/06/26) applies Electronic Visit Verification to “personal care and home health services” under 42 U.S.C. 1396b(l), for ACC, DDD and fee-for-service alike, and AHCCCS’s EVV page names those services as attendant care, personal care, homemaker, habilitation, respite and in-home skilled nursing. ABA is not among them. A visit is subject to EVV only when the provider type, the service code and the place of service all match AHCCCS’s published list, so an agency that also bills habilitation in the home should check that list. [22][23]

## Claims for DDD members: filing deadline and payment

The claim goes to the member’s DDD Health Plan, not to DDD. A.R.S. § 36-2904(G) bars AHCCCS contractors from paying a claim “initially submitted more than six months after the date of the service” or after eligibility is posted, whichever is later, or one not submitted as a clean claim within twelve months. ACOM 203, which names DES/DDD among the Contractors it governs, adds that 95% of clean claims must be adjudicated within 30 days and 99% within 60 “unless a subcontract specifies otherwise,” with interest at 10% a year from the 46th day on a non-hospital clean claim paid after 45 days. [1][8][2]

The plans’ own limits are shorter. UnitedHealthcare Community Plan’s Arizona manual, which covers DDD, requires network providers to submit initial claims “within 90 days from the date of service or based on their contracted timely filing terms” (180 days for non-participating providers), corrected claims within one year, and secondary claims within 180 days of the date of service; it says to allow up to 30 days for payment of an initial claim. Mercy Care DD’s manual could not be retrieved at this review, so check the Mercy Care contract for its limit. [1][8][2]

## Intake gates

The questions that decide whether a family can start with DES/DDD (Arizona Division of Developmental Disabilities), and what they have to bring.

- **Age limit**: 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]
- **Diagnosis recency**: 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]
- **Who may diagnose**: 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]
- **Diagnostic tools required**: 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]
- **Referral required?**: 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]
- **Telehealth**: 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]
- **Prior-auth decision time**: 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]
- **Other insurance (who pays first)**: 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]

## Delivery and billing rules

Coverage decides whether DES/DDD (Arizona Division of Developmental Disabilities) 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**: 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]
- **Bill as provider**: 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]
- **Concurrent billing (97153 + 97155):** Not published / unverified. Verify via: The member's DDD Health Plan — Mercy Care DD or UnitedHealthcare Community Plan DD — plus the DDD support coordinator on the service-plan side. [11][10]
- **Session-note signature** _(ask the plan)_: 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.

## What intake should collect for DES/DDD (Arizona Division of Developmental Disabilities)

- **DDD enrollment + ALTCS status:** Enrolled DDD member, ALTCS application pending, or ACC-only — three different routes with different timelines.
- **Which DDD Health Plan:** Mercy Care DD or UHCCP DD — the choice sets the PA form, portal, and auth cadence.
- **Support coordinator contact:** DDD members have one — coordinate the ABA request with the existing service plan.
- **Other DDD services in place:** Habilitation and respite hours shape the realistic ABA schedule.

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

## Verification of benefits (VOB) data

How DES/DDD (Arizona Division of Developmental Disabilities) ABA benefits route and read on an eligibility check. Data last updated 2026-10-15.

### EDI routing

- **Supports 270/271 eligibility:** Yes
- **Real-time eligibility:** Yes
- **Behavioral health administrator:** The member's DDD Health Plan (Mercy Care DD → 86052, or UHCCP DD → 03432)
- **BH administrator payer ID:** 86052 / 03432
- **ABA rides on:** medical benefit
- **Two-hop verification required:** No
- **Where the 271 carries MCO enrollment:** DDD enrollment surfaces in the AHCCCS 271 via EB05 descriptions "DDD Subcontractor Plan" / "DES/DDD Targeted Support Coordination" (e.g. EB*3*IND*CQ**DES/DDD TARGETED SUPPORT COORDINATION with DTP*292), 2120C NM103 "DDDS Code and Description", and contract-type codes @ (DES/DD/RI) and S (MHS/CAP/DD). The member's actual DDD Health Plan (Mercy Care DD or UHCCP/APIPA DD) appears as the NM1*Y2 managed-care enrollment — so eligibility resolves in ONE AHCCCS 270/271 hop, and ABA then rides that plan's payer ID.
- **Eligibility span granularity:** Daily (same AHCCCS 271 mechanics as arizona-ahcccs).

### Code-level coverage

| Code | Covered | Prior auth | Unit cap | Place of service | Telehealth | Modifiers |
| --- | --- | --- | --- | --- | --- | --- |
| 97151 | Yes | Not required — both DDD Health Plans (Mercy Care DD, UHCCP DD) skip PA on 97151/97152, same as their ACC lines. | — | office/clinic, home (POS 12 — pays a ~10–11.5% premium on the AHCCCS schedule), school, community, telehealth (modality allowed under AMPM 320-S; ABA-specific POS/modifier not itemized) | — | HM (below bachelor's / BT-RBT), HN (bachelor's / BCaBA), HO (master's / BCBA), HP (doctoral / BCBA-D) |
| 97152 | Yes | Not required — both DDD Health Plans (Mercy Care DD, UHCCP DD) skip PA on 97151/97152, same as their ACC lines. | — | office/clinic, home (POS 12 — pays a ~10–11.5% premium on the AHCCCS schedule), school, community, telehealth (modality allowed under AMPM 320-S; ABA-specific POS/modifier not itemized) | — | HM (below bachelor's / BT-RBT), HN (bachelor's / BCaBA), HO (master's / BCBA), HP (doctoral / BCBA-D) |
| 97153 | Yes | Required — through the member's DDD Health Plan on its own ABA machinery (Mercy Care's ABA form, 6-month auths; or Optum's Provider Express Treatment Form). | — | office/clinic, home (POS 12 — pays a ~10–11.5% premium on the AHCCCS schedule), school, community, telehealth (modality allowed under AMPM 320-S; ABA-specific POS/modifier not itemized) | — | HM (below bachelor's / BT-RBT), HN (bachelor's / BCaBA), HO (master's / BCBA), HP (doctoral / BCBA-D) |
| 97154 | Yes | Required — through the member's DDD Health Plan on its own ABA machinery (Mercy Care's ABA form, 6-month auths; or Optum's Provider Express Treatment Form). | — | office/clinic, home (POS 12 — pays a ~10–11.5% premium on the AHCCCS schedule), school, community, telehealth (modality allowed under AMPM 320-S; ABA-specific POS/modifier not itemized) | — | HM (below bachelor's / BT-RBT), HN (bachelor's / BCaBA), HO (master's / BCBA), HP (doctoral / BCBA-D) |
| 97155 | Yes | Required — through the member's DDD Health Plan on its own ABA machinery (Mercy Care's ABA form, 6-month auths; or Optum's Provider Express Treatment Form). | — | office/clinic, home (POS 12 — pays a ~10–11.5% premium on the AHCCCS schedule), school, community, telehealth (modality allowed under AMPM 320-S; ABA-specific POS/modifier not itemized) | — | HM (below bachelor's / BT-RBT), HN (bachelor's / BCaBA), HO (master's / BCBA), HP (doctoral / BCBA-D) |
| 97156 | Yes | Required — through the member's DDD Health Plan on its own ABA machinery (Mercy Care's ABA form, 6-month auths; or Optum's Provider Express Treatment Form). | — | office/clinic, home (POS 12 — pays a ~10–11.5% premium on the AHCCCS schedule), school, community, telehealth (modality allowed under AMPM 320-S; ABA-specific POS/modifier not itemized) | — | HM (below bachelor's / BT-RBT), HN (bachelor's / BCaBA), HO (master's / BCBA), HP (doctoral / BCBA-D) |
| 97157 | Yes | Required — through the member's DDD Health Plan on its own ABA machinery (Mercy Care's ABA form, 6-month auths; or Optum's Provider Express Treatment Form). | — | office/clinic, home (POS 12 — pays a ~10–11.5% premium on the AHCCCS schedule), school, community, telehealth (modality allowed under AMPM 320-S; ABA-specific POS/modifier not itemized) | — | HM (below bachelor's / BT-RBT), HN (bachelor's / BCaBA), HO (master's / BCBA), HP (doctoral / BCBA-D) |
| 97158 | Yes | Required — through the member's DDD Health Plan on its own ABA machinery (Mercy Care's ABA form, 6-month auths; or Optum's Provider Express Treatment Form). | — | office/clinic, home (POS 12 — pays a ~10–11.5% premium on the AHCCCS schedule), school, community, telehealth (modality allowed under AMPM 320-S; ABA-specific POS/modifier not itemized) | — | HM (below bachelor's / BT-RBT), HN (bachelor's / BCaBA), HO (master's / BCBA), HP (doctoral / BCBA-D) |
| 0362T | Yes | Required — through the member's DDD Health Plan on its own ABA machinery (Mercy Care's ABA form, 6-month auths; or Optum's Provider Express Treatment Form). | — | office/clinic, home (POS 12 — pays a ~10–11.5% premium on the AHCCCS schedule), school, community, telehealth (modality allowed under AMPM 320-S; ABA-specific POS/modifier not itemized) | — | HM (below bachelor's / BT-RBT), HN (bachelor's / BCaBA), HO (master's / BCBA), HP (doctoral / BCBA-D) |
| 0373T | Yes | Required — through the member's DDD Health Plan on its own ABA machinery (Mercy Care's ABA form, 6-month auths; or Optum's Provider Express Treatment Form). | — | office/clinic, home (POS 12 — pays a ~10–11.5% premium on the AHCCCS schedule), school, community, telehealth (modality allowed under AMPM 320-S; ABA-specific POS/modifier not itemized) | — | HM (below bachelor's / BT-RBT), HN (bachelor's / BCaBA), HO (master's / BCBA), HP (doctoral / BCBA-D) |

Code notes:

- **97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, 0362T, 0373T:** ALTCS-DD path — ABA rides Mercy Care DD or UHCCP DD, same PA machinery as those plans' ACC lines. AMPM 320-S covers ASD "and/or other diagnoses as justified by medical necessity" — no strict autism-dx requirement. Per-code daily unit caps are not published (AzCH uses hour bands, not caps).

### Medicaid rates

Source: Not separately published by the member's DDD Health Plan (Mercy Care DD / UHCCP DD). AHCCCS ACC/DDD plans are capitated, but ABA tracks the AHCCCS physician fee schedule (see arizona-ahcccs rates) as the public benchmark — the member's DDD Health Plan (Mercy Care DD / UHCCP DD)'s actual contracted rate is not published (and is NOT a statutory floor, unlike New Mexico). Effective 2023-11-01 (AHCCCS benchmark).

| Code | Rate | Unit | Modifier tiers |
| --- | --- | --- | --- |
| 97151 | Benchmark: $30.06 (HN) / $35.78 (HO) / $44.73 (HP) office — see arizona-ahcccs | 15min | — |
| 97152 | Benchmark: $21.49 (HM) / $25.58 (HN) / $28.43 (HO/HP) office — see arizona-ahcccs | 15min | — |
| 97153 | Benchmark: $17.91 (HM) / $21.32 (HN) / $23.69 (HO/HP) office — see arizona-ahcccs | 15min | — |
| 97154 | Benchmark: $4.48 (HM) / $5.33 (HN) / $5.92 (HO/HP) office — see arizona-ahcccs | 15min | — |
| 97155 | Benchmark: $25.05 (HN) / $29.82 (HO) / $37.28 (HP) office — see arizona-ahcccs | 15min | — |
| 97158 | Benchmark: $6.26 (HN) / $7.46 (HO) / $9.32 (HP) office — see arizona-ahcccs | 15min | — |

### Contacts

- **Phone menu path:** Ask which DDD Health Plan the member is enrolled in — Mercy Care DD or UHCCP DD — first; routing, the PA form, and the phone/fax used all depend on that answer (see mercy-care-arizona / unitedhealthcare-community-plan-arizona contacts).

Questions to ask on a verification call:

- Which DDD Health Plan is the member enrolled in — Mercy Care DD or UHCCP DD?
- Is there a daily or weekly unit cap on 97153–97155 treatment codes, and over what period?
- Is telehealth allowed for ABA codes, and does it need a specific POS or modifier?
- What POS codes (home, clinic, school, community) do you actually accept on ABA claims?

### VOB data sources

- https://des.az.gov/services/disabilities/developmental-disabilities/individuals-and-families/supports-and-services/ddd-health-plans-info (accessed 2026-07-23)
- https://www.azahcccs.gov/Resources/Downloads/EDIchanges/AZ270_271_CG.pdf (accessed 2026-07-23)
- https://www.mercycareaz.org/providers/claims (accessed 2026-07-23)
- https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/autismABA/azaba/azABA_Provider_Orient.pdf (accessed 2026-07-23)
- https://www.azahcccs.gov/shared/Downloads/MedicalPolicyManual/300/320S.pdf (accessed 2026-07-23)
- https://www.azahcccs.gov/AHCCCS/Downloads/PublicNotices/rates/FinalPublicNotice_RateChanges_20231101_ABA.pdf (accessed 2026-07-23)
- https://azahcccs.gov/PlansProviders/Downloads/FFSrates/ABA/FY26_Final_ABA_FeeSchedule.xlsx (accessed 2026-07-23)

## Common questions

### What is the timely filing limit for ABA claims for a DDD member?

It is set by the member’s DDD Health Plan, inside the AHCCCS outer limit of six months to file and twelve to reach clean-claim status. UnitedHealthcare Community Plan requires network providers to file within 90 days of the date of service (or per contract); check your Mercy Care contract for Mercy Care DD. AHCCCS requires the plans to adjudicate 95% of clean claims within 30 days.

### How quickly must a DDD member be seen for ABA after the assessment?

The DDD contractors are bound by AHCCCS’s behavioral health appointment standard (ACOM 417, current version eff. 10/1/2026): initial assessment within seven calendar days of the referral or request, and the initial appointment “no later than 21 days after the initial assessment” for members under 18 (23 calendar days for adults), with later services no more than 45 calendar days from identification of need. Mercy Care DD and UHCCP DD must meet it through their networks, so plan the treatment authorization request to land well inside that window.

### How do DDD members get ABA in Arizona?

Through their chosen DDD Health Plan — Mercy Care DD or UHCCP DD, both statewide — on the same AMPM 320-S clinical rules and the same plan-level ABA PA machinery as those plans' ACC lines.

### Can a child get ABA through an ACC plan instead of DDD?

Yes — children under 21 can get ABA via their ACC plan under EPSDT even without DDD. If the child is ALTCS/DDD-eligible, the DDD path adds bundled services (habilitation, respite); over age 3, ALTCS approval is the gate.

### Does county matter for DDD members?

No — both DDD Health Plans are statewide, unlike ACC plans, which are restricted to geographic service areas.

### What is the DDD Health Plans’s fee schedule for ABA?

There is no public plan fee schedule. AHCCCS says its fixed ABA rates (effective November 1, 2023) apply only to fee-for-service programs and have “no impact on the contracts that AHCCCS health plans negotiate with their providers”: “MCOs and providers may negotiate any contracted rate that is agreed to by both parties.” Your rate is in your contract with the DDD Health Plans; the AHCCCS fee-for-service schedule does not bind the plan.

### Can an out-of-state BCBA treat DDD members in Arizona, including by telehealth?

Arizona requires a license (A.R.S. § 32-2091.02) but lets an out-of-state provider deliver telehealth after registering under A.R.S. § 36-3606. AHCCCS defines a Behavior Analyst as one licensed under A.R.S. § 32-2091, so plan on an Arizona license for Medicaid work.

### Does DDD require EVV for ABA?

Not as ABA. AMPM 540, which names DES/DDD among the programs it binds, limits EVV to personal care and home health services (attendant care, personal care, homemaker, habilitation, respite, in-home skilled nursing). DDD habilitation delivered in the home is a different matter — check AHCCCS’s provider-type, service-code and place-of-service list.

## Primary sources

1. [A.R.S. § 36-2904 — AHCCCS contracts; claim submission time limits (subsection G)](https://www.azleg.gov/ars/36/02904.htm)
2. [UnitedHealthcare Community Plan of Arizona — Care Provider Manual, 2027 edition (posted 10/13/2026; ACC, ALTCS EPD, DDD)](https://www.uhcprovider.com/content/dam/provider/docs/public/admin-guides/comm-plan/AZ-Provider-Manual.pdf)
3. [AHCCCS Behavioral Health Services Matrix (B2Matrix, October 2026 sheet)](https://www.azahcccs.gov/PlansProviders/Downloads/MedicalCodingResources/B2Matrix.xlsx)
4. [CMS — NCCI for Medicaid (methodologies required for Medicaid fee-for-service; optional for MCOs)](https://www.cms.gov/medicare/coding-billing/ncci-medicaid)
5. [CMS — Medicaid NCCI Edit Files (practitioner MUE table effective 10/1/2026)](https://www.cms.gov/medicare/coding-billing/ncci-medicaid/medicaid-ncci-edit-files)
6. [AHCCCS Telehealth Code Set (guidelines eff. 01/01/2026; code sheet eff. 06/01/2026)](https://www.azahcccs.gov/PlansProviders/Downloads/MedicalCodingResources/TelehealthCodeSet.xlsx)
7. [AMPM 320-I — Telehealth (AHCCCS)](https://www.azahcccs.gov/shared/Downloads/MedicalPolicyManual/300/320-I.pdf)
8. [AHCCCS ACOM 203 — Claims Processing (eff. 10/01/22)](https://www.azahcccs.gov/Shared/Downloads/ACOM/PolicyFiles/200/203v2.pdf)
9. [AHCCCS Contractor Operations Manual (ACOM) 417 — Appointment Availability, Transportation Timeliness, Monitoring, and Reporting (current version eff. 10/01/26)](https://www.azahcccs.gov/shared/Downloads/ACOM/PolicyFiles/400/417_Appointment_Availability_Monitoring_and_Reporting.pdf)
10. [DES — DDD Health Plans information](https://des.az.gov/services/disabilities/developmental-disabilities/individuals-and-families/supports-and-services/ddd-health-plans-info)
11. [AMPM 320-S — Behavior Analysis Services (AHCCCS)](https://www.azahcccs.gov/shared/Downloads/MedicalPolicyManual/300/320S.pdf)
12. [AZA United — navigating the systems of care](https://azaunited.org/blog/navigating-the-systems-of-care)
13. [AHCCCS — Final Public Notice, FFS rate changes 11/1/2023 (ABA codes)](https://www.azahcccs.gov/AHCCCS/Downloads/PublicNotices/rates/FinalPublicNotice_RateChanges_20231101_ABA.pdf)
14. [Optum — Arizona AHCCCS Autism/ABA Program provider orientation (BH4129)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/autismABA/azaba/azABA_Provider_Orient.pdf)
15. [Mercy Care — Applied Behavior Analysis provider page](https://www.mercycareaz.org/providers/applied-behavior-analysis.html)
16. [AHCCCS — Rate Setting for Applied Behavioral Analysis (ABA) Services FAQ (10/31/2023)](https://www.azahcccs.gov/PlansProviders/Downloads/FFSrates/ABA_RateSettingFAQs.pdf)
17. [A.R.S. § 32-2091.02 — a behavior analyst must be licensed](https://www.azleg.gov/ars/32/02091-02.htm)
18. [A.R.S. § 32-2091.12 — unlicensed practice is a class 2 misdemeanor](https://www.azleg.gov/ars/32/02091-12.htm)
19. [A.R.S. § 36-3606 — interstate telehealth services; registration of out-of-state providers](https://www.azleg.gov/ars/36/03606.htm)
20. [A.R.S. § 36-3601 — telehealth definitions (“health care provider” includes Title 32, ch. 19.1 licensees)](https://www.azleg.gov/ars/36/03601.htm)
21. [A.R.S. § 32-2091.14 — AHCCCS recognizes licensed behavior analysts as behavioral health professionals](https://www.azleg.gov/ars/32/02091-14.htm)
22. [AMPM 540 — Electronic Visit Verification (effective 08/06/26)](https://www.azahcccs.gov/shared/Downloads/MedicalPolicyManual/500/540.pdf)
23. [AHCCCS — Electronic Visit Verification (What is EVV?, updated Oct. 22, 2025)](https://www.azahcccs.gov/AHCCCS/Initiatives/EVV/)
24. [DES/DDD — Vendor announcements (provider policy updates, QM bulletins, claims notices)](https://des.az.gov/services/disabilities/developmental-disabilities/vendors-providers/vendor-announcements)
25. [DES/DDD — Division Operations Policy 414, Service Authorization Decisions (rev. 5/29/2024)](https://des.az.gov/sites/default/files/media/Division_Operations_Policy_Manual_414_Requirements_for_Service_Authorization_Decisions_and_Notice_of_Adverse_Benefit_Determination.pdf)
26. [DES/DDD — AdSS Operations Policy 414 (DDD health plans), Service Authorization Decisions (rev. 5/29/2024)](https://des.az.gov/sites/default/files/media/AdSS_Operations_Policy_Manual_414_Requirements_for_Service_Authorization_Decisions_and_Notice_of_Adverse_Benefit_Determination.pdf)
27. [AHCCCS — Prior Authorization Metrics for Medical Items and Services, CY2025 (3/31/2026)](https://www.azahcccs.gov/Resources/Downloads/PriorAuthorizationMetricAnnualReports/CMS_PA_Mandate_Report_Final_033026.pdf)
28. [42 CFR 438.210(d) — Medicaid managed care authorization decision timeframes](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-438/subpart-D/section-438.210)
29. [DES/DDD — Division Operations Policy 434, Coordination of Benefits and TPL (rev. 6/17/2026)](https://des.az.gov/sites/default/files/media/Division_Operations_Policy_Manual_434_Coordination_of_Benefits_and_TPL.pdf)
30. [DES/DDD — AdSS Operations Policy 434 (DDD health plans), COB and TPL (rev. 6/12/2024)](https://des.az.gov/sites/default/files/media/AdSS_Operations_Policy_Manual_434_Coordination_of_Benefits_and_Third_Party_Liability.pdf)
31. [32 CFR 199.8 — TRICARE double coverage (secondary to other plans, primary to Medicaid)](https://www.ecfr.gov/current/title-32/subtitle-A/chapter-VII/subchapter-M/part-199/section-199.8)
32. [VA — CHAMPVA Guidebook (updated 1/1/2025), CHAMPVA as secondary payer](https://www.va.gov/files/2025-12/CHAMPVA-Guidebook.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.