---
title: "Blue Cross and Blue Shield of Nebraska ABA coverage: the intake guide."
url: "https://carelu.com/payers/bcbs-nebraska"
markdown_url: "https://carelu.com/payers/bcbs-nebraska.md"
state: NE (Nebraska)
payer: Blue Cross Blue Shield Nebraska
kind: Commercial insurance
description: "How Blue Cross and Blue Shield of Nebraska handles ABA — Medical Policy I.178 and its preauthorization, 2 hours of supervision per 10 direct, office or telehealth only, telehealth for 97151/97155/97156, the Neb. Rev. Stat. § 44-7,106 mandate and its 25-hour cap, and which plans the mandate misses."
last_reviewed: September 2026
vob_data_updated: 2026-09-27
---

# Blue Cross and Blue Shield of Nebraska ABA coverage: the intake guide.

_Payer Guide · Blue Cross Blue Shield · Nebraska · Last updated September 2026 · 11 primary sources_

> Nebraska's Blue plan: Medical Policy I.178 (preauthorization required), 2 hrs supervision per 10 direct, office or telehealth only, 25 hr/wk mandate cap on state-regulated plans.

Blue Cross and Blue Shield of Nebraska (BCBSNE) is the state's Blue plan, and its ABA rules are unusually specific. Medical Policy I.178 requires preauthorization, sets 2 hours of BCBA supervision per 10 hours of direct treatment, caps treatment plans at 40 hours a week, and limits ABA to an office setting or telehealth. It also makes coverage conditional: ABA is medically necessary under I.178 only "when a state mandate requires or a benefit plan explicitly provides coverage for ABA." So the first intake question is which plan the family has — a state-regulated plan the Nebraska mandate reaches, a self-funded group, or an ACA individual or small-group plan the mandate does not reach.

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Required — BCBSNE lists Medical Policy I.178 (Autism Spectrum Disorders) under "Medical Policies Requiring Preauthorization," and I.178's code list includes the assessment codes 97151, 97152 and 0362T alongside the treatment codes. Submit through NaviNet; BCBSNE checks per procedure code in MedPolicy Blue [2][1][3]
- **Prior auth for treatment**: Required — the same I.178 preauthorization covers 97153-97158 and 0373T. The treatment plan is updated and resubmitted "in general, every 6 months or as required by a state mandate," and continuation needs mastery of at least 50 percent of stated goals or a plan that addresses the barriers. A BCBSNE authorization "is effective for 12 months from the decision date." Claims for services that needed preauthorization and did not have it "will be denied, and the provider will be liable" [1][3]
- **Autism diagnosis required?**: Yes — ASD, "made by a licensed medical professional or licensed psychologist." I.178 treats ABA as medically necessary only "when a state mandate requires or a benefit plan explicitly provides coverage for ABA"; for groups outside the Nebraska mandate, ABA "for any indication may be considered not medically necessary" unless the benefit plan covers it [1]

## At a glance

- **Covers ABA?:** Yes where the Nebraska mandate applies or the benefit plan covers ABA (Medical Policy I.178)
- **Prior auth:** Required — I.178 is on BCBSNE's preauthorization list; submit in NaviNet
- **Supervision:** 2 hours per 10 hours of direct treatment, face to face
- **Setting:** Office or telehealth only; daycare excluded
- **Telehealth codes:** 97151, 97155, 97156 only (POS 02/10, modifier 95)
- **State mandate:** Neb. Rev. Stat. § 44-7,106 (LB 254, eff. 1/1/2015)
- **Mandate age:** Under 21 (screening, diagnosis, and treatment of ASD)
- **Mandate caps:** 25 hrs/week maximum benefit for behavioral health treatment incl. ABA
- **Exempt from mandate:** Non-grandfathered individual/small-group ACA plans; self-funded ERISA (to the extent preempted)
- **Licensure:** NE Licensed Behavior Analyst (Behavior Analyst Practice Act, Neb. Rev. Stat. § 38-4401 et seq.)

## Medical Policy I.178: when BCBSNE pays for ABA

I.178 opens by calling intensive behavioral interventions, ABA included, potentially "not medically necessary" for any indication, and then carves out the mandate: "Some state mandate benefit coverage for applied behavioral analysis for treatment of ASD. In those states, the applicable mandate must be followed." An initial course is medically necessary when a mandate or the benefit plan covers ABA and the child has an ASD diagnosis from "a licensed medical professional or licensed psychologist," a treatment plan with measurable goals based on standardized assessments for 40 hours a week or less, and an appropriately licensed or certified provider. Continuation needs an updated plan "in general, every 6 months," mastery of at least 50 percent of goals, and evidence of progress toward closing the gap between chronological and developmental age; without that, coverage "may be denied through the peer review process." Treatment for convenience, custodial care or respite is excluded. [1]

## The Nebraska mandate: what it guarantees (and doesn't)

Nebraska's mandate (LB 254 of 2014) requires coverage of screening, diagnosis and treatment of ASD for individuals under 21 on policies delivered, issued, amended or renewed on or after January 1, 2015, and on self-funded plans "to the extent not preempted by federal law." Behavioral health treatment including ABA is capped at "a maximum benefit of twenty-five hours per week until the insured reaches twenty-one years of age"; otherwise no visit limits, and no dollar limits or cost sharing less favorable than for a general physical illness. The insurer may review treatment "not more than once every six months," at its own cost. ABA must be "provided or supervised, either in person or by telehealth, by a behavior analyst certified by a national certifying organization or a licensed psychologist." The mandate does not apply "to non-grandfathered plans in the individual and small group markets that are required to include essential health benefits." For those plans, note that Nebraska's essential-health-benefit benchmark — itself a BCBSNE small-group plan — lists "Services for treatment of autism spectrum disorders, including but not limited to applied behavioral analysis" among its exclusions, so ask about ABA specifically on any BCBSNE ACA plan. [7][8]

## Setting, telehealth and supervision

Three BCBSNE rules shape the schedule. Setting: "Services must be delivered in an office setting or through telehealth," and daycare is excluded. Telehealth: BCBSNE's telehealth policy allows only 97151, 97155 and 97156 with POS 02 or 10 and modifier 95, so technician treatment (97153) and group codes are in-person. Supervision: "2 hours per 10 hours of direct treatment," face to face, by a BCBA. PT, OT and speech therapy are not allowed on top of 40 billed hours of ABA. [1][4]

## Licensure & rates in Nebraska

Nebraska licenses behavior analysts under the Behavior Analyst Practice Act (Neb. Rev. Stat. § 38-4401 et seq.): the Licensed Behavior Analyst credential for BCBAs and the Licensed Assistant Behavior Analyst for BCaBAs, issued by the DHHS Licensure Unit, whose regulations (172 NAC 86) are still being drafted. BCBSNE publishes no ABA fee schedule; commercial rates are set in your participation agreement. Nebraska Medicaid's schedule (97153 at $18.70 per 15 minutes since August 2025) is a low benchmark, not a guide to BCBSNE rates. [11][12]

## Intake gates

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

- **Who may diagnose**: "A diagnosis of ASD has been made by a licensed medical professional or licensed psychologist." On mandate plans, treatment must also be "prescribed or ordered for an individual diagnosed with an autism spectrum disorder by a licensed physician or a licensed psychologist." [1][7]
- **Diagnostic tools required**: No diagnostic instrument is required. The instruments I.178 names sit in the treatment plan and progress review: goals "based on standardized assessments," collected data "including additional testing such as ABLLS, VB-MAPP or other developmentally appropriate assessments," and psychological tests as evidence of progress toward closing the gap between chronological and developmental age. The August 2025 revision removed the Vineland testing criterion. [1]
- **Telehealth**: Three ABA codes only. BCBSNE's telehealth policy lists the codes that may be billed with POS 02 or POS 10 and modifier 95, and the ABA codes on it are 97151, 97155 and 97156; "All other procedure codes are not medically appropriate to be performed via telehealth" — so 97152, 97153, 97154, 97157, 97158, 0362T and 0373T are in-person only. Member cost shares apply. Since May 1, 2023, providers delivering telehealth exclusively must live in Nebraska, belong to a credentialed Nebraska-based PHO, or be employed by a licensed or credentialed Nebraska facility. These rules are specific to BCBSNE members; FEP and out-of-state Blue members follow their own plan. The Nebraska mandate itself contemplates ABA "provided or supervised, either in person or by telehealth." [4][1][7]
- **Prior-auth decision time**: BCBSNE publishes its clock: "Preauthorizations that are not urgent will be processed within 7 calendar days of receipt. Urgent preauthorization requests will be processed within 72 hours of receipt," and "An authorization is effective for 12 months from the decision date." If the criteria are met at submission the request may auto-approve; otherwise it pends for medical review. On fully insured plans Nebraska's LB 77 (operative January 1, 2026) sets the same seven days for nonurgent and seventy-two hours for urgent requests after all necessary information is in, "Health care services are deemed authorized if a utilization review agent fails to comply with the deadlines," and a prior authorization "shall be valid for at least one year." Self-funded ERISA plans follow 29 CFR 2560.503-1 instead (pre-service decisions "not later than 15 days after receipt of the claim"). [3][9][13]
- **Other insurance (who pays first)**: BCBSNE: "no preauthorization is required when BCBSNE is secondary to any other insurance (including Medicare or another Blue Plan). When BCBSNE is secondary, our medical policy will still apply." Out-of-state Blue members follow their home plan: "All medical policy criteria and preauthorization requirements applicable to out-of-state Blue Cross and/or Blue Shield patients are dictated by the Blue Plan that insures the member." For a child on two parents' fully insured plans, Nebraska's rule is the birthday rule: "The plan of the parent whose birthday falls earlier in the calendar year is the primary plan" (same birthday: the plan that covered the parent longest). If the child also has Nebraska Medicaid, BCBSNE pays first — Medicaid returns claims to the provider when other coverage is known. TRICARE pays after BCBSNE ("TRICARE shall be last pay"). [3][10][14][15]
- **Age limit** _(plan-dependent)_: I.178 sets no upper age; it splits its criteria at age 7 and under (deficits "relative to age expected norms") and age 8 and over (behaviors "interfering with" functioning). The Nebraska mandate covers ASD screening, diagnosis and treatment "in an individual under twenty-one years of age," with the 25-hour weekly ABA cap "until the insured reaches twenty-one years of age," on the plans it reaches. Non-grandfathered individual and small-group ACA plans are outside the mandate, and a self-funded plan follows its plan document. [1][7]
  - Ask the plan: NaviNet benefits for the member's group — confirm funding type and any ABA age limit in the plan.
- **Referral required?** _(plan-dependent)_: I.178 states no referral requirement. On plans the Nebraska mandate reaches, covered "Treatment" is care "prescribed or ordered for an individual diagnosed with an autism spectrum disorder by a licensed physician or a licensed psychologist," so keep that order on file. [1][7]
  - Ask the plan: NaviNet benefits for the member's group — ask whether the plan requires a referral for behavioral health.
- **Diagnosis recency** _(ask the plan)_: No recency window is published. I.178 asks for an "Initial assessment request with diagnostic evaluation" but puts no age on the evaluation. [1]
  - Ask the plan: BCBSNE utilization management through NaviNet, if the only diagnostic report is several years old.

## Delivery and billing rules

Coverage decides whether Blue Cross Blue Shield Nebraska 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**: A number, stated in the policy: "ABA services are provided by a BCBA or line therapist supervised face to face by a BCBA/ AS, certified in Nebraska. Supervision should be 2 hours per 10 hours of direct treatment." The treatment plan must also document that "ABA services will be delivered by an appropriate provider who is licensed or certified according to the requirements of applicable state laws and benefit plan requirements" — in Nebraska that means the Licensed Behavior Analyst credential. [1][11]
- **Daily limits / MUEs**: Weekly, not daily. I.178's treatment plan must call for ABA "for 40 hours per week or less" in both of its age bands (7 and under; 8 and over), and PT, OT and speech therapy are not allowed on top of 40 billed ABA hours. On state-regulated plans the Nebraska mandate is tighter: "Coverage for behavioral health treatment, including applied behavior analysis, shall be subject to a maximum benefit of twenty-five hours per week until the insured reaches twenty-one years of age," and I.178 says "the applicable mandate must be followed." No per-day unit ceiling is published. [1][7]
- **Session-note signature**: BCBSNE's Medical Record Standards apply to every provider: "All entries in the medical record contain the author's identification. Author identification may be a handwritten signature or a unique electronic identifier," "All entries are dated," and "Providers should not add late signatures to medical records, other than a short delay that occurs during transcription process." I.178 separately requires a "comprehensive medical record" for ABA, including progress notes that link to specific treatment-plan goals and documentation of "treatment participants and staff, procedures and setting." [5][1]
- **Place of service**: Office or telehealth — stated flatly in I.178: "Services provided in a daycare setting are an exclusion of the member's contract and are excluded. Services must be delivered in an office setting or through telehealth." Home, school and community settings are not on that list, so confirm before scheduling any of them. Nebraska's mandate does not add settings; it only says it does not affect services owed "under an individualized family service plan, individualized education program, or individualized service plan." [1][7]
- **Concurrent billing (97153 + 97155)** _(ask the plan)_: Not published for 97153 with 97155. The only concurrency rule in I.178 is about other therapies: its 2022 revision note says "Additional services of Physical therapy, Occupational therapy and Speech therapy are not allowed if 40 hours of ABA therapy are billed." [1]
  - Ask the plan: BCBSNE provider services or NaviNet — ask whether 97155 pays alongside 97153 for the same clock time when the BCBA and technician are both with the child.
- **Bill as provider** _(ask the plan)_: Not published. I.178 says who may deliver ABA (a BCBA, or a line therapist supervised face to face by a BCBA) but not whose NPI the claim carries. [1]
  - Ask the plan: BCBSNE provider services and your participation agreement — ask whether technician time bills under the supervising BCBA's NPI.

## What intake should collect for Blue Cross Blue Shield Nebraska

- **Plan type and funding:** State-regulated large-group or grandfathered (mandate applies), ACA individual/small-group (mandate does not apply), or self-funded (plan document governs). I.178 covers ABA only where a mandate or the plan does.
- **BCBSNE member or out-of-state Blue:** Out-of-state Blue members follow their home plan's medical policy and preauthorization rules, not I.178.
- **Diagnosis report:** ASD diagnosis by a licensed medical professional or licensed psychologist, with the diagnostic evaluation for the initial request.
- **Where therapy will happen:** I.178 allows an office setting or telehealth only; daycare is excluded. Confirm before planning home or school sessions.
- **Requested weekly hours:** 40 hours or less under I.178; 25 hours a week under the mandate on state-regulated plans. No PT/OT/ST on top of 40 billed ABA hours.

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

## Verification of benefits (VOB) data

How Blue Cross Blue Shield Nebraska ABA benefits route and read on an eligibility check. Data last updated 2026-09-27.

### EDI routing

- **Payer ID (pVerify):** 00215
- **Supports 270/271 eligibility:** Yes

### Code-level coverage

| Code | Covered | Prior auth | Unit cap | Place of service | Telehealth | Modifiers |
| --- | --- | --- | --- | --- | --- | --- |
| 97151 | Yes, where the benefit plan covers ABA (see notes) | Required — Medical Policy I.178 ("Preauthorization Required") lists this code; submit in NaviNet. Authorization effective 12 months from the decision date. | No per-code cap. I.178 treatment plans run 40 hours/week or less (no PT/OT/ST on top of 40 billed ABA hours); state-regulated plans under Neb. Rev. Stat. § 44-7,106 cap behavioral health treatment incl. ABA at 25 hours/week to age 21. per week | office, telehealth — POS 02 or POS 10 | Yes — on BCBSNE's GP-X-016 telehealth code list; bill POS 02 or 10 with modifier 95. Member cost shares apply. | 95 (telehealth, with POS 02/10) |
| 97152 | Yes, where the benefit plan covers ABA (see notes) | Required — Medical Policy I.178 ("Preauthorization Required") lists this code; submit in NaviNet. Authorization effective 12 months from the decision date. | No per-code cap. I.178 treatment plans run 40 hours/week or less (no PT/OT/ST on top of 40 billed ABA hours); state-regulated plans under Neb. Rev. Stat. § 44-7,106 cap behavioral health treatment incl. ABA at 25 hours/week to age 21. per week | office | No — not on BCBSNE's GP-X-016 telehealth code list ("All other procedure codes are not medically appropriate to be performed via telehealth"). | None published |
| 97153 | Yes, where the benefit plan covers ABA (see notes) | Required — Medical Policy I.178 ("Preauthorization Required") lists this code; submit in NaviNet. Authorization effective 12 months from the decision date. | No per-code cap. I.178 treatment plans run 40 hours/week or less (no PT/OT/ST on top of 40 billed ABA hours); state-regulated plans under Neb. Rev. Stat. § 44-7,106 cap behavioral health treatment incl. ABA at 25 hours/week to age 21. per week | office | No — not on BCBSNE's GP-X-016 telehealth code list ("All other procedure codes are not medically appropriate to be performed via telehealth"). | None published |
| 97154 | Yes, where the benefit plan covers ABA (see notes) | Required — Medical Policy I.178 ("Preauthorization Required") lists this code; submit in NaviNet. Authorization effective 12 months from the decision date. | No per-code cap. I.178 treatment plans run 40 hours/week or less (no PT/OT/ST on top of 40 billed ABA hours); state-regulated plans under Neb. Rev. Stat. § 44-7,106 cap behavioral health treatment incl. ABA at 25 hours/week to age 21. per week | office | No — not on BCBSNE's GP-X-016 telehealth code list ("All other procedure codes are not medically appropriate to be performed via telehealth"). | None published |
| 97155 | Yes, where the benefit plan covers ABA (see notes) | Required — Medical Policy I.178 ("Preauthorization Required") lists this code; submit in NaviNet. Authorization effective 12 months from the decision date. | No per-code cap. I.178 treatment plans run 40 hours/week or less (no PT/OT/ST on top of 40 billed ABA hours); state-regulated plans under Neb. Rev. Stat. § 44-7,106 cap behavioral health treatment incl. ABA at 25 hours/week to age 21. per week | office, telehealth — POS 02 or POS 10 | Yes — on BCBSNE's GP-X-016 telehealth code list; bill POS 02 or 10 with modifier 95. Member cost shares apply. | 95 (telehealth, with POS 02/10) |
| 97156 | Yes, where the benefit plan covers ABA (see notes) | Required — Medical Policy I.178 ("Preauthorization Required") lists this code; submit in NaviNet. Authorization effective 12 months from the decision date. | No per-code cap. I.178 treatment plans run 40 hours/week or less (no PT/OT/ST on top of 40 billed ABA hours); state-regulated plans under Neb. Rev. Stat. § 44-7,106 cap behavioral health treatment incl. ABA at 25 hours/week to age 21. per week | office, telehealth — POS 02 or POS 10 | Yes — on BCBSNE's GP-X-016 telehealth code list; bill POS 02 or 10 with modifier 95. Member cost shares apply. | 95 (telehealth, with POS 02/10) |
| 97157 | Yes, where the benefit plan covers ABA (see notes) | Required — Medical Policy I.178 ("Preauthorization Required") lists this code; submit in NaviNet. Authorization effective 12 months from the decision date. | No per-code cap. I.178 treatment plans run 40 hours/week or less (no PT/OT/ST on top of 40 billed ABA hours); state-regulated plans under Neb. Rev. Stat. § 44-7,106 cap behavioral health treatment incl. ABA at 25 hours/week to age 21. per week | office | No — not on BCBSNE's GP-X-016 telehealth code list ("All other procedure codes are not medically appropriate to be performed via telehealth"). | None published |
| 97158 | Yes, where the benefit plan covers ABA (see notes) | Required — Medical Policy I.178 ("Preauthorization Required") lists this code; submit in NaviNet. Authorization effective 12 months from the decision date. | No per-code cap. I.178 treatment plans run 40 hours/week or less (no PT/OT/ST on top of 40 billed ABA hours); state-regulated plans under Neb. Rev. Stat. § 44-7,106 cap behavioral health treatment incl. ABA at 25 hours/week to age 21. per week | office | No — not on BCBSNE's GP-X-016 telehealth code list ("All other procedure codes are not medically appropriate to be performed via telehealth"). | None published |
| 0362T | Yes, where the benefit plan covers ABA (see notes) | Required — Medical Policy I.178 ("Preauthorization Required") lists this code; submit in NaviNet. Authorization effective 12 months from the decision date. | No per-code cap. I.178 treatment plans run 40 hours/week or less (no PT/OT/ST on top of 40 billed ABA hours); state-regulated plans under Neb. Rev. Stat. § 44-7,106 cap behavioral health treatment incl. ABA at 25 hours/week to age 21. per week | office | No — not on BCBSNE's GP-X-016 telehealth code list ("All other procedure codes are not medically appropriate to be performed via telehealth"). | None published |
| 0373T | Yes, where the benefit plan covers ABA (see notes) | Required — Medical Policy I.178 ("Preauthorization Required") lists this code; submit in NaviNet. Authorization effective 12 months from the decision date. | No per-code cap. I.178 treatment plans run 40 hours/week or less (no PT/OT/ST on top of 40 billed ABA hours); state-regulated plans under Neb. Rev. Stat. § 44-7,106 cap behavioral health treatment incl. ABA at 25 hours/week to age 21. per week | office | No — not on BCBSNE's GP-X-016 telehealth code list ("All other procedure codes are not medically appropriate to be performed via telehealth"). | None published |

Code notes:

- **97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, 0362T, 0373T:** I.178 covers ABA only when a state mandate requires it or the benefit plan explicitly covers it. "Services must be delivered in an office setting or through telehealth"; daycare excluded. Supervision "2 hours per 10 hours of direct treatment." Out-of-state Blue members follow their home plan.

### Contacts

- **Portal:** [NaviNet (BCBSNE preauthorization and precertification)](https://navinet.navimedix.com/plan-central/bcbsnebraska)

Questions to ask on a verification call:

- Is this plan fully insured, self-funded, or an ACA individual/small-group plan? Medical Policy I.178 covers ABA only where the Nebraska mandate applies or the plan explicitly covers ABA.
- Does the benefit plan cover ABA, and is the 25 hr/week mandate cap applied?
- Will ABA be authorized in the home or school? I.178 says services must be delivered in an office setting or through telehealth.
- Does 97155 pay alongside 97153 for the same clock time, and whose NPI should technician time bill under?

### VOB data sources

- https://pverify.com/wp-content/uploads/2026/03/pVerifyPayers_All-Payers-List-3-2026.pdf (accessed 2026-09-27)
- https://www.nebraskablue.com/Providers/Policies-and-Procedures/General/Preauthorization-and-Precertification (accessed 2026-09-27)
- https://medicalpolicy.nebraskablue.com/Policy/32/19 (accessed 2026-09-27)
- https://www.caqh.org/sites/default/files/CAQH%20CORE%20Eligibility%20Benefits%20(270_271)%20Data%20Content%20Rule%20vEB2.0.pdf (accessed 2026-07-23)
- https://www.excellusbcbs.com/prior-authorization (accessed 2026-07-23)
- https://www.nebraskablue.com/-/media/Files/NebraskaBlueDotCom/Providers/Prior-Authorization/Prior_Authorization_List.pdf (accessed 2026-09-27)
- https://www.nebraskablue.com/en/Providers/Policies-and-Procedures/General/Telehealth (accessed 2026-09-27)
- https://nebraskalegislature.gov/laws/statutes.php?statute=44-7,106 (accessed 2026-07-23)

## Common questions

### Does Blue Cross Blue Shield of Nebraska cover ABA therapy?

Under BCBSNE Medical Policy I.178, ABA is covered when the Nebraska autism mandate applies or the member's benefit plan explicitly covers ABA, with preauthorization. The mandate reaches state-regulated plans for children under 21 but not ACA individual or small-group plans, and self-funded groups follow their plan documents — so check the plan first.

### Does BCBS Nebraska allow ABA by telehealth?

Only for 97151, 97155 and 97156, billed with POS 02 or 10 and modifier 95. BCBSNE considers all other codes, including 97153, not appropriate for telehealth. I.178 limits ABA to an office setting or telehealth.

### Does the 25-hour cap apply to every BCBS Nebraska member?

No. It comes from the state mandate, which covers state-regulated plans. ACA individual and small-group plans are outside the mandate, and self-funded groups follow their plan documents. I.178 itself caps treatment plans at 40 hours a week.

### Does this guide cover Nebraska Medicaid members?

No. Nebraska Medicaid ABA runs through the Heritage Health MCOs and has its own guides in this directory, with different criteria and rates.

## Primary sources

1. [BCBSNE Medical Policy I.178 — Autism Spectrum Disorders (MedPolicy Blue)](https://medicalpolicy.nebraskablue.com/Policy/32/19)
2. [BCBSNE — Prior Authorization List (current as of 8/14/2026)](https://www.nebraskablue.com/-/media/Files/NebraskaBlueDotCom/Providers/Prior-Authorization/Prior_Authorization_List.pdf)
3. [BCBSNE Policy GP-X-014 — Preauthorization and Precertification](https://www.nebraskablue.com/Providers/Policies-and-Procedures/General/Preauthorization-and-Precertification)
4. [BCBSNE Policy GP-X-016 — Telehealth](https://www.nebraskablue.com/en/Providers/Policies-and-Procedures/General/Telehealth)
5. [BCBSNE — Medical Record Standards](https://www.nebraskablue.com/-/media/Files/NebraskaBlueDotCom/Providers/Policies-and-Procedures/Medical_Record_Standards.pdf)
6. [Blue Cross and Blue Shield of Nebraska — provider resources](https://www.nebraskablue.com/en/Providers)
7. [Neb. Rev. Stat. § 44-7,106 (full text)](https://nebraskalegislature.gov/laws/statutes.php?statute=44-7,106)
8. [CMS — Nebraska EHB Benchmark Plan Summary (plan years 2025–2027)](https://www.cms.gov/files/document/ne-bmp-summary-py2025-2027.pdf)
9. [Nebraska LB 77 (2025) — Ensuring Transparency in Prior Authorization Act, slip law](https://nebraskalegislature.gov/FloorDocs/109/PDF/Slip/LB77.pdf)
10. [210 NAC 39 — Nebraska Coordination of Benefits Regulation](https://doi.nebraska.gov/sites/default/files/doc/Chapter%2039.pdf)
11. [NE DHHS Licensure — Behavior Analyst](https://dhhs.ne.gov/licensure/Pages/Behavior-Analyst.aspx)
12. [SFY27 Mental Health & Substance Use Fee Schedule (REVISED edition, republished Sept. 2026)](https://dhhs.ne.gov/Medicaid%20Practitioner%20Fee%20Schedules/REVISED%20MHSUD%20SFY27%20Fee%20Schedule.xlsx)
13. [29 CFR 2560.503-1 — ERISA claims procedure (eCFR)](https://www.ecfr.gov/current/title-29/section-2560.503-1)
14. [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)
15. [32 CFR 199.8 — TRICARE double coverage (eCFR)](https://www.ecfr.gov/current/title-32/subtitle-A/chapter-VII/subchapter-M/part-199/section-199.8)

Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed September 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.