Blue Cross Blue Shield of Wyoming is the state’s home Blue and the card intake teams see most. For ABA, three layers stack: BCBSWY’s own medical policy and authorization rules, Wyoming’s parity-based autism coverage (Bulletin 01-2019, since Wyoming has no autism statute), and the plan’s funding type, which decides whether the bulletin applies at all.
BCBSWY publishes its medical policies through a Highmark-hosted search; its ABA policy is 15.01.002 (Applied Behavioral Analysis, effective June 16, 2025, applying to all commercial lines). Everything below comes from that policy, BCBSWY’s provider manual and website, and Wyoming law.
BCBSWY does not publish a list of ABA codes needing authorization. Its prior-authorization page says to check requirements in Availity: "The Authorization Pre-Check tool allows you to determine if a prior authorization is required for a member upfront … you will get a yes or no answer." Requests go through Availity’s Authorization Tool (under Patient Registration) or on the prior authorization request form by fax to 307-432-2917, with medical records attached. BCBSWY reviews against its medical policies and decides "Non-urgent prior authorization requests … within 5 calendar days from date of receipt" and urgent ones "within 72 hours from date of receipt"; ask Provider Support (888-359-6592) if no decision arrives in that time. BCBSWY only treats a request as urgent when delay would threaten life or limb or leave severe pain unmanaged; note that Wyoming’s prior-authorization statute defines urgent services to "include mental and behavioral health care services."[3][2][8]
Federal Employee Program members follow a separate path: the manual lists "Applied Behavioral Analysis" among the services authorized by FEP case management at 1-800-210-7257, and FEP does not permit retroactive authorizations. Denied authorizations can be appealed in writing "up to 180 days from the date of the denial notice," with no required form. When BCBSWY is the secondary payer, secondary authorization is required for most member prefixes; check the manual’s prefix table.[3][2][8]
BCBSWY medical policy 15.01.002, Applied Behavioral Analysis (issued January 1, 2017; last revision April 2025; effective June 16, 2025; applies to "all commercial lines of business"), calls ABA "medically necessary for treatment of Autism Spectrum Disorder (ASD) as defined by the current version of" the DSM, subject to the member’s benefit plan. Initial authorization requires all of: (1) an ASD diagnosis "documented as a current diagnosis by a licensed psychiatrist or psychologist or pediatrician or neurologist or family practice with special training in treatment of Autism Spectrum Disorder," where current means "the member must have been seen within the past year for treatment of the disorder or as determined as appropriate by a Medical Director"; (2) a Functional Behavioral Assessment completed by one of those clinicians or a BCBA "within the past twelve months"; (3) an individual treatment plan with specific goals, "Measurable goals that are objective in nature and measurable based on a standardized assessment that is completed on a regularly documented basis by a licensed psychologist or psychiatrist" (the standardized assessment "must include a baseline measurement, progress to date, and anticipated timeline"), the types of therapy used in sessions, and the location of each visit and the licensure or certification of the person performing it; and (4) documentation that everyone providing ABA is licensed or certified, with copies of certifications for anyone who is not a licensed psychologist or psychiatrist. "Registered Behavior Technicians are benefited if certified by BACB."[1]
Continuing authorization requires that the child still meets every initial criterion, that the treatment plan has been updated as therapy progressed, and documentation of "Standardized testing results that were documented in the initial treatment plan as the source of measurement for the goals outlined," an interpretation of those results "demonstrating the progression to date," and an updated plan "documenting new anticipated timelines for previously outlined goals, presentation of new goals, and description of retired goals." The policy does not name graphs; it asks for standardized test results and their interpretation. Not a benefit: goals for academic work or tutoring, services to create or fulfill an IEP, "Services rendered in a school setting," and accompanying the child to outside activities unless the child has shown significant behavioral difficulty in that activity. Art, music, dance, pet, vision, sensory or auditory integration, nutrition and similar therapies are not medically necessary as ABA. The policy sets no age limit, unit cap or supervision ratio, and names no diagnostic instrument. Its listed place of service is "Inpatient/Outpatient."[1]
Wyoming has no autism insurance statute, and intake should say so plainly. The state’s autism coverage comes from mental-health parity. W.S. 26-20-701 (the Mental Health and Substance Use Disorder Insurance Parity Act, House Enrolled Act 89, signed February 27, 2019) requires individual and group health insurance policies, nonprofit service contracts and HMO contracts to meet the federal Mental Health Parity and Addiction Equity Act. On April 19, 2019 the Insurance Department issued Bulletin No. 01-2019 applying it to autism: "treatments for Autism Spectrum Disorder cannot be excluded from the mental health services in an insurance policy," for "all individual and group health insurance policies that offer mental health benefits and are under the jurisdiction of the Department," effective "no later than July 1, 2019." Three lines matter most for ABA. "Exclusion of Applied Behavior Analysis (ABA) therapy to treat children with autism spectrum disorder on the basis that ABA therapy is experimental or investigational treatment will not be allowed." Autism benefits "may not be subject to any separate cost-sharing requirements or treatment limitation that only apply to mental health/substance use disorder benefits," and any quantitative or non-quantitative limit (including preauthorization and medical-necessity rules) must match what applies to medical/surgical benefits in the same classification. And carriers may still review medical necessity, including periodic review of continuing treatment, if the review is no more stringent than for medical/surgical care. The bulletin defines treatment as "evidence-based care and related equipment prescribed or ordered for an individual diagnosed with an autism spectrum disorder by a licensed physician or a licensed psychologist who determines the care to be medically necessary, including but not limited to behavioral health treatment." It sets no age limit and no dollar cap. Its limits: a bulletin is weaker than a statute; it reaches only policies that include mental health coverage; and self-funded employer plans regulated by ERISA are outside the Department’s jurisdiction.[6][7][8]
Wyoming licenses behavior analysts. Since 2022 (HB0110, Enrolled Act 18) the State Board of Psychology "shall issue a license as a behavior analyst or an assistant behavior analyst" to an applicant who "holds a current certification as a board certified behavior analyst" (or BCaBA) verified with the certifying entity (W.S. 33-27-124(a)); the Board’s rules name "The BACB" as "the sole certifying entity recognized by the Board" and require BACB verification, license verification from every other state, proof of lawful presence and fingerprint cards (Rules ch. 4, § 4-3). A licensed assistant behavior analyst practices "only under the supervision of a licensed behavior analyst or licensed psychologist" (33-27-124(c)); the Board’s rule requires that supervision to be "at least two percent (2%) of the total behavior-analytic service hours provided per month," with at least one meeting a month (Board Rules ch. 14, § 14-5). Behavior technicians are not licensed: 33-27-125(a)(viii) exempts a technician "under the supervision of a licensed behavior analyst or licensed assistant behavior analyst," who may not design assessment or intervention plans, and (ix) exempts a caregiver working under that analyst’s direction. Representing yourself as a behavior analyst and practicing without a license or an exemption is a misdemeanor (33-27-119(b)). For a BCBA licensed in another state there is no shortcut written down for behavior analysts: 33-27-124(b) lets the Board license someone "currently licensed as a behavior analyst … in good standing in another jurisdiction that has licensure requirements comparable to" Wyoming’s, but that is still a Wyoming license, and the Board’s temporary 30-day license (Rules ch. 3, § 3-1) is written only for psychologists. Payers add their own floor: Wyoming Medicaid says a telehealth provider "must be licensed by, or otherwise under the jurisdiction of, the appropriate State of Wyoming licensing board," and BCBSWY says telemedicine providers "must be licensed in Wyoming." Plan on a Wyoming license for any BCBA treating a Wyoming child, including by telehealth. Credentialing has a state clock: under W.S. 26-56-102 a carrier must acknowledge an application within 7 calendar days, flag an incomplete one within 30, and "conclude the process of credentialing … within sixty (60) calendar days," and once you are credentialed with a contract in effect it must pay covered services "beginning with the date the health carrier received a completed credentialing application." Commercial ABA rates are negotiated and unpublished; the only public benchmark is the Wyoming Medicaid fee schedule (97153 $12.30 and 97155 $24.60 per 15-minute unit from July 1, 2026).[10][11][12][13][14][15][16][2][5][8][17]
BCBSWY’s own credentialing page requires "a valid, active license … in the State of Wyoming, as applicable," credentials through CAQH, and re-credentials every three years. Its list of practitioner types to be credentialed does not name behavior analysts but says it is "not limited to" those listed. BCBSWY also states that "Participation with BCBSWY cannot be dated prior to approval of the credentialing application"; W.S. 26-56-102(c) separately requires back-payment to the date of a completed application once you are credentialed with a contract in effect, so keep the date you submitted.[10][11][12][13][14][15][16][2][5][8][17]
Wyoming’s insurance code sets three clocks that apply to fully insured plans. Claims: "Claims for benefits under a life, accident or health insurance policy shall be rejected or accepted and paid by the insurer … within forty-five (45) days after receipt of the proofs of loss and supporting evidence" (W.S. 26-15-124(a)); a court can add attorney’s fees and 10% interest when a refusal to pay is unreasonable. Prior authorization: the Ensuring Transparency in Prior Authorization Act (W.S. 26-55, effective July 1, 2024) requires a decision on a non-urgent request "within five (5) calendar days of obtaining all necessary information" and on an urgent one within 72 hours, after which an urgent request "shall be considered authorized"; it defines urgent services to "include mental and behavioral health care services." Outpatient authorizations must be valid for "not less than one (1) year," an approval cannot be revoked if the service is delivered within 45 business days, a new plan must honor a prior plan’s authorization for at least 90 days, a peer-to-peer must be offered within 5 business days of a denial, and since January 1, 2026 a provider whose requests for a service were at least 90% approved (minimum five requests) in the past 12 months is exempt from PA for that service for a year (26-55-112). Telehealth: a policy covering mental health may not deny coverage for a service "delivered using remote audio or audio-visual delivery systems" if it would cover it in person, may not charge higher cost-sharing, and may not pay the provider less than in person (W.S. 26-20-701(b)). Autism treatment counts as mental health under the Department’s Bulletin 01-2019. Whether a given ABA code is "covered in person" is still the plan’s call, and self-funded ERISA plans sit outside all three statutes.[8][9][6][2]
BCBSWY’s clean-claim policy requires the "Rendering Provider’s (type 1/individual) National Provider Identifier (NPI)" on the claim, with the rendering NPI in box 24j. Telemedicine is billed with modifier 95 or GT and place of service 02. Participating providers accept "the lesser of provider’s charges or the Maximum Allowable Amount, minus any Cost Sharing Amounts." BCBSWY’s manual does not print a timely-filing limit in the sections read; your contract sets it.[8][9][6][2]
The questions that decide whether a family can start with Blue Cross Blue Shield of Wyoming, and what they have to bring. Each maps onto something intake should ask on the first call.
The diagnosis must be "current": policy 15.01.002 defines that as "the member must have been seen within the past year for treatment of the disorder or as determined as appropriate by a Medical Director." Separately, the Functional Behavioral Assessment must have been completed "within the past twelve months."[1]
A "licensed psychiatrist or psychologist or pediatrician or neurologist or family practice with special training in treatment of Autism Spectrum Disorder" (policy 15.01.002). The FBA may also be done by a BCBA with special training in ASD. For fully insured plans, Bulletin 01-2019 defines covered treatment as care prescribed or ordered for an individual "diagnosed with an autism spectrum disorder by a licensed physician or a licensed psychologist."[1][6]
Policy 15.01.002 names no diagnostic instrument; it requires the DSM ASD diagnosis and an FBA within 12 months. Treatment-plan goals must be measurable against "a standardized assessment that is completed on a regularly documented basis by a licensed psychologist or psychiatrist," including a baseline, progress to date and an anticipated timeline; no specific test is named.[1]
No referral, prescription or physician order is required by BCBSWY: neither its Provider Policies and Procedures Manual (revised May 28, 2026) nor ABA policy 15.01.002 asks for one. What the policy requires instead is a current diagnosis documented by a psychiatrist, psychologist, pediatrician, neurologist or family practice with ASD training (child seen for it within the past year) and an FBA within 12 months, submitted with the authorization request through Availity; FEP members’ ABA is authorized by FEP case management (1-800-210-7257). On the CMS-1500, field 17 (Name of Referring Physician) is "NOT REQUIRED" and 17b takes the NPI "of the referring, ordering or supervising Provider." Wyoming’s Bulletin 01-2019 defines covered autism treatment as care "prescribed or ordered for an individual diagnosed with an autism spectrum disorder by a licensed physician or a licensed psychologist," so keep that prescription or order on file for a fully insured plan. Self-funded ERISA plans sit outside the bulletin.[2][1][3][6]
BCBSWY pays "real-time interactive face-to-face" telemedicine for services reimbursable in person and "within the provider’s scope of practice"; "Eligible providers must be licensed in Wyoming." It "can be used directly to an established patient’s home," with the member’s consent documented, billed with modifier 95 or GT and POS 02. Under BlueCard, a telemedicine provider bills the Blue plan where the provider is physically located. For fully insured plans, W.S. 26-20-701(b) bars denying a covered mental health service because it is delivered by remote audio or audio-visual means, charging more cost-sharing, or paying less. No ABA-specific telehealth code list was found.[2][8]
BCBSWY’s manual: the plan covering the person as an employee or subscriber is primary over one covering them as a dependent, and for a child on two parents’ plans "The primary Plan is the Plan of the parent whose birthday is earlier in the year" when the parents are married or not separated or share joint custody without a coverage order; with the same birthday, the plan covering a parent longer is primary. BCBSWY requires its own authorization when it is secondary for most member prefixes. If the child also has Wyoming Medicaid, BCBSWY pays first (Medicaid is payer of last resort, 42 CFR 433.139). TRICARE pays after this plan (10 U.S.C. 1079(i)(1)); CHAMPVA is the last payer (38 CFR 17.270).[2][22][19][16][20][21]
BCBSWY’s ABA policy 15.01.002 sets no age limit; any age term would come from the member’s benefit plan. For fully insured Wyoming plans that include mental health coverage, Bulletin 01-2019 sets no age limit and no dollar cap, and bars autism-only limits that do not apply to medical/surgical benefits. Self-funded ERISA plans are outside it, so plan funding type decides whether that binds.[1][6]
Ask the plan: Availity benefits check on the member ID: establish fully insured vs. self-funded ERISA, then the plan’s ABA age terms.
BCBSWY processes non-urgent prior-authorization requests "within 5 calendar days from date of receipt" and urgent ones "within 72 hours." That matches W.S. 26-55-107/108 for fully insured plans (5 calendar days after all necessary information; urgent within 72 hours or the request "shall be considered authorized"), and the Act defines urgent services to "include mental and behavioral health care services." Outpatient authorizations must be valid for "not less than one (1) year." Self-funded ERISA plans follow 29 CFR 2560.503-1 (15 days pre-service). Appeals of denials: within 180 days of the denial notice.[2][3][8][9][18]
Ask the plan: At benefits verification ask whether the plan is fully insured (Wyoming-regulated) or self-funded (ERISA), whether BCBSWY treats ABA as an urgent behavioral health service under W.S. 26-55-102(a)(x), and what authorization length and reauthorization lead time it will use.
Coverage decides whether Blue Cross Blue Shield of Wyoming 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.
BCBSWY’s ABA policy 15.01.002 sets no supervision ratio, hours or technician cap. It requires documentation "that all individuals providing ABA services are licensed or certified," with copies of certifications for anyone who is not a licensed psychologist or psychiatrist, and RBTs "are benefited if certified by BACB." Wyoming law sets the floor: technicians practice "under the supervision of a licensed behavior analyst or licensed assistant behavior analyst" (W.S. 33-27-125(a)(viii)), and BCaBA supervision must be at least 2% of monthly service hours (Board Rules § 14-5).[1][10][12]
School is out: ABA policy 15.01.002 says "Services rendered in a school setting are not a benefit," nor are services to create or fulfill an IEP. Accompanying the child to activities outside the home (recreation, eating out, shopping, medical appointments) is not a benefit unless the child has shown significant behavioral difficulty during that activity, and the treatment plan must list the location of each visit. The policy’s place of service is "Inpatient/Outpatient." Telemedicine "can be used directly to an established patient’s home," billed with POS 02 (provider manual).[1][2]
None published: neither the provider manual nor ABA policy 15.01.002 sets a per-day or per-week unit maximum for any ABA code; hours are set in the authorization. Bulletin 01-2019 bars autism-only treatment limits that do not apply to medical/surgical benefits on fully insured plans.[2][1][6]
Ask the plan: The Availity authorization response for the member (approved units and span), or BCBSWY Provider Support, 888-359-6592: ask whether any claim edit caps 97153 units per day.
Not addressed: neither the BCBSWY provider manual nor ABA policy 15.01.002 says whether 97153 and 97155 may be billed for the same clock time.[2][1]
Ask the plan: BCBSWY Provider Support, 888-359-6592: ask whether 97153 and 97155 may be billed for the same clock time.
The provider manual sets no ABA session-note signature rule.[2]
Ask the plan: Your BCBSWY provider agreement and BCBSWY Provider Support, 888-359-6592.
A clean BCBSWY claim requires the "Rendering Provider’s (type 1/individual) National Provider Identifier (NPI)" (box 24j). Whether a technician’s 97153 is billed with the technician or the supervising BCBA as rendering provider is not stated in the manual.[2]
Ask the plan: BCBSWY Provider Support, 888-359-6592, or your provider agreement: ask whose NPI goes in 24j on RBT lines.
It depends on the plan. For fully insured plans that include mental health coverage, Wyoming’s Bulletin 01-2019 bars excluding autism treatment and bars denying ABA as experimental. Self-funded employer plans follow their own documents. Confirm in Availity.
Treatment, yes: medical policy 15.01.002 sets the criteria for initial and continuing authorization of ABA. BCBSWY does not publish an ABA code list, so run each code through Availity’s Authorization Pre-Check. FEP members need authorization from FEP case management (1-800-210-7257).
Policy 15.01.002 asks for an updated treatment plan, the standardized test results the initial plan named as the measure for each goal, an interpretation showing progress to date, and new timelines, new goals and retired goals. It does not mention graphs.
No. Policy 15.01.002 says services rendered in a school setting, and services to create or fulfill an IEP, are not a benefit.
A licensed psychiatrist, psychologist, pediatrician, neurologist or family practice clinician with special training in ASD, and the diagnosis must be current (the child seen for it within the past year).
Within 5 calendar days for non-urgent requests and 72 hours for urgent ones, per its provider manual, which matches Wyoming’s prior-authorization statute for fully insured plans.
BCBSWY says telemedicine providers "must be licensed in Wyoming," and Wyoming licenses behavior analysts, so get a Wyoming license first. Under BlueCard, a distant provider bills the Blue plan where the provider is located.
BCBSWY’s provider manual (revised May 28, 2026): identify the member by the suitcase logo and the three-character prefix, check eligibility at BlueCard Eligibility, 800-676-BLUE (2583), where the prefix routes the call to the member’s home plan, and submit the claim to BCBSWY, which is "your single point of contact for claims." For prior authorization, call the same line and "ask to be transferred to the Medical Management Department," or use the out-of-area Pre-Cert/Pre-auth Search, which shows the home plan’s medical policy and precertification rules. FEP and Medicare Advantage are excluded from BlueCard; FEP ABA is authorized by FEP case management (1-800-210-7257).
Not a statute. Wyoming relies on Insurance Department Bulletin 01-2019 (April 2019), which applies the state’s mental health parity law (W.S. 26-20-701) to autism: no autism exclusions, no ABA-is-experimental denials, and no autism-only limits, on fully insured plans with mental health coverage.
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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