---
title: "CareSource Indiana Marketplace ABA coverage: the intake guide."
url: "https://carelu.com/payers/caresource-indiana-marketplace"
markdown_url: "https://carelu.com/payers/caresource-indiana-marketplace.md"
state: IN (Indiana)
payer: CareSource Indiana Marketplace
kind: Commercial insurance
description: "How CareSource's Indiana Marketplace plan covers ABA: no benefit limit in the 2026 EOC, prior authorization every 6 months, the specialist-diagnosis rule in policy MP-MM-1329, cost sharing, and how it differs from CareSource Indiana Medicaid."
last_reviewed: September 2026
---

# CareSource Indiana Marketplace ABA coverage: the intake guide.

_Payer Guide · CareSource · Indiana Marketplace · Last updated September 2026 · 8 primary sources_

> CareSource's Indiana exchange plan: ABA has no benefit limit in the 2026 EOC, PA every 6 months, new ABA policy MP-MM-1329 from 10/1/2026.

CareSource sells an Indiana Marketplace (ACA exchange) plan as well as the Indiana Medicaid plan in its own guide (caresource-indiana). They share a brand, not a rulebook. The Medicaid plan follows IHCP criteria. The Marketplace plan follows its Evidence of Coverage and CareSource's Marketplace ABA policy, MP-MM-1329, which covers Georgia, Indiana, Ohio and West Virginia and takes effect in its current form on October 1, 2026.

The 2026 Indiana Marketplace EOC lists "Adaptive Behavior Treatment, including Applied Behavioral Analysis (ABA)" under Autism Spectrum Disorder Services with the benefit limit "None." Unlike Medicaid, the family pays the deductible, copayment and coinsurance shown in their Schedule of Benefits. The diagnosis rule is stricter than most: MP-MM-1329 accepts a diagnosis only from four named specialist types, independent of the ABA provider.

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Yes — applied behavioral analysis is on CareSource's 2026 Indiana Marketplace prior authorization list, and medical necessity review is required "for all ABA services initially with a baseline" [2][3]
- **Prior auth for treatment**: Yes — review at baseline and "again, every 6 months"; continuation requests go in every 6 months with updated progress and assessment scores [3]
- **Autism diagnosis required?**: Yes — a "definitive, primary diagnosis of ASD and the ASD level" from a child and adolescent psychiatrist, clinical psychologist, child neurologist or developmental pediatrician, independent of the ABA provider [3]

## At a glance

- **Product:** ACA Marketplace (exchange), Indiana — not the caresource-indiana Medicaid plan
- **ABA benefit limit:** None — 2026 EOC, Autism Spectrum Disorder Services
- **Cost sharing:** Deductible, copayment and coinsurance per the Schedule of Benefits, no less favorable than for physical illness
- **Prior auth:** Required — ABA is on the 2026 Indiana Marketplace PA list; review at baseline and every 6 months
- **Criteria:** MP-MM-1329 (eff. 10/1/2026); CareSource uses MCG for ABA medical necessity
- **Who may diagnose:** Child/adolescent psychiatrist, clinical psychologist, child neurologist or developmental pediatrician, independent of the ABA provider
- **State mandate:** IC 27-8-14.2 — individual policies must offer ASD coverage (group policies must cover); no age, hour or dollar cap
- **Decision clock:** Urgent 24 hours, pre-service 48 hours (EOC; IC 27-1-37.5-23)

## Same brand, different product

A CareSource card in Indiana tells you little until you know the product. The Marketplace plan has its own EOC, prior authorization list, network and cost sharing. Being in network for CareSource Medicaid does not make a practice in network for the Marketplace plan, and the Medicaid ABA rules do not carry across. [1][2][4]

The Marketplace prior authorization list (PA-INMP(2026)) includes "Applied behavioral analysis (ABA)." Services from a non-network provider need prior authorization for everything, not just listed services. Requests go through the CareSource Provider Portal ("the preferred and faster method"), by phone at 1-833-230-2101, or in writing on the Medical Prior Authorization Request Form to CareSource, P.O. Box 1307, Dayton, OH 45401-1307. [1][2][4]

## What the 2026 EOC promises

The EOC says "The Plan provides Benefits for Covered Persons to diagnose and treat Autism Spectrum Disorders," covering "Medically Necessary evidence-based treatment" prescribed or ordered for a diagnosed individual. In its benefit table, adaptive behavior treatment including ABA carries the benefit limit "None." Physical, speech and occupational therapy for autism are "Included in Habilitative Benefits," which the same EOC caps at 20 visits each. ABA must be "provided as prescribed by or under the supervision of a professional who is licensed; certified; or registered by an appropriate agency of this state to perform the services in accordance with a treatment plan." [1][6]

Cost sharing applies: "Deductible, Copayment, and Coinsurance amounts are listed in the Schedule of Benefits." Under the EOC's behavioral health parity clause, those amounts can be no less favorable than the ones for a physical sickness. For an individual policy, Indiana's mandate (IC 27-8-14.2-5) only requires the insurer to offer autism coverage, so the EOC is the document that puts ABA in this plan. Quote the family's deductible status and coinsurance along with the benefit. [1][6]

## The diagnosis and assessment rules in MP-MM-1329

CareSource "uses MCG Health for the review of medical necessity criteria for ABA" and adds documentation rules of its own. To start ABA it needs a "definitive, primary diagnosis of ASD and the ASD level" from a child and adolescent psychiatrist, clinical psychologist, child neurologist or developmental pediatrician. That clinician must evaluate "independent of the ABA provider and with a relationship with the member." It also needs the standardized diagnostic tools used (for example ADOS, ADI-R or CARS-2). If the diagnostic evaluation is more than 24 months old, add a description of clinical symptoms present within the past year. [3]

A licensed ABA practitioner then completes a behavioral assessment (generally no more than 8 hours every 6 months) and a treatment plan before services start. The assessment must be no more than 2 months old when treatment is requested. The initial plan generally runs 26 weeks and must include biopsychosocial history, IEP/504 information, school placement and hours, SMART goals, requested weekly hours, a discharge plan and a parent/caregiver training plan signed by the caregiver. [3]

Caregiver coaching is required in every ABA request: at least 2 hours a month or 12 hours per standard 6-month authorization, and up to 18. If the minimum is not met, "other authorized ABA units may be reduced in subsequent authorization periods." Continuation requests go in every 6 months. Two successive 6-month periods without meaningful progress on standardized assessments is a discontinuation criterion. [3]

## Intake gates

The questions that decide whether a family can start with CareSource Indiana Marketplace, and what they have to bring.

- **Age limit**: None published. The 2026 EOC sets no age limit on autism services, MP-MM-1329 sets none (it says ABA "should begin early in life, ideally by the age of 2, typically lasting 3 to 4 years"), and IC 27-8-14.2 has no age cap. [1][3][6]
- **Diagnosis recency**: An older diagnosis is accepted with an update: if "the diagnostic evaluation was completed more than 24 months from the date of the request," add a "description of clinical symptoms (eg, provider letter) present within the past year that require treatment." Separately, the behavioral assessment "should not be older than 2 months when requesting an authorization for treatment services." [3]
- **Who may diagnose**: One of four specialists, "upon evaluation independent of the ABA provider and with a relationship with the member": a child and adolescent psychiatrist, a clinical psychologist, a child neurologist or a developmental pediatrician. A general pediatrician or the ABA agency's own clinician does not qualify under the policy text. [3]
- **Diagnostic tools required**: "Standardized diagnostic assessment tools used as part of a referral for services (eg, Autism Diagnostic Observation Schedule [ADOS], Autism Diagnostic Interview Revised [ADI-R], Childhood Autism Rating Scale, 2nd edition [CARS-2])." The treatment plan also needs a standardized skills assessment such as VB-MAPP or ABLLS-R. [3]
- **Referral required?**: The EOC covers ASD treatment "prescribed or ordered for an individual diagnosed with an Autism Spectrum Disorder," and ABA is provided "as prescribed by or under the supervision of" a state-licensed, certified or registered professional under a treatment plan. MP-MM-1329 expects the diagnostic tools "as part of a referral for services." No separate PCP referral form is named. [1][3]
- **Prior-auth decision time**: The 2026 EOC lists urgent care reviews "Within twenty-four (24) hours from the receipt of request" and preservice reviews "Within forty-eight (48) hours from the receipt of the request." That matches IC 27-1-37.5-23, which excludes weekends and state and federal holidays; a missed deadline means the service "shall be automatically deemed authorized" (IC 27-1-37.5-28). Continuation requests are due every 6 months. [1][7][9]
- **Telehealth** _(plan-dependent)_: "Telehealth services may be provided when appropriate in instances deemed medically necessary with supporting documentation that provides a plan for the provision of service delivery, primarily adaptive behavior treatment with protocol modification or family adaptive behavior treatment guidance" — the 97155 and 97156 services. No code list or POS is published, and services from an in-state provider while the member is out of state are excluded. [3]
  - Ask the plan: Include the telehealth delivery plan in the PA request and confirm payable codes with CareSource Provider Services (1-833-230-2101).
- **Other insurance (who pays first)** _(plan-dependent)_: The EOC's COB section follows the birthday rule for a child whose parents are married or living together: "The Health Plan of the parent whose birthday falls earlier in the calendar year is the Primary Health Plan" (same birthday: the plan covering that parent longest), unless a court decree says otherwise. If the child also has Indiana Medicaid, this plan pays first; the provider "must also obtain PA from the appropriate IHCP PA contractor," and IHCP will not pay for services this plan denied as out-of-network. TRICARE is "last pay" (32 CFR 199.8). [1][10][11][12]
  - Ask the plan: Collect every coverage the child has, both parents' birthdays and any custody decree at intake; confirm primacy with CareSource and the other carrier.

## Delivery and billing rules

Coverage decides whether CareSource Indiana Marketplace 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**: MP-MM-1329: "Services delivered by a BCaBA must be supervised by a BCBA, BCBA-D, or a licensed psychologist who tested in ABA and is certified by the American Board of Professional Psychology in Behavioral and Cognitive Psychology," and a BCaBA must be enrolled in the Marketplace program and affiliated with the employing organization. Paraprofessionals must be "supervised appropriately according to applicable state regulations"; in Indiana a direct-contact technician must act "under the extended authority and direction of" an Indiana-licensed behavior analyst. No supervision-hours ratio is published. [3][8]
- **Daily limits / MUEs**: No per-day unit ceiling and no annual ABA benefit limit (EOC: "None"). Hours are set per member: "requested number of ABA hours per week based on the member's specific needs, not on a general program structure." Behavioral assessments "are not to exceed 8 hours every 6 months unless additional justification is provided," and caregiver coaching is authorized at up to 18 hours per 6-month period. [3][1]
- **Place of service** _(plan-dependent)_: No POS list is published. MP-MM-1329 excludes "any program or service performed in nonconventional settings, even if performed by a licensed provider," education services available under IDEA, and "services provided by a healthcare provider located in-state when an individual receiving ABA services is out of state." Treatment plans must include school transition plans and IEP/504 information to avoid duplicating school services. [3]
  - Blocked on: Ask CareSource Provider Services (1-833-230-2101) which POS codes it pays for ABA in home, clinic, community and school.
- **Concurrent billing (97153 + 97155):** Not published / unverified. Verify via: CareSource's Marketplace "Applied Behavior Analysis for Autism Spectrum Disorder – Reimbursement Policy" (named in MP-MM-1329), or Provider Services at 1-833-230-2101. [3]

## What intake should collect for CareSource Indiana Marketplace

- **Marketplace or Medicaid:** Decides which CareSource rulebook applies. A Hoosier Healthwise or HIP card belongs in the caresource-indiana Medicaid guide.
- **Deductible status and coinsurance:** ABA has no benefit limit, but deductible, copay and coinsurance apply per the Schedule of Benefits. The family needs the number, not just a yes.
- **Who made the diagnosis:** Child/adolescent psychiatrist, clinical psychologist, child neurologist or developmental pediatrician, independent of your practice. Get the ASD level and the tools used (ADOS, ADI-R, CARS-2).
- **Evaluation date:** Older than 24 months needs a clinician's description of symptoms within the past year.
- **IEP/504 and school schedule:** The policy requires IEP/504 information and weekly school hours in the treatment plan, and excludes services duplicating school services.
- **Caregiver availability:** At least 12 hours of caregiver coaching per 6-month authorization is expected; missed minimums can cut later authorizations.

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

## Common questions

### Does CareSource Indiana Marketplace cover ABA?

Yes. The 2026 Indiana Marketplace EOC lists adaptive behavior treatment including ABA under Autism Spectrum Disorder Services with no benefit limit, subject to prior authorization and the deductible, copay and coinsurance in the member's Schedule of Benefits.

### Is this the same as CareSource Indiana Medicaid?

No. The Medicaid plan follows IHCP ABA rules and has its own guide. The Marketplace plan follows its own EOC, prior authorization list and policy MP-MM-1329, with its own network and cost sharing.

### Who can diagnose autism for a CareSource Marketplace ABA request?

Under MP-MM-1329, a child and adolescent psychiatrist, clinical psychologist, child neurologist or developmental pediatrician, evaluating independently of the ABA provider. The request also needs the ASD level and the standardized tools used, such as ADOS, ADI-R or CARS-2.

### How long does an authorization last?

Medical necessity is reviewed at baseline and every 6 months; the initial treatment plan generally runs 26 weeks and continuation requests are due every 6 months.

### Will the family owe cost sharing?

Yes, usually. The EOC applies the deductible, copayment and coinsurance from the Schedule of Benefits, no less favorable than for physical illness. Check deductible status before quoting.

## Primary sources

1. [CareSource — Indiana Marketplace 2026 Evidence of Coverage (POLMP-IN(2026))](https://www.caresource.com/documents/marketplace-2026-in-basic-eoc.pdf)
2. [CareSource — 2026 Indiana Marketplace Prior Authorization List (PA-INMP(2026))](https://www.caresource.com/documents/2026-in-marketplace-prior-authorization-list.pdf)
3. [CareSource — Applied Behavior Analysis for Autism Spectrum Disorder, MP-MM-1329 (GA, IN, OH, WV Marketplace; eff. 10/01/2026)](https://www.caresource.com/documents/marketplace-oh-policy-medical-mm-1329-20261001)
4. [CareSource — Indiana Marketplace provider prior authorization page](https://www.caresource.com/in/providers/provider-portal/prior-authorization/marketplace/)
5. [Ind. Code § 27-8-14.2-4 — group coverage](https://codes.findlaw.com/in/title-27-insurance/in-code-sect-27-8-14-2-4/)
6. [Ind. Code § 27-8-14.2-5 — individual offer](https://codes.findlaw.com/in/title-27-insurance/in-code-sect-27-8-14-2-5/)
7. [Ind. Code 27-1-37.5-23 — prior authorization response deadlines](https://codes.findlaw.com/in/title-27-insurance/in-code-sect-27-1-37-5-23/)
8. [Ind. Code § 25-8.5-3-6 — practice restriction and exceptions](https://law.justia.com/codes/indiana/title-25/article-8-5/chapter-3/section-25-8-5-3-6/)
9. [Ind. Code 27-1-37.5-28 — missed deadline = deemed authorized](https://codes.findlaw.com/in/title-27-insurance/in-code-sect-27-1-37-5-28/)
10. [IHCP — Prior Authorization module (PROMOD00012)](https://www.in.gov/medicaid/providers/files/modules/prior-authorization.pdf)
11. [IHCP — Third-Party Liability module (PROMOD00017)](https://www.in.gov/medicaid/providers/files/modules/third-party-liability.pdf)
12. [32 CFR 199.8 — TRICARE double coverage (eCFR)](https://www.ecfr.gov/current/title-32/section-199.8)

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.

Source: Carelu ABA Payer Directory — https://carelu.com/payers. Free to cite with attribution.