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.[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)" — while an ABA organization credentials as a facility "Licensed as a Mental Health Outpatient Facility" with oversight "from a licensed behavioral health or Behavior Analyst Certification Board (BACB) - certified professional." Most BCBA-level practices therefore contract as an organization.[1][11]
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][13][14]
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.
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][12][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.[3]
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.
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.[3]
Ask the plan: The member's benefit summary in Availity — some plan designs require a referral for specialty services.
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." ABA organizations are credentialed at an outpatient level: "Services will be provided at an Outpatient Mental Health Clinic level of intensity." 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)"; an ABA organization must be "Licensed as a Mental Health Outpatient Facility" and "receive oversight from a licensed behavioral health or Behavior Analyst Certification Board (BACB) - certified professional." 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.
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.
Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed September 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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