Blue Cross and Blue Shield of Louisiana, now branded Louisiana Blue, is the state’s dominant commercial carrier, with HMO Louisiana as its subsidiary. Since January 1, 2026 it manages behavioral health authorizations, including ABA, itself; Lucet no longer does. Its ABA medical policy, 00816 (current version effective May 1, 2026), applies to every product it administers or underwrites unless a contract says otherwise.
Two Louisiana-specific points stand out: the policy treats ABA for people 21 and older as investigational, and the billing rules use Louisiana’s own credential tiers (LBA, SCABA, registered line technician) rather than BACB titles.
Louisiana Blue’s January 2026 manual: "Authorization is required for Applied Behavioral Analysis services," submitted through the Louisiana Blue Authorizations application in iLinkBlue, and "all reviews and authorizations related to the diagnosis and treatment of autism are handled by Louisiana Blue." Both initial and concurrent requests need the ABA Treatment Request Form; out-of-state providers fax (1-800-363-9170). Policy 00816 asks for standardized outcome measures (Vineland, VB-MAPP or similar), clinical and treatment history, skill, behavior and caregiver goals with graphed baseline data, direct observations in one or more settings, and transition and discharge plans; continued requests add progress data and an explanation of unmet goals. Services are expected to fade over successive authorizations, and "repeated 35-hour authorizations for CPT 97153" are not routinely approved without clear justification. InterQual behavioral health criteria may supplement the review. Non-urgent requests can take up to 15 days (most within five) and urgent ones up to 72 hours.[3][2][1]
Reauthorizations need graphs. Policy 00816’s "Criteria to Continue ABA Services" ask for standardized outcome measures (Vineland, VB-MAPP or another age-appropriate tool) "assessing progress since the prior authorization period," an updated clinical history, skill-acquisition goals with baseline and intervention data, target criteria, a "data-driven rationale for continued services and graphical display of performance over time," behavioral goals with the same "graphical display of performance over time," caregiver-training data with "graphical representation of progress," an explanation of goals not yet met, revised goals after mastery or stagnation, direct observations and a transition and discharge plan. Initial requests need the same elements with a "graphical display of baseline performance."[3][2][1]
Some Louisiana Blue policies "do not cover Autism and some cover with different maximum benefit limitations," and autism benefits "do not apply for some individual policies and may vary for self-funded groups and BlueCard members," so verify benefits in iLinkBlue first.[3][2][1]
Policy 00816 allows ABA entirely at school or in a hybrid with other settings, with limits: registered line technicians "should be trained and certified in ABA therapy and preferably have at least 6 months of experience"; their role "does not include academic instruction or educational services"; school ABA "should generally not exceed 6 hours per day" without clear documentation; and the RLT should be present only during identified high-support periods, supported by interviews with teachers and school staff. The record must show ongoing collaboration with, and training of, school personnel.[1]
The January 2026 behavioral health billing section sets the credential rules. An LBA "Can bill directly" with modifier TG. A SCABA "Cannot bill directly" and is billed "through the supervising LBA" with modifier TF; an RLT with a bachelor’s degree is billed through the supervising LBA with HN, and an RLT without one with no modifier. Missing modifiers can get a claim returned or denied. Concurrent billing is allowed when both services are delivered simultaneously and the record says so: 97155 with 97153 (technician face-to-face, 97155 directing the technician) and 97155 with 97154. Claims with a primary autism diagnosis count toward the member’s autism maximum. Claims must be filed within 15 months of service, or the period in the member’s contract. A claim Louisiana Blue returns for more information must be resubmitted "within 90 days or before the timely filing period expires, whichever is later," and a paper claim should not be stamped "Corrected Copy," because the scanners drop stamped text.[4][5]
Louisiana’s autism mandate is La. R.S. 22:1050. Any "health coverage plan" issued, delivered or renewed in the state on or after January 1, 2014 must "provide coverage for the diagnosis and treatment of autism spectrum disorders in individuals less than twenty-one years of age," and the definition of a health coverage plan reaches insurance policies, HMO and PPO contracts, group plans and the Office of Group Benefits programs (state employees). Treatment includes habilitative care, defined to include applied behavior analysis, plus pharmacy, psychiatric, psychological and therapy care, but only care "prescribed, provided, or ordered" by "a physician or psychologist who shall be licensed in this state and who shall supervise provision of such care." Coverage may not be limited by visit count and may carry ordinary copays and deductibles, but it "shall be subject to a maximum benefit of thirty-six thousand dollars per year," and payments for unrelated care do not count toward that cap. An ABA provider must be BACB-certified or able to document equivalent education, training and supervised experience. Plans may review treatment against medical-necessity criteria "based in part on evidence of continued improvement," with appeal rights under R.S. 22:1121 et seq. The statute does not apply to individually underwritten guaranteed-renewable policies or limited-benefit policies, and self-funded employer plans answer to ERISA rather than state insurance law. legis.la.gov notes its text is current through the 2025 First Extraordinary Session.[6]
Louisiana licenses behavior analysts (La. R.S. 37:3701 et seq.; the BACB lists Louisiana’s law as enacted in 2013). The Louisiana Behavior Analyst Board issues three credentials: the licensed behavior analyst (LBA, master’s degree plus a nationally accredited exam and a Louisiana jurisprudence exam), the state-certified assistant behavior analyst (SCABA, bachelor’s level, practicing under an LBA), and the registered line technician (RLT, 18 or older with a high school diploma, registered with the board by the supervising LBA and renewed every year). It is a misdemeanor for anyone not licensed, certified or registered "to engage in the practice of behavior analysis," and to "employ as a line technician, a line technician who is not registered." Licensed psychologists may provide ABA within their training. Out-of-state BCBAs: BACB certification alone does not authorize practice in Louisiana. The board may make rules for temporary licensure and for reciprocity from states with standards "at least as stringent," and the Telehealth Access Act (R.S. 40:1223.4) requires each licensing board to provide by rule for "Licensing or registration of out-of-state healthcare providers who seek to furnish healthcare services via telehealth to persons at originating sites in Louisiana." We could not open the board’s own rules (its website is behind a captcha), so confirm the current telehealth or temporary-licensure route with the board before a remote BCBA treats a Louisiana child. The chapter is scheduled to terminate on July 1, 2028 unless the legislature extends it. On rates: commercial ABA rates are negotiated and unpublished; the public benchmark is the Louisiana Medicaid fee schedule (97153 $12.50 and 97155 $22.50 per 15 minutes), which Medicaid MCOs must pay at least.[7][8][9][10][11][12][13][14][19][20][16][17]
Louisiana’s prompt-pay law covers contracted providers of fully insured plans: an electronic clean claim "shall be paid, denied, or pended not more than twenty-five days" after receipt (R.S. 22:1833), a paper clean claim filed within 45 days of service within 45 days (60 days if filed later or resubmitted) (R.S. 22:1832), and a late payment carries "a late payment adjustment equal to twelve percent per annum." An issuer may elect a single 30-day standard by notice to the commissioner, and it gets the same window to audit a paid claim that it gives you to file one. These sections do not apply to the Office of Group Benefits, and self-funded ERISA plans are outside them.[7][8][9][10][11][12][13][14][19][20][16][17]
Louisiana Blue’s BlueCard Program Provider Manual (January 2026): "you can submit claims for Blue members visiting you from other areas directly to Louisiana Blue. We are your sole contact for all BCBS claims submissions, payments, adjustments, services and inquiries." BlueCard "applies to all inpatient, outpatient and professional claims," with PPO, POS and HMO products included. Section 5.6 warns that autism benefits "may vary for self-funded groups and BlueCard® members," so verify the home plan’s ABA benefit first.[26][27]
Authorizations follow the member’s own plan. In iLinkBlue, enter the member’s prefix under "Authorizations - Out of Area Members" and the router "electronically routes the user to the member’s Blue Plan to retrieve the general medical policy, prior authorization or prior certification information," with pre-service review through Electronic Provider Access. An out-of-state provider treating a Louisiana Blue member works the other way round: it signs in to its own local Blue plan’s portal and "will be routed to iLinkBlue through a BCBS Association router," and files the claim with its local plan. For Louisiana Blue members, "all reviews and authorizations related to the diagnosis and treatment of autism are handled by Louisiana Blue."[26][27]
The questions that decide whether a family can start with Blue Cross and Blue Shield of Louisiana (Louisiana Blue), and what they have to bring. Each maps onto something intake should ask on the first call.
The policy names outcome measures, not diagnostic instruments: "Standardized outcome measures (e.g., Vineland, VB MAPP, or other age-appropriate assessments)" at initiation and each continuation.[1]
Louisiana Blue requires authorization with its ABA Treatment Request Form, not a referral; the authorization records a "Referred By" and "Referred To" provider, which can be the same. Louisiana Blue publishes no separate ABA order form or validity period. On the claim, Section 5.30 requires the ordering/referring provider’s name and NPI (CMS-1500 block 17B) only for diagnostic radiology centers, DME suppliers, infusion therapy, laboratories, sleep labs and specialty pharmacy; ABA is not on that list. For a fully insured Louisiana plan, R.S. 22:1050(G)(11) covers autism treatment "prescribed, provided, or ordered" by "a physician or psychologist who shall be licensed in this state and who shall supervise provision of such care," so keep that order on file. Self-funded ERISA plans sit outside the statute.[2][1][6][28]
Section 5.37 of the Professional Provider Office Manual (current as of January 2026) lists all ABA codes, 97151 through 97158, as direct-to-consumer telehealth codes that "may be billed as audiovisual telehealth services only." Bill modifier GT or 95 and place of service 10 for telehealth from the provider’s own platform; Louisiana Blue "does not consider place of service 02 valid" and such claims may reject. Services must be within "the scope of an individual provider’s license," the provider needs verbal or written consent, and the section’s list of provider types whose telehealth it supports (physicians, PAs, APRNs and midwives, chiropractors, podiatrists, medical psychologists, social workers, psychologists, LPCs, dietitians, occupational, speech and physical therapists) does not name behavior analysts, while the same section says "Telehealth services rendered by provider types not authorized by Louisiana Blue are not eligible for reimbursement." Get written confirmation from Louisiana Blue (provider.relations@lablue.com) that an LBA-rendered ABA telehealth claim will pay before relying on it. The attending provider "must be licensed to practice in the state where the member is located." The member’s contract must carry telehealth benefits (check iLinkBlue). For a fully insured Louisiana plan, R.S. 22:1821(F)(2) makes services by telehealth subject to the insurer’s "utilization review criteria and requirements" and voids policy terminology "that either discriminates against or prohibits" telehealth. The clinician still needs Louisiana authority to practice: the behavior analyst licensing law applies, and R.S. 40:1223.4 tells each board to license or register out-of-state providers serving patients located in Louisiana. Self-funded employer plans are outside the state insurance statute.[4][15][13][29]
"For nonurgent services, Louisiana Blue has up to 15 days to complete but will be completed as soon as possible. Most are completed within five days." Urgent cases: up to 72 hours, most within 24.[2]
Policy 00816 considers ABA for "individuals who are 21 years of age and older with autism spectrum disorder to be investigational." For a fully insured Louisiana plan, R.S. 22:1050 requires autism coverage for individuals "less than twenty-one years of age," subject to "a maximum benefit of thirty-six thousand dollars per year." Self-funded ERISA plans, individually underwritten guaranteed-renewable policies and limited-benefit policies are outside the statute.[1][6]
Ask the plan: iLinkBlue coverage check: confirm the member’s autism benefit, age terms and annual maximum.
For a child on two plans, ask both carriers for the order of benefits; Louisiana’s commissioner sets the order by regulation (R.S. 22:1836(B)), which we did not read. What the statute does say: no plan may call itself "always excess" or "always secondary" outside those rules, a plan may not reduce benefits because the child could have enrolled in another plan, and a plan may not "pend, delay, or deny payment" to a provider "solely on the basis of the insured’s failure" to report other coverage (a contracted provider must pass along any coordination-of-benefits information it gets). If the child also has Louisiana Medicaid, the commercial plan pays first: Medicaid is payer of last resort (42 CFR 433.139), and since November 2025 the Medicaid plans hold ABA authorizations as pending until you send the primary insurer’s determination. TRICARE pays after this plan (10 U.S.C. 1079(i)(1)); CHAMPVA is the last payer (38 CFR 17.270).[18][22][30][23][24]
Ask the plan: Check coverage in iLinkBlue and ask Louisiana Blue for the coordination-of-benefits order; record all other coverage.
Policy 00816 sets no recency rule for the diagnosis.[1]
Ask the plan: Louisiana Blue ABA Utilization Review Department, 1-800-821-2745.
Coverage decides whether Blue Cross and Blue Shield of Louisiana (Louisiana Blue) pays. These decide whether the claim survives: how sessions must be staffed and supervised, what may be billed concurrently, the per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.
Louisiana Blue publishes no numeric ratio. SCABAs and RLTs "Cannot bill directly" and are billed through the supervising LBA, and the school rules expect RLTs to be trained and certified in ABA, preferably with 6 months’ experience. State law requires RLTs to be registered by their supervising LBA.[4][1][9]
"Concurrent billing will be allowed as follows when both services are administered simultaneously": 97155 with 97153 (technician face-to-face, 97155 directing the technician for protocol modification) and 97155 with 97154. The record must show both were simultaneous.[4]
No daily unit cap is published, but school-setting ABA "should generally not exceed 6 hours per day," and consecutive authorizations at the highest intensity (for example repeated 35-hour 97153 authorizations) are not routinely approved. Claims with a primary autism diagnosis count toward the member’s autism maximum.[1][4]
School is allowed (entirely or hybrid) under policy 00816’s school criteria: RLT present only in high-support periods, no academic instruction, generally no more than 6 hours a day, documented collaboration with school staff. Other settings follow the authorization.[1]
LBA bills directly with modifier TG; SCABA services are billed through the supervising LBA with TF; RLT services through the supervising LBA with HN (bachelor’s degree) or no modifier (no bachelor’s).[4]
Not addressed in policy 00816 or the manual sections read, beyond requiring the record to show simultaneous delivery when concurrent codes are billed.[1][4]
Ask the plan: Louisiana Blue provider manual documentation standards or the ABA Utilization Review Department, 1-800-821-2745.
Yes. Policy 00816’s continuation criteria ask for graphical display of performance over time for skill and behavior goals and graphical representation of caregiver-training progress, along with standardized outcome measures since the last authorization.
Its telehealth section lists 97151–97158 as audio-video telehealth codes (POS 10, modifier GT or 95), but its list of provider types approved for telehealth does not name behavior analysts and says services by provider types it has not authorized are not paid. Get written confirmation before billing ABA telehealth.
No. Since January 1, 2026 Louisiana Blue manages behavioral health authorizations, including ABA, itself. Submit through the Louisiana Blue Authorizations application in iLinkBlue.
Its policy 00816 treats ABA for people 21 and older with autism as investigational, and the state mandate covers under-21s only.
Through the supervising LBA: SCABA with modifier TF, RLT with a bachelor’s degree with HN, RLT without one with no modifier. The LBA bills directly with TG.
Yes, under policy 00816’s limits: the technician is there for identified high-support periods, does no academic teaching, and school ABA generally stays under 6 hours a day.
A Louisiana Blue network provider files claims for other Blue plans’ members with Louisiana Blue, which routes them to the member’s home plan; authorization comes from the home plan, reached through iLinkBlue by entering the member’s prefix. An out-of-state provider treating a Louisiana Blue member files with its own local Blue plan and reaches Louisiana Blue’s authorization rules through that plan’s portal. Autism benefits can differ for BlueCard and self-funded members, so check them first.
Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed October 2026; it is general information, not billing, legal, or clinical advice. Always verify current requirements against the payer's live policy and a benefits check for the specific member.
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