Blue Cross and Blue Shield of Montana (BCBSMT) is Montana’s Blue plan and a division of Health Care Service Corporation. Its ABA program is more generous than Montana’s mandate: since January 1, 2021 BCBSMT says ABA for autism "is now covered as standard claims administration subject to copays, coinsurance and deductible without age, dollar or visit limits," on fully insured plans, the Federal Employee Program and ASO plans, though ASO (self-funded) groups "may request to ‘opt out’ of ABA coverage."
The mechanics run through BCBSMT’s own Behavioral Health team: an ABA Initial Assessment Request, then the ABA Clinical Service Request Form for treatment and each concurrent review, with medical necessity judged on MCG care guidelines. The forms carry the details that most often trip up intake: a diagnosis no older than 36 months, an assessment within the last 30 days, and an active license in the state where the child is treated.
BCBSMT asks providers to "notify" it of every ABA request. The initial process confirms that the member "has a confirmed autism diagnosis by an appropriate diagnostician," that the provider is qualified, that the member has ABA benefits, and that "the initial treatment plan meets medical necessity," using the ABA Clinical Service Request Form and the ABA Initial Assessment Request. The 2026 behavioral health PA code list (updated July 2026) names 97153, 97154, 97155, 97156, 97157, 97158, 0362T and 0373T; 97151 and 97152 are not on it, but the Initial Assessment Request asks for them and should be sent "at least two weeks before requested start date" and "received within 30 days of the start date of your assessment."[1][5][6][7][10][4]
For treatment, the Clinical Service Request goes in "at least two weeks before requested start date" and "can be submitted up to 60 days prior"; a form submitted after the start date sends the claim through BCBSMT’s normal process with instructions to follow. An initial request needs the diagnostic evaluation report, baseline and skills assessment results and a comprehensive treatment plan; a concurrent request needs a skills reassessment and updated plan. A reassessment package "will be authorized every 6 months." A claim submitted without the initial or concurrent authorization is denied and may need a retroactive review. Medical necessity is judged on MCG care guidelines and BCBSMT medical policies, which are licensed and not public.[1][5][6][7][10][4]
BCBSMT’s Clinical Service Request sets line-staff rules for 1:1 therapy: 18 or older, a high school diploma or GED, a criminal background check before working, 40 hours of training in ASD and evidence-based behavioral techniques, and "on-going supervisory oversight by the BCBA or ABA treatment supervisor for a minimum of 5% of hours directly worked with members." The supervisor attests to following BACB supervision guidelines and to having "an active license in the state where this member’s services are rendered." Training time is not billable.[7][8]
Supervision by telehealth needs its own approval: the ABA Supervision via Telehealth Request & Attestation asks whether the member is in a rural Health Professional Shortage Area or otherwise meets BCBSMT’s telehealth supervision standards, requires written member consent, and commits the provider to make "the functional assessment every six months to be ‘face to face.’"[7][8]
Montana’s autism mandate is MCA 33-22-515, enacted in 2009. It reaches "each group disability policy, certificate of insurance, or membership contract" delivered, issued, renewed, extended or modified in Montana, and requires "coverage for diagnosis and treatment of autism spectrum disorders for a covered child 18 years of age or younger." Health service corporations (MCA 33-30-102 applies chapter 22 to them) and HMOs (MCA 33-31-111 lists 33-22-515 among the provisions that bind them) are covered too. The covered diagnoses are written in older DSM terms: autistic disorder, Asperger’s disorder, or pervasive developmental disorder not otherwise specified, "as defined by the most recent edition" of the DSM. Habilitative and rehabilitative care "includes medically necessary interactive therapies derived from evidence-based research, including applied behavior analysis," and it must be "prescribed, provided, or ordered by a licensed physician or licensed psychologist." ABA under the statute "must be provided by an individual who is licensed by the behavior analyst certification board or is certified by the department of public health and human services as a family support specialist with an autism endorsement." The statute lets a plan cap the benefit: coverage "may be limited to a maximum benefit of" $50,000 a year for a child 8 or younger and $20,000 a year from 9 through 18. Ordinary deductibles, coinsurance and copays may apply, but special cost sharing for autism care may not. When treatment is ongoing, the insurer "may request that the treating physician provide a treatment plan" (diagnosis, treatment by type and frequency, anticipated duration and outcomes, and why it is medically necessary) and may ask for an update "every 6 months." The section also binds the state and university employee plans, local-government employee plans and non-ERISA self-funded MEWAs. Two gaps matter at intake: the text speaks only of group coverage, and ERISA self-funded employer plans sit outside state insurance law altogether.[13][14][15]
Montana licenses behavior analysts. Since 2017 (Ch. 425, L. 2017), MCA Title 37, chapter 17, part 4 has the Board of Psychologists license behavior analysts and assistant behavior analysts; the BACB’s licensure table lists Montana (2017, MT Board of Psychologists). "An individual may not represent to the public that the individual is an assistant behavior analyst or a behavior analyst without a license," and a license requires current BACB certification at the matching level (BCBA or BCaBA), a fingerprint background check and the Board’s coursework rules (MCA 37-17-403). A behavior technician supervised by a licensed behavior analyst does not need a license, and neither do school district staff, licensed psychologists and those acting under their authority, licensed clinical professional counselors, licensed social workers and family support specialists with an autism endorsement (MCA 37-17-404). A BCaBA or technician must be supervised by a licensed behavior analyst or by a licensed psychologist board-certified by ABPP in behavioral and cognitive psychology (MCA 37-17-405). For telehealth, MCA 37-2-305 lets "a person licensed under this title" treat by telehealth when it is appropriate and meets the standard of care; it creates no registration for providers licensed only in another state. So a BCBA licensed elsewhere should plan on a Montana license before treating a child located in Montana, including by video. Commercial ABA rates are negotiated and unpublished; the public benchmark is the Montana Medicaid ABA fee schedule (July 1, 2025: 97153 $11.36 and 97155 $20.46 per 15-minute unit).[32][21][22][23][24][25][33][29]
Montana’s prompt-pay statute, MCA 33-18-232, says an insurer "shall pay or deny a claim within 30 days after receipt of a proof of loss" unless it makes a reasonable request for more information, and then within 60 days. A late insurer owes the claim "plus 10% annual interest" from the date it was due (interest under $5 is not payable). The statute governs insurers; a self-funded ERISA plan follows its own plan document and federal claims rules. Timely filing limits are set by each carrier’s contract, not by Montana statute.[17][12][29]
BCBSMT’s professional claims go on the CMS-1500 or electronically through Availity. Its Medical Provider Manual, which "explains the process to submit claims" and the payment process, and its Coding and Compensation Policies are published only inside Availity’s Payer Spaces, so the timely filing limit and ABA coding rules have to be read there. Rates are contracted and unpublished; the public Montana benchmark is Montana Medicaid’s ABA schedule (97153 $11.36 per 15 minutes, July 2025).[17][12][29]
The questions that decide whether a family can start with Blue Cross and Blue Shield of Montana, and what they have to bring. Each maps onto something intake should ask on the first call.
"Current diagnostic required not older than 36 months," and the current skills assessment "must be within the last 30 days."[7][6]
An "appropriate diagnostician." The forms accept a PCP (family practice, internal medicine, pediatrics) or a specialized ASD-diagnosing provider (developmental-behavioral or neurodevelopmental pediatrics, child neurology, adult or child psychiatry, licensed clinical psychology, or other specified).[1][7]
No diagnostic instrument is named. For treatment, choose one recognized instrument for the whole episode "such as the VB MAPP, ABLLS, AFLS, ABAS or the Vineland."[7]
No separate referral is required, but the Clinical Service Request has the diagnostic practitioner (or the ABA supervisor after confirming with the diagnostician) certify that they are "recommending ABA services." For a fully insured Montana group plan, MCA 33-22-515 covers ABA "prescribed, provided, or ordered by a licensed physician or licensed psychologist," and lets the insurer ask the treating physician for a treatment plan, updated every 6 months. Self-funded ERISA plans sit outside the statute.[7][13]
None in BCBSMT’s ABA benefit since 1/1/2021 ("without age, dollar or visit limits"), though ASO groups may opt out of ABA altogether. For fully insured Montana group plans, MCA 33-22-515 requires coverage "for a covered child 18 years of age or younger" and lets the plan cap the autism benefit at $50,000 a year through age 8 and $20,000 a year from 9 through 18. Self-funded ERISA plans and individual policies are outside the statute’s text, so funding type and plan type decide whether that binds.[1][13]
Ask the plan: BCBSMT BH Call Center, 1-855-313-8909 (FEP 1-877-885-3751), or Availity: confirm ABA benefits, especially on ASO plans.
ABA supervision by telehealth needs BCBSMT’s Supervision via Telehealth Request & Attestation (rural HPSA or BCBSMT’s telehealth supervision standards, written consent, face-to-face functional assessment every six months). BCBSMT’s Telemedicine Coding and Compensation Policy and covered-code list are in Availity. For state-regulated plans, MCA 33-22-138 requires telehealth coverage equivalent to in-person care; self-funded groups set their own rules.[8][11][16]
Blocked on: BCBSMT Telemedicine Coding and Compensation Policy in Availity, or the BH Call Center, 1-855-313-8909: ask which ABA codes BCBSMT pays by telehealth beyond supervision.
Depends on how the plan is funded. Fully insured Montana plans fall under MCA 33-32-211: for a prospective (prior-authorization) review the insurer must decide and notify "not later than 7 business days after the date the health insurance issuer receives the request" or after it receives all necessary information, with one extension of up to 7 business days for matters beyond its control; a request that fails the filing procedure must be flagged within 3 days. Urgent care requests are decided within 48 hours (MCA 33-32-212). A reduction or termination of an approved course of treatment before it ends is an adverse determination that must be noticed in advance, and the service continues pending the internal review. Once approved, a certification "is valid for at least 6 months," and 12 months for treatment of a chronic condition (MCA 33-32-107). 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," with one 15-day extension. BCBSMT asks for ABA forms at least two weeks before the requested start date and mails a prior-authorization letter to the member and provider.[19][20][18][26][1][7]
Ask the plan: BCBSMT BH Call Center, 1-855-313-8909: confirm whether the plan is fully insured or ASO and the expected decision time.
If the child also has Montana Medicaid, the commercial plan pays first: Montana Healthcare Programs requires providers to "bill other insurance carriers before billing Montana Healthcare Programs" in most cases, and Medicaid is the payer of last resort under 42 CFR 433.139. If the other insurer has not responded in 90 days, Medicaid can be billed with proof the claim was sent. When a child is on two commercial plans, the order of benefits comes from Montana’s coordination-of-benefits rules for state-regulated plans and from the plan document for self-funded plans; we could not open the Montana rule text this run (rules.mt.gov returned a captcha), so get the order from the carrier.[27][28]
Ask the plan: Ask BCBSMT at benefits verification for the member’s coordination-of-benefits order, and record every other coverage the child has.
Coverage decides whether Blue Cross and Blue Shield of Montana 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.
Line staff need "on-going supervisory oversight by the BCBA or ABA treatment supervisor for a minimum of 5% of hours directly worked with members," and the supervisor attests to following BACB supervision guidelines with an active license in the state of service. Montana law: a licensed behavior analyst or ABPP-certified behavioral psychologist supervises BCaBAs and technicians (MCA 37-17-405).[7][23]
BCBSMT says ABA has been covered "without age, dollar or visit limits" since 1/1/2021; hours are requested per week (focused or comprehensive) and set by authorization. No per-day unit limit is published outside Availity.[1][7]
The request form schedules ABA by location (office/clinic, home, community/daycare, school, other) and asks for clinical justification for "services rendered at a location other than office or home." Telehealth supervision needs a separate approved attestation.[7][8]
The forms name a "Rendering Qualified Healthcare Provider (QHP)," a master’s or PhD-level clinician or state-recognized credential with a license or certification number, and the QHP certifies that the line therapists "for whom I, or an outpatient mental health agency or clinic, will bill" meet BCBSMT’s staff requirements. Whether technician time is billed under the QHP’s NPI is not stated publicly.[7][6]
Blocked on: BCBSMT Network Management or the Coding and Compensation Policies in Availity: confirm the rendering NPI for technician-delivered 97153.
Not stated in BCBSMT’s public ABA documents; its coding and compensation policies are published only in Availity.[1][12]
Blocked on: BCBSMT Coding and Compensation Policies in Availity Payer Spaces (Plan Documents Viewer), or the BH Call Center, 1-855-313-8909.
Not stated in BCBSMT’s public ABA documents.[7]
Blocked on: BCBSMT Medical Provider Manual in Availity Payer Spaces, or Network Management.
BCBSMT’s edition of the BlueCard Program Provider Manual (June 2026): a Montana provider files claims for patients from other Blue plans "to BCBSMT," which routes them to the member’s plan. Pre-service rules come from the member’s plan, and the manual tells providers to remind patients that they "are responsible for obtaining pre-certification/preauthorization for out-patient services from their BCBS Plan." Check them on the out-of-area Medical Policy and Pre-Authorization/Pre-Certification Router using the member’s three-character prefix, or call BlueCard Eligibility at 800-676-BLUE (2583) and ask for the precertification area, which offers a behavioral health option. For BCBSMT’s own members, call 800-447-7828 or use Availity, and BCBSMT’s ABA forms and PA code list apply.
Yes, for autism spectrum disorder. BCBSMT says it has covered ABA without age, dollar or visit limits since January 1, 2021 on fully insured, FEP and ASO plans, though ASO groups can opt out.
97151 and 97152 are not on its 2026 PA code list, but BCBSMT asks for an ABA Initial Assessment Request two weeks before the assessment. Treatment codes need prior authorization on the Clinical Service Request Form.
Not older than 36 months, and the skills assessment must be within the last 30 days.
At least 5% of the hours a line therapist works directly with members, by the BCBA or ABA treatment supervisor, who must hold an active license in the state where services are delivered.
BCBSMT requires the supervisor’s active license in the state where services are rendered, and Montana licenses behavior analysts, so a Montana license is needed.
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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