BlueCross BlueShield of Tennessee (BCBST) is the state's Blue plan. This guide covers its commercial plans; its TennCare plans, BlueCare and TennCareSelect, have their own guides. BCBST's commercial manual says ABA "is covered by the Federal Employee Program (FEP) as of 1/1/2017, by Postal Service Health Benefits (PSHB) as of 1/1/2025, and BCBST fully insured plans as of 1/1/2018," while "Coverage of ABA services for self-funded plans may vary and it is the provider's responsibility to verify coverage." So the first intake question is the funding type.
Yes, with two checks. BCBST reimburses telehealth "in accordance with the Tennessee Telehealth mandate (TCA 56-7-1003)," and it denies telehealth claims only for codes that are not on Medicare's telehealth list — every ABA code, 97151 through 97158 plus 0362T and 0373T, is on the CMS list for calendar year 2026. Bill POS 10 for telehealth in the home or POS 02 elsewhere; the 95 and GT modifiers are informational. The two checks: some self-funded groups list telehealth as a contract exclusion, and the authorization has to include the telehealth hours. Tennessee's telemedicine statute requires coverage "consistent with" in-person coverage, and waives the prior in-person visit for an initial behavioral health evaluation or assessment.[1][6][7]
BCBST does not publish a public ABA fee schedule. Its manual says behavioral health services are reimbursed on the "provider-contracted Behavioral Health Fee Schedule," with new codes priced by "RBRVS as defined by the Federal Register, GPCIs for Tennessee, and appropriate network conversion factor," and that the plan "will pay the Maximum Allowable Charge (MAC)" under the reimbursement schedules — "Charges higher than the reimbursement rates aren't eligible for reimbursement." Your rates are in your BCBST network attachment; for a quote before contracting, ask BCBST provider network management. Being on the fee schedule is not a guarantee of payment: final reimbursement depends on eligibility, code edits, cost sharing, benefit exclusions and authorization. BlueCare (TennCare) rates are a separate contract — see the BlueCare Tennessee guide.[1]
Bill the code that matches who was delivering the time. When the BCBA is physically present, the claim carries the BCBA's service; when the RBT is alone with the member, it carries the RBT's service. The exception is 97155: "if the BCBA is directing an RBT, the client is present, and one or more protocols have been modified then 97155 may be billed concurrently with the RBT codes." RBT codes may be billed for RBTs, BCaBAs, or a provider who has finished ABA training and is waiting to sit the BCBA exam, and BCBST recognizes 97153HO when a qualified professional delivers 97153 personally. RBT supervision follows the BACB's guidelines. The manual's ABA code table lists 0362T, 0373T, 97151, 97152, 97153, 97153HO, 97154, 97155, 97156, 97157 and 97158, each per 15 minutes; it lists no HCPCS H-code (such as H0031 or H0032) for ABA.[1]
Tennessee's statute is a parity rule, not an ABA mandate. A plan that "provides benefits for neurological disorders" must cover ASD treatment "at least as comprehensive as those provided for other neurological disorders," for "any person less than twelve (12) years of age," with deductibles, copayments and limits "no more stringent" than for other neurological disorders; it "shall not expand the type or scope of treatment." BCBST's own coverage decision goes further than the statute on fully insured plans (ABA covered since 2018), which is why the funding type, not the statute, is the load-bearing intake question.[8][1]
Tennessee licenses behavior analysts: only a holder of a license from the Applied Behavior Analyst Licensing Committee may use the title "Licensed Behavior Analyst" and practice ABA as defined in T.C.A. § 63-11-302. BCBST's credentialing criteria for an individual Behavior Analyst are stricter than the license alone — "Licensed in the state of Tennessee as a Behavior Analyst" and "board-certified Behavior Analyst-Doctoral (BCBA D)" — The organizational credentialing list in BCBST's October 2026 commercial manual has no separate entry for an ABA organization; the nearest listed type, Outpatient Mental Health Facility, must be "Licensed as a Mental Health Outpatient Facility." Ask BCBST provider network how an ABA group practice should credential before assuming either route.[1][11]
BCBST does not run an any-willing-provider network. Its commercial manual (effective October 1, 2026) says its "ability to credential providers, as well as maintain a separate network and not include any willing provider, isn't considered discrimination," and network need is a recognized reason for a denial: providers "denied participation in a BlueCross network for reason other than network need may not reapply for participation for a least one year."[1]
Who can be credentialed matters for ABA. The manual's credentialing requirements for an individual "Behavior Analyst (CBA)" are a Tennessee Behavior Analyst license and certification as a "board-certified Behavior Analyst-Doctoral (BCBA D)." A BCBA without the doctoral credential does not meet that individual listing as written, so ask BCBST provider network how your practice should enroll.[1]
Filing deadline: “Our commercial timely filing period is six months from the date of service for individual providers”; when BCBST is secondary, it is 60 days from the date of service or 60 days from the primary carrier’s notice of payment. Corrections: “corrected bills must be submitted within two years of the end of the year the claim was originally submitted” (a claim filed February 15, 2020 could be corrected through December 31, 2022); only adjudicated claims are corrected, while returned or rejected claims are resubmitted as new claims. Taxonomy: “professional claims need a taxonomy code to be submitted for the billing and rendering providers,” and both must match the contracted provider. Appeals: a medical-necessity denial may be appealed within 180 days of the denial notice, and a denial for failing to get authorization within 60 days; neither extends the filing deadline.[1][12]
Payment clock: Tennessee’s prompt-pay law (Tenn. Code Ann. 56-7-109) gives a health insurance entity 21 calendar days for a claim submitted electronically and 30 calendar days for a paper claim to pay a clean claim, pay the undisputed part, or say what is missing, with 1% interest a month on late amounts. A claim submitted more than 90 days after the date of service is not a “clean claim” under the statute, so file early. A self-funded employer plan may sit outside Tennessee insurance law, so confirm the funding type first.[1][12]
BCBST asks for a narrative of progress against the plan, and its program description asks for graphs. The Initiation and Continuation form must be resubmitted “at least once every six months” and asks whether measurable progress has been made toward goals and documented in the treatment plan, and whether progress can be maintained if ABA is reduced or discontinued. The behavioral health program description requires that “progress toward behavioral changes is graphed, analyzed, interpreted” with titled graphs, labeled axes, legends and phase-change lines, and that the initial assessment include “Graphed Baseline Data for Target Behaviors.” No data-recency window is published.[4][5]
The questions that decide whether a family can start with Blue Cross Blue Shield Tennessee, and what they have to bring. Each maps onto something intake should ask on the first call.
BCBST: "Claims should be submitted to the primary carrier prior to submission to us. Upon claim submission to us, please provide a copy of the remittance advice from the primary carrier." When BCBST is secondary it uses maintenance of benefits: "If the primary insurance carrier's payment amount is the same or more than what we would've paid, we won't make any additional payment," and the provider "can't bill the member for any amount over the maximum allowable charge." Between two parents' group plans, Tennessee's rule is the birthday rule — "the benefits of the Plan of the parent whose birthday falls earlier in a year are determined before those of the Plan of the parent whose birthday falls later in that year," and on the same birthday the plan that covered the parent longer goes first. If the child also has TennCare, BCBST pays first; Medicaid rejects a claim back to the provider when other coverage is known. TRICARE pays after BCBST ("TRICARE shall be last pay").[1][10][16][17]
BCBST publishes no age limit for ABA. The state layer is thin: Tenn. Code Ann. § 56-7-2367 requires plans that cover neurological disorders to give ASD benefits "at least as comprehensive as those provided for other neurological disorders," and "These benefits and coverage for treatment shall be provided to any person less than twelve (12) years of age" — a parity rule, not an ABA mandate, and it "shall not expand the type or scope of treatment." The age answer for a given child comes from the benefit document.[8][1]
Ask the plan: Availity benefits check or BCBST Provider Service 1-800-924-7141 for the member's group.
Not stated as a requirement. BCBST's ABA forms ask for "diagnostic confirmation like diagnostic reports, doctor's orders, etc.," which treats a doctor's order as one acceptable piece of evidence rather than a mandatory referral. BCBST's commercial and Medicare Advantage provider administration manual (effective July 1, 2026) has no referral or order requirement in its ABA sections, and the ABA assessment and treatment request forms list "doctor's orders" only as one example of diagnostic confirmation. Tennessee's statute adds none. So no published service-order rule: at benefits verification ask whether this member's plan requires a PCP referral for specialty behavioral services, and bring the diagnostic report (with any physician order) to the assessment request.[3][1][4]
Ask the plan: The member's benefit summary in Availity — some plan designs require a referral for specialty services.
Yes in principle, with a group-level exception. BCBST's commercial manual: "We reimburse for services rendered via telehealth in accordance with the Tennessee Telehealth mandate (TCA 56-7-1003)," but "This reimbursement may not apply to certain self-funded groups if telehealth is listed as a coverage exclusion in their contract." Its code rule keys off Medicare: "Any service code not on the current CMS Telehealth qualifying code list … billed by the originating or distant site provider with POS code 02 will be denied as a non-contracted service." Every ABA code — 97151 through 97158, 0362T and 0373T — is on the CMS calendar-year 2026 telehealth list. Claims "must be billed with the correct place of service (POS) 10: Telehealth provided in patient's home or POS 02"; modifiers such as 95 are informational. Tennessee's statute requires coverage of covered services delivered by provider-based telemedicine "consistent with" in-person coverage, and does not require a prior in-person visit for "a patient who is receiving an initial behavioral health evaluation or assessment." BCBST publishes no ABA-specific telehealth code list for commercial plans.[1][6][7]
Ask the plan: Availity benefits check for the member's group — confirm telehealth is not a contract exclusion (self-funded groups) and that the authorization includes telehealth hours.
BCBST's commercial manual: "For urgent care, the decision must be completed as soon as possible based on the clinical situation, but no later than 72 hours of the receipt of the request," and "For non-urgent care, the decision must be made within 15 calendar days or seven (7) days for non-urgent care requests submitted electronically for Fully Insured and Marketplace members." Fully insured plans are also under Tennessee's Prior Authorization Fairness Act: a non-urgent request is "deemed approved within seven (7) calendar days" if the carrier fails to decide, ask for the missing information, or flag a medical-necessity question; it gets "an additional five (5) calendar days" after the provider responds, and "the prior authorization request process must not exceed seventeen (17) calendar days." An urgent request is deemed approved after "seventy-two (72) hours plus, if applicable, one (1) additional business day." Self-funded ERISA plans follow 29 CFR 2560.503-1: pre-service decisions "not later than 15 days after receipt of the claim," urgent care "not later than 72 hours after receipt of the claim," and an urgent request to extend care decided within 24 hours if made "at least 24 hours prior to the expiration." Continuations of ABA are due "at least once every six months."[1][9][15][4]
Ask the plan: Availity: confirm whether the member is fully insured or self-funded, which decides which clock applies, and submit electronically for the 7-day track.
No recency window is published. BCBST's ABA forms ask for the "Initial/First Date ASD Diagnosed" and for diagnostic confirmation, but set no maximum age on the report.[4]
Ask the plan: BCBST behavioral health UM, (423) 535-5717 option 2, when an older diagnostic report is all the family has.
Not published. BCBST's commercial manual and ABA forms ask for diagnostic confirmation but name no required diagnosing specialty or license. LCSW: not stated by BCBST. Tennessee’s practice act puts “assessment, diagnosis and treatment of mental, emotional and behavioral disorders” within clinical social work (T.C.A. § 63-23-105), but whether BCBST accepts an LCSW diagnosis for ABA is not published — ask BCBST at authorization.[3][14]
Ask the plan: BCBST behavioral health UM, (423) 535-5717 option 2.
No diagnostic instrument is named. What BCBST does specify is the ABA assessment itself: its program description lists "Graphed Baseline Data for Target Behaviors," a "Functional Assessment," hypotheses about the function of target behaviors "Based on Direct Observations and Interviews," measurable time-limited goals, and service recommendations with units, frequency and expected duration.[5]
Ask the plan: BCBST behavioral health UM, (423) 535-5717 option 2 — ask whether a specific ASD instrument is expected in the diagnostic report.
Coverage decides whether Blue Cross Blue Shield Tennessee 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.
BCBST points to the BACB rather than setting its own number: "ABA providers using Registered Behavior Therapists (RBT) are expected to demonstrate compliance with the supervision guidelines outlined by the Behavior Analyst Certification Board." That puts the operative floor at the BACB's RBT supervision requirement. BCBST's behavioral health program descriptions add that the initial assessment and the behavior support plan each carry the signature of the licensed BCBA who wrote them.[1][5]
Yes, when a protocol is modified. BCBST's commercial manual: "Providers should bill in a manner consistent with the CPT code descriptions. In addition, if the BCBA is directing an RBT, the client is present, and one or more protocols have been modified then 97155 may be billed concurrently with the RBT codes." Without a protocol change, the rule is one code for the time: "When the Board Certified/Licensed BCBA is physically present with the member (with or without the Registered Behavior Technician (RBT) being present) then the procedure code for the claim would be the applicable service the BCBA provides. If the RBT was alone with the member carrying out the service plan, then the code would be for the applicable service the RBT provides."[1]
Published, in two BCBST documents. The commercial manual requires "Progress notes for each service contact documenting the date and time of service, duration/end time of service, the type of service provided, a summary of treatment interventions used, the treatment plan goals and objectives addressed in the session, and the name and credentials of service provider," with each treatment plan and review "signed by a member, family member, or legally appointed representative." BCBST's ABA program description is more specific: each service-encounter note should include "Signature, Date, and Credentials of the Servicing Professional (e.g., BCBA or RBT)" and "Signature and Date of Guardian/Caregiver (if training was provided)"; the initial assessment carries the "Signature of the licensed BCBA who completed the assessment"; and the behavior support plan is signed by the BCBA who developed it and by the member or representative. No signing deadline is stated.[1][5]
Home, clinic, school and community all appear — BCBST's ABA program description asks each progress note to record the "Location of Service (e.g., Home, Clinic, School, Community)" — but school has a narrow role: "Service in the school environment should be limited to ensuring consistency in plan implementation across all settings. Service in the school should not include developing a BSP for the school or addressing behavior for academic purposes." Telehealth is covered separately below.[5][1]
The code follows who delivered the time. "The RBT service codes can be used by Registered Behavior Technicians, Board Certified Assistant Behavior Analysts (BCaBA) or by a provider who has completed their training in Applied Behavior Analysis and is waiting to take the exam to become a Board Certified Behavior Analyst (BCBA)," and BCBST lists 97153HO for 97153 "administered by a physician or other qualified healthcare professional" (dates of service from 9/1/2019). Credentialing sets who can hold the contract: an individual Behavior Analyst must be "Licensed in the state of Tennessee as a Behavior Analyst" and, per the manual, "board-certified Behavior Analyst-Doctoral (BCBA D)"; the organizational credentialing list in the October 2026 manual has no separate entry for an ABA organization (the nearest type, Outpatient Mental Health Facility, must be "Licensed as a Mental Health Outpatient Facility"), so ask BCBST network management how an ABA group is credentialed. Which NPI goes in the rendering field is not stated.[1]
Ask the plan: BCBST provider network / credentialing for how a group should enroll its BCBAs, and your participation agreement for the rendering-provider field.
Not published. BCBST's manual and ABA forms set no per-day or per-week ABA unit ceiling; the initiation and continuation form asks for requested hours per week per code and, at continuation, hours approved versus hours used. Tennessee's statute adds no hour cap either — it only requires ASD benefits no more restrictive than those for other neurological disorders, for insureds under 12.[4][8]
Ask the plan: The member's benefit summary in Availity, or BCBST Provider Service 1-800-924-7141 — ask for any visit, hour or dollar limit on ABA for this group.
Until the end of the second year after the year the claim was first submitted (BCBST's example: a claim filed February 15, 2020 could be corrected through December 31, 2022). Returned or rejected claims are filed again as new claims, not corrected bills.
BCBST's commercial manual lists 97151–97158, 97153HO (97153 delivered by the qualified professional), 0362T and 0373T, all per 15 minutes. It lists no HCPCS H-codes for ABA.
Its behavioral health program description says progress is graphed, analyzed and interpreted, and the continuation form, due at least every six months, asks whether measurable progress toward documented goals has been made.
Yes on fully insured BlueCross BlueShield of Tennessee plans (since 1/1/2018), FEP and PSHB. Self-funded employer plans "may vary," so verify the member's group in Availity. ABA needs prior authorization and an autism spectrum disorder diagnosis.
Yes, generally. BCBST reimburses telehealth under Tennessee's telehealth law and denies only codes that are not on Medicare's telehealth list; all ABA codes (97151-97158, 0362T, 0373T) are on the 2026 list. Bill POS 10 (home) or 02, and make sure the authorization covers telehealth hours. Some self-funded groups exclude telehealth in their contract. For BlueCare (TennCare), see the BlueCare guide — its approved code list also includes every ABA code.
BCBST does not publish a public ABA fee schedule. Behavioral health services pay on the provider-contracted Behavioral Health Fee Schedule in your BCBST network attachment, with new codes priced from Medicare RVUs and a network conversion factor. Ask BCBST network management for rates before contracting; BlueCare (TennCare) rates are a separate contract.
Yes, when the BCBA is directing the RBT, the client is present and at least one protocol is modified — BCBST's manual says 97155 "may be billed concurrently with the RBT codes" in that case.
There is no published open or closed status. BCBST's manual says it may maintain a network that does not include any willing provider and can deny participation for network need. For an individual Behavior Analyst its credentialing list requires a Tennessee license and BCBA-D certification, so ask BCBST provider network about joining as a group.
Generally yes. BCBST pays telehealth for codes on Medicare's telehealth list, and 97155 is on the 2026 list along with the other ABA codes. Bill POS 10 or 02 and include the telehealth hours in the authorization. BCBST publishes no cap on the share of supervision done remotely; BACB supervision rules still apply, and some self-funded groups exclude telehealth.
Six months from the date of service for commercial claims; 60 days when BCBST is secondary (BCBST Provider Administration Manual, October 2026).
Yes. Professional claims need billing and rendering taxonomy codes that match the contracted provider (BCBST Provider Administration Manual).
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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