---
title: "Blue Cross & Blue Shield of Mississippi ABA coverage: the intake guide."
url: "https://carelu.com/payers/blue-cross-blue-shield-mississippi"
markdown_url: "https://carelu.com/payers/blue-cross-blue-shield-mississippi.md"
state: MS (Mississippi)
payer: "Blue Cross & Blue Shield of Mississippi"
kind: Commercial insurance
description: "How Blue Cross & Blue Shield of Mississippi covers ABA: medical policy L.8.01.403 with no age limit and no weekly hour cap, no treatment-plan prior authorization since 8/1/2024, the coding policy unit limits, Mississippi’s § 83-9-26 mandate and LBA licensure."
last_reviewed: October 2026
---

# Blue Cross & Blue Shield of Mississippi ABA coverage: the intake guide.

_Payer Guide · Blue Cross & Blue Shield of Mississippi · Last updated October 2026 · 18 primary sources_

> BCBSMS medical policy L.8.01.403: no age limit, no hour cap (from 10/15/2025), no treatment-plan PA (from 8/1/2024); 97151 once per 6 months.

Blue Cross & Blue Shield of Mississippi (BCBSMS) is the state’s Blue Cross plan; its ABA policy names fully insured members, self-funded groups, State Health Plan (state and school employee) participants and FEP members. Its ABA rules sit in medical policy L.8.01.403 (Treatment of Autism Spectrum Disorder) and its ABA coding policy. Since 2018 it has applied no age limit, since August 1, 2024 it no longer requires treatment-plan approval for most members, and since October 15, 2025 it has had no weekly hour maximum: treatment is "medically necessary according to the Member’s individualized specific treatment plan."

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: No prior authorization since 8/1/2024 for fully insured, self-funded group and State Health Plan members; the policy still requires a physician or psychologist referral for the ABA assessment, and 97151 is medically necessary once every six months. FEP members remain subject to PA [1]
- **Prior auth for treatment**: No: "submission of the individualized ABA treatment plan for approval by the Company is no longer required" for fully insured and self-funded group members (eff. 8/1/2024); FEP members remain subject to prior authorization [1]
- **Autism diagnosis required?**: Yes: a licensed physician (M.D./D.O.) or licensed psychologist must diagnose ASD meeting all DSM-5 criteria [1]

## At a glance

- **Covers ABA?:** Yes, for ASD, under medical policy L.8.01.403
- **State mandate:** Miss. Code Ann. § 83-9-26 (HB 885, 2015; policies issued or renewed from 1/1/2016)
- **Mandate age:** Statute lets ABA stop at age 8; BCBSMS removed its age limit on 1/15/2018
- **Mandate caps:** Statute allows 25 hours/week; BCBSMS removed its 25-hour maximum on 10/15/2025
- **Exempt from mandate:** Self-funded ERISA plans; non-grandfathered individual and small-group ACA plans; small employers (≤100) must only offer it
- **Licensure:** Mississippi Autism Board license (LBA/LABA); RBTs registered under the supervisor
- **Fee schedule:** Not public — contracted BCBSMS rates; Mississippi Medicaid 97153 is $15.08 per 15 min as a benchmark

## Medical policy L.8.01.403: diagnosis, referral, assessment and treatment

ABA is medically necessary when "A licensed physician (M.D./D.O.) or licensed psychologist has diagnosed the Member with ASD having met all of the following DSM-5 criteria," and "A referral for authorization of ABA assessment must be submitted by a licensed physician (M.D./D.O.) or a licensed psychologist." The behavioral identification assessment (97151) "is considered medically necessary once every six months"; the initial assessment "must be performed within four to six hours and completed within three days," and it must be provided by a BCBA or BCBA-D. Follow-up assessments 97152 and 0362T are each medically necessary up to three hours every six months. The BCBA writes the treatment plan with measurable goals based on standardized autism-specific testing (ABLLS, VB-MAPP or comparable) done within two months of starting, and shares it with the PCP and referring provider. [1]

Treatment (97153, 97154, 97156, 97157, 97158) "is considered medically necessary according to the Member’s individualized specific treatment plan," delivered by a BCBA, BCBA-D, a BCaBA supervised by a BCBA, or "A Licensed Board Certified RBT who is supervised by a BCBA or BCBA-D." Protocol modification (97155) is two hours per 10 hours of therapy; 0373T three hours every two months. Continuation needs an interim reassessment (97151) at least every six months, an order to continue from the physician or psychologist, an updated plan, and standardized testing once a year by a developmental pediatrician, child psychiatrist or child psychologist. The policy history records the age-8 limit and three-year limit removed effective January 15, 2018, the network-provider requirement for diagnosis and referral removed September 10, 2025, and the 25-hour weekly maximum removed October 15, 2025. Effective August 1, 2024, treatment-plan approval "is no longer required" for fully insured, self-funded group and State Health Plan members; FEP members keep PA, no age or visit limits, and a 200-hour annual limit on Blue Focus. [1]

## Coding policy: who bills and the unit limits

BCBSMS’s ABA coding policy says "claims can only be filed by the BCBA or BCBA-D provider"; BCaBA and RBT time is "considered practice expense and is not reported separately." It sets 97151 at no more than once every six months, 97152 and 0362T at a combined six hours every six months, treatment codes at "the medically necessary hours per week (7 days) according to the Member's individualized specific treatment plan," 97155 at two hours per ten hours of therapy and 0373T at three hours every two months. "97155 may be reported concurrently with technician delivered services 97153 when the patient is present" and the BCBA is directing the technician, but when both are present time is counted on a single technician’s face-to-face time. "If any of the reporting criteria is not met or the hours outlined above are exceeded, the services will be denied." [2]

## The Mississippi mandate: what it guarantees

Mississippi’s autism mandate is Miss. Code Ann. § 83-9-26, enacted as HB 885 in 2015. A health insurance policy "shall provide coverage for the screening, diagnosis, and treatment of autism spectrum disorder" for policies delivered, issued or renewed in the state (or outside it if insuring Mississippi residents) on or after January 1, 2016. Treatment means evidence-based care "prescribed or ordered" by a licensed physician or licensed psychologist who finds it medically necessary, and it includes "behavioral health treatment" (behavior modification and counseling programs "including applied behavior analysis"), pharmacy, psychiatric, psychological and therapeutic care. Behavioral health treatment must be "provided or supervised by a licensed behavior mental health professional," and a diagnosis of ASD means assessments "performed by a licensed psychologist or licensed physician." The limits sit in subsection (5): ABA coverage "shall be limited to twenty-five (25) hours per week, and shall not be required beyond the age of eight (8) years," and "no more than ten (10) hours per week shall be for the services of a licensed behavior analyst," with all services "under the supervision or direction of a licensed behavior analyst or licensed psychologist." Those limits can be exceeded under an ongoing treatment plan "if medical necessity for the extension is determined to exist," and otherwise the policy’s appeal rights govern. Dollar limits, deductibles and coinsurance may not be less favorable than for medical and surgical benefits. Except for inpatient care, the insurer may review the treatment plan every six months, at its own cost. Schools’ IEP, IFSP and IDEA obligations are not shifted to insurers. Subsection (8) exempts non-grandfathered individual and small-group plans that carry ACA essential health benefits, and subsection (9) requires small employers with 100 or fewer eligible employees only to offer the coverage (they may charge for it). Self-funded ERISA plans are outside state law. The Insurance Department’s autism page lists Blue Cross & Blue Shield of Mississippi, UnitedHealthcare and Ambetter of Magnolia as having "voluntarily removed all age restrictions" for ABA, and tells families to confirm with their plan. [3][4]

## Licensure, telehealth and out-of-state BCBAs

Mississippi licenses behavior analysts. The BACB’s licensure table lists Mississippi (2015) with the Mississippi Autism Board, which licenses Licensed Behavior Analysts and Licensed Assistant Behavior Analysts under Miss. Code Ann. § 73-75. To be licensed as a behavior analyst a person needs at least a master’s degree, "current and active certification" as a BCBA or BCBA-D, a fingerprint-based state and FBI background check, and the Board’s other requirements, which include an oral examination the Board gives at least quarterly (Rule 3.2); licenses run three years but never past the BACB certification. Assistant behavior analysts need a bachelor’s degree, BCaBA certification and proof of supervision by a licensed behavior analyst. Technicians are not licensed: the supervising licensee registers each Registered Behavior Technician with the Board, the technician "works solely under the license of the behavior analyst," and supervision follows the BACB’s policy (Rule 9). For a BCBA licensed in another state, the statute’s exemption list (§ 73-75-5: licensed psychologists, other licensed professionals within scope, supervised technicians, family members, trainees, school employees) does not include behavior analysts licensed elsewhere, and the Board’s rules contain no telehealth provision, so plan on a Mississippi license before treating a Mississippi patient in person or by telehealth. The route is licensure by reciprocity (Rule 3.4), which still requires meeting the Rule 3.1 and 3.2 requirements; a temporary license exists only for applicants awaiting exam scores or the next oral exam, restricts practice to Mississippi and requires supervision. The autism mandate ties into this: a "licensed behavior analyst" in § 83-9-26 is one licensed under § 73-75-13. [5][6][7][8][9][10]

For state-regulated plans, Miss. Code Ann. § 83-9-351 says "All health insurance and employee benefit plans in this state must provide coverage for telemedicine services to the same extent that the services would be covered if they were provided through in-person consultation," with cost sharing no higher than in person. Telemedicine other than remote monitoring and store-and-forward "must be 'real-time' audio visual capable," and the claim carries the procedure code "with the appropriate modifier indicating interactive communication was used." The section was set to lapse on July 1, 2025; SB 2415 (2025), as sent to the Governor, moves the repeal date to July 1, 2028. Self-funded employer plans are covered only to the extent federal law permits. [5][6][7][8][9][10]

## Payment speed and rates

BCBSMS publishes no ABA rate table. Mississippi’s prompt-pay law, Miss. Code Ann. § 83-9-5(1)(h), requires clean claims to be paid within 25 days of receipt of due written proof for electronic claims and 35 days for paper, with interest of 3% a month after that; a clean claim "requires no further information, adjustment or alteration by the provider." The public benchmark is Mississippi Medicaid’s fee schedule (July 2026 Mississippi Medicaid ASD fee schedule, per 15-minute unit: 97151 $34.18 (no PA), 97152 $41.74, 97153 $15.08, 97154 $9.42, 97155 and 97156 $24.35, 97157 and 97158 $12.17, 0362T $56.64, 0373T $41.49, ages 0–20). [12][18]

## Intake gates

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

- **Age limit**: None in BCBSMS policy: the age-8 limit and three-year treatment limit were removed effective 01/15/2018; FEP has no age restriction. The statute’s age-8 floor matters only if a plan document still carries it. [1][3]
- **Diagnosis recency**: No diagnosis expiry; continuation requires an interim reassessment at least every six months and standardized autism-specific testing once a year. [1]
- **Who may diagnose**: A licensed physician (M.D./D.O.) or licensed psychologist; the network-provider requirement for the diagnosis was removed 9/10/2025. [1]
- **Diagnostic tools required**: DSM-5 criteria for the diagnosis; treatment goals and progress must use standardized autism-specific testing (ABLLS, VB-MAPP or comparable, CPT 96112/96113) with age norms, within two months of starting and yearly. [1]
- **Referral required?**: Yes: "A referral for authorization of ABA assessment must be submitted by a licensed physician (M.D./D.O.) or a licensed psychologist," and continuation needs "an order for continuation of ABA treatment" from that physician or psychologist. [1]
- **Telehealth** _(plan-dependent)_: BCBSMS’s ABA medical and coding policies do not address telehealth. For state-regulated plans, Miss. Code Ann. § 83-9-351 says "All health insurance and employee benefit plans in this state must provide coverage for telemedicine services to the same extent that the services would be covered if they were provided through in-person consultation," with cost sharing no higher than in person. Telemedicine other than remote monitoring and store-and-forward "must be 'real-time' audio visual capable," and the claim carries the procedure code "with the appropriate modifier indicating interactive communication was used." The section was set to lapse on July 1, 2025; SB 2415 (2025), as sent to the Governor, moves the repeal date to July 1, 2028. Self-funded employer plans are covered only to the extent federal law permits. [1][2][9][10]
  - Ask the plan: BCBSMS Provider Services: ask which ABA codes, POS and modifier it pays by telehealth.
- **Prior-auth decision time** _(plan-dependent)_: Treatment-plan approval is no longer required for fully insured, self-funded group and State Health Plan members (from 8/1/2024). Where a BCBSMS plan does require PA (FEP), fully insured rules follow the Mississippi Prior Authorization Reform Act. Fully insured plans fall under the Mississippi Prior Authorization Reform Act (SB 2140, effective July 1, 2024). It applies to health insurance issuers, health benefit plans and private review agents, "with the exception of employee or employer self-insured health benefit plans" under ERISA. A non-urgent decision is due "no later than seven (7) calendar days after obtaining all necessary information," an urgent one "no later than forty-eight (48) hours after receiving all information needed." A missed deadline means the services are "automatically deemed authorized." An approval stays valid for the lesser of six months, the length of treatment set by the clinician, or the plan’s renewal (12 months for chronic-condition treatment). Self-funded employer (ERISA) plans follow 29 CFR 2560.503-1 instead: pre-service decisions "not later than 15 days after receipt of the claim," one 15-day extension, urgent care within 72 hours, and at least 180 days to appeal a denial. [1][11][14]
  - Ask the plan: BCBSMS Provider Services: confirm whether this member’s group requires any ABA authorization.
- **Other insurance (who pays first)** _(plan-dependent)_: Mississippi’s coordination-of-benefits regulation (19 Miss. Admin. Code Pt. 3, R. 7.01) lets insurers file coordination provisions but sets no order-of-benefits rule of its own, so the order for a child on two parents’ plans comes from the plan documents (ask about the birthday rule at verification). The same regulation says "other health plans" for coordination "shall not include … Medicaid," and Medicaid is payer of last resort (42 CFR 433.139), so this plan pays before Mississippi Medicaid or a MississippiCAN plan. TRICARE pays after this plan (10 U.S.C. 1079(i)(1)); CHAMPVA is the last payer (38 CFR 17.270). [13][15][16][17]
  - Ask the plan: Ask BCBSMS at verification for the member’s coordination-of-benefits order and record every other coverage the child has.

## Delivery and billing rules

Coverage decides whether Blue Cross & Blue Shield of Mississippi 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**: BCaBAs and RBTs must be "supervised by a BCBA or BCBA-D"; 97155 protocol modification is medically necessary at two hours per 10 hours of therapy; 0362T and 0373T need documented onsite BCBA supervision. The Autism Board requires a Mississippi-licensed supervisor following BACB supervision policy. [1][2][8]
- **Concurrent billing (97153 + 97155)**: "97155 may be reported concurrently with technician delivered services 97153 when the patient is present, one or more protocols have been identified" and the BCBA is directing the technician; when the BCBA and BCaBA or RBT are both present, time is "based on a single technician's face to face time." [2]
- **Daily limits / MUEs**: No daily or weekly hour cap on treatment since 10/15/2025 (hours per the individualized plan, counted per 7-day week). 97151 once per six months; 97152 and 0362T a combined six hours per six months; 97155 two hours per ten hours of therapy; 0373T three hours every two months. Exceeding these limits means denial. [1][2]
- **Place of service**: BCBSMS removed its exclusion for home-based care and school settings in 2019, while excluding services "primarily academic or educational in nature regardless of setting," respite, shadow and paraprofessional services, and programs public schools must provide (IEP, special education, IDEA, autism classrooms). [1]
- **Bill as provider**: "claims can only be filed by the BCBA or BCBA-D provider"; BCaBA and RBT time "is considered practice expense and is not reported separately." [2]
- **Session-note signature** _(ask the plan)_: BCBSMS’s ABA policies require documented onsite supervision for 0362T and 0373T and specific treatment-plan content, but do not say who signs session notes or when. [1][2]
  - Ask the plan: BCBSMS Provider Services (number on the member card) or your BCBSMS provider agreement.

## What intake should collect for Blue Cross & Blue Shield of Mississippi

- **Group type:** Fully insured, self-funded group, State Health Plan or FEP: FEP members still need prior authorization.
- **Diagnosis by a physician or psychologist:** BCBSMS requires a licensed M.D./D.O. or licensed psychologist to diagnose ASD under DSM-5.
- **Referral / order:** A physician or psychologist referral for the ABA assessment, and an order to continue at each six-month review.
- **Standardized autism-specific testing:** ABLLS, VB-MAPP or comparable, within two months of starting treatment and yearly after.
- **Other insurance:** Record every other coverage; Medicaid pays after BCBSMS.

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

## Common questions

### Does Blue Cross & Blue Shield of Mississippi cover ABA?

Yes, for ASD under medical policy L.8.01.403, with no age limit since 2018 and no weekly hour maximum since October 15, 2025.

### Does BCBSMS require prior authorization for ABA?

Not for fully insured, self-funded group or State Health Plan members since August 1, 2024. FEP members still need prior authorization. A physician or psychologist referral is still required for the assessment.

### Can RBTs bill BCBSMS?

No. Only the BCBA or BCBA-D files claims; BCaBA and RBT time is practice expense, not billed separately.

### Can 97155 and 97153 be billed at the same time with BCBSMS?

Yes, when the patient is present and the BCBA is directing the technician on an identified protocol.

### Does a BCBA need a Mississippi license?

Yes. Mississippi licenses behavior analysts through the Mississippi Autism Board, and its law has no exemption for behavior analysts licensed in other states.

## Primary sources

1. [Blue Cross & Blue Shield of Mississippi — Medical Policy L.8.01.403, Treatment of Autism Spectrum Disorder (ASD) (last updated 03/24/2026)](https://beblue.bcbsms.com/policy-search/medical/policy-detail/treatment-of-autism-spectrum-disorder-asd)
2. [Blue Cross & Blue Shield of Mississippi — Applied Behavioral Analysis (ABA) Coding Policy](https://beblue.bcbsms.com/policy-search/coding/policy-detail/applied-behavioral-analysis-aba-coding-policy)
3. [Miss. Code Ann. § 83-9-26 — Screening, Diagnosis, and Treatment of Autism Spectrum Disorder (Mississippi Insurance Department copy)](https://www.mid.ms.gov/wp-content/uploads/2023/04/MissCodeAnn83-9-26.pdf)
4. [Mississippi Insurance Department — Autism (FAQ on the § 83-9-26 mandate; carriers that voluntarily removed ABA age limits)](https://www.mid.ms.gov/mississippi-insurance-department/healthcare/autism/)
5. [BACB — U.S. Licensure of Behavior Analysts (Mississippi: 2015, MS Autism Board)](https://www.bacb.com/u-s-licensure-of-behavior-analysts/)
6. [Miss. Code Ann. § 73-75-13 — eligibility for licensure as a behavior analyst or assistant behavior analyst (FindLaw)](https://codes.findlaw.com/ms/title-73-professions-and-vocations/ms-code-sect-73-75-13/)
7. [Miss. Code Ann. § 73-75-5 — exemptions from the behavior analyst licensure chapter (FindLaw)](https://codes.findlaw.com/ms/title-73-professions-and-vocations/ms-code-sect-73-75-5/)
8. [Mississippi Autism Board — Title 30 Part 3301, Licensure of Behavior Analysts and Assistant Behavior Analysts (rules final 3/13/2024)](https://www.msautismboard.ms.gov/sites/autism/files/UploadedDocuments/2024/MAB%20R&R%20(Final)%203.13.2024.pdf)
9. [Miss. Code Ann. § 83-9-351 — Telemedicine coverage (FindLaw, current as of Jan. 1, 2025)](https://codes.findlaw.com/ms/title-83-insurance/ms-code-sect-83-9-351/)
10. [Mississippi SB 2415 (2025) — extends the § 83-9-351 telemedicine repealer to July 1, 2028 (as sent to the Governor)](https://billstatus.ls.state.ms.us/documents/2025/dt/SB/2400-2499/SB2415SG.pdf)
11. [Mississippi SB 2140 (2024), "Mississippi Prior Authorization Reform Act" — as sent to the Governor (eff. July 1, 2024)](https://billstatus.ls.state.ms.us/documents/2024/pdf/SB/2100-2199/SB2140SG.pdf)
12. [Miss. Code Ann. § 83-9-5(1)(h) — payment of clean claims (FindLaw, current as of Jan. 1, 2025)](https://codes.findlaw.com/ms/title-83-insurance/ms-code-sect-83-9-5/)
13. [19 Miss. Admin. Code Pt. 3, R. 7.01 — (88-102) Coordinating or Integrating Accident and Health Insurance Benefits (Cornell LII)](https://www.law.cornell.edu/regulations/mississippi/19-Miss-Code-R-SS-3-7-1)
14. [29 CFR 2560.503-1 — ERISA claims procedure (eCFR)](https://www.ecfr.gov/current/title-29/section-2560.503-1)
15. [42 CFR 433.139 — Medicaid third-party liability (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-433/subpart-D/section-433.139)
16. [10 U.S.C. 1079(i)(1) — TRICARE pays after other coverage except Medicaid](https://www.govinfo.gov/content/pkg/USCODE-2023-title10/html/USCODE-2023-title10-subtitleA-partII-chap55-sec1079.htm)
17. [38 CFR 17.270 — CHAMPVA is the last payer](https://www.ecfr.gov/current/title-38/section-17.270)
18. [Mississippi Division of Medicaid — Autism Spectrum Disorder Services Fee Schedule, July 2026 (.xlsx)](https://medicaid.ms.gov/wp-content/uploads/2026/07/ASD-FEE_SHEDULE-JULY-2026-fnl.xlsx)

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.