---
title: "CHAMPVA and ABA: what is actually published."
url: "https://carelu.com/payers/champva"
markdown_url: "https://carelu.com/payers/champva.md"
state: US (national)
payer: CHAMPVA
kind: Commercial insurance
description: "CHAMPVA is a VA program, not TRICARE. What the CHAMPVA Guidebook actually says about ABA: pre-authorization for treatment only, 25% cost-share after a $50/$100 deductible, the $3,000 catastrophic cap, and what intake must verify directly."
last_reviewed: October 2026
---

# CHAMPVA and ABA: what is actually published.

_Payer Guide · CHAMPVA · Last updated October 2026 · 10 primary sources_

> A VA program, not TRICARE. ABA is covered, treatment needs pre-authorization, and the family pays 25% after deductible.

CHAMPVA is the Civilian Health and Medical Program of the Department of Veterans Affairs. It is not TRICARE, it is not administered by a TRICARE regional contractor, and none of the Autism Care Demonstration machinery applies to it. The VA says so directly: "CHAMPVA is a VA program, while TRICARE is a regionally managed health care program for active duty and retired members of the uniformed services." The two are mutually exclusive — if you are eligible for or enrolled in TRICARE, you cannot get CHAMPVA benefits.

This is a deliberately short page, because CHAMPVA publishes deliberately little. The Guidebook confirms that applied behavior analysis is a covered benefit, that treatment requires pre-authorization while the evaluation does not, and what the family pays. The detailed ABA rules are in the CHAMPVA Operational Policy Manual (Ch. 2 Sec. 18.6): a DSM diagnosis of ASD, a treatment plan with every pre-authorization request, approval for up to a year, BCBA-level authorized providers who bill for their technicians, and no per-code unit caps. Writing in TRICARE’s rules would be wrong, so this guide tells you what is verified and where to call for the rest.

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Not required — the CHAMPVA Guidebook requires pre-authorization for ABA treatment only, "not the evaluation" [2]
- **Prior auth for treatment**: Required — ABA treatment is on CHAMPVA’s pre-authorization list (the evaluation is not). The CHAMPVA Operational Policy Manual adds: “Preauthorization for ABA services must include an ABA TP. Upon receipt of the ABA TP, preauthorization may be granted for one year of ABA services.” [2][11]
- **Autism diagnosis required?**: Yes — “The beneficiary must be diagnosed with ASD using the current Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria” (CHAMPVA Operational Policy Manual Ch. 2 Sec. 18.6). ABA “for all other diagnoses that are not ASD” is excluded, and so are “Diagnoses and referrals from Nurse Practitioners (NPs), Physician Assistants (PAs), or other providers not having the qualifications listed in Operational Policy.” [11]

## At a glance

- **Covers ABA?:** Yes — listed as a covered benefit in the CHAMPVA Guidebook
- **Program type:** VA cost-sharing program, not TRICARE and not an insurance network
- **Pre-authorization:** Required for ABA treatment only — "not the evaluation"
- **Cost-share (CHAMPVA primary):** CHAMPVA pays 75% of the allowable amount; the patient pays the deductible plus a 25% cost-share
- **Deductible:** $50 per individual, $100 per family, per calendar year
- **Catastrophic cap:** $3,000 per year, then CHAMPVA pays in full
- **CHAMPVA secondary:** Patient pays nothing in most cases; CHAMPVA pays up to 100% of the allowable amount
- **Network:** None — "we do not have a network of health care providers, so you can visit most authorized providers"

## Who CHAMPVA covers — and who it cannot

CHAMPVA covers the spouse or dependent child of a veteran rated permanently and totally disabled from a service-connected disability; the surviving spouse or child of a veteran who died from a service-connected disability; and the surviving spouse or child of a veteran who was rated permanently and totally disabled from a service-connected disability at the time of death. Dependent children can remain eligible from 18 to 23 while enrolled in school, and a child who is permanently unable to support themselves because of a disability that began before age 18 can remain eligible. Surviving spouses who remarry at age 55 or older keep the benefit. [1][2]

The exclusion matters for triage: a person eligible for or enrolled in TRICARE cannot get CHAMPVA. The VA is explicit that a military retiree, or the spouse of a veteran killed in action, is and may always be a TRICARE beneficiary and cannot choose between the programs. If a family arrives holding both stories, sort that out before you build a case around the wrong program’s rules. [1][2]

## What the Guidebook says about ABA

ABA appears twice in the current Guidebook, updated Jan. 1, 2025. It is listed among the services that require pre-authorization, as "Applied behavior analysis (ABA) for treatment only (not the evaluation)." And it has its own line in the Behavioral Health Services benefit table — "Autism – Applied Behavioral Analysis (ABA) requires pre-authorization for treatment only (not evaluation)" — with the cost-share shown alongside. [2]

That split is the operationally useful fact. The diagnostic evaluation does not need to be pre-authorized, so a family can be evaluated without waiting on CHAMPVA. Treatment does, and CHAMPVA takes pre-authorization requests directly: by phone on 800-733-8387, by email to VHAHAC.preauthorizationFM@va.gov, or by mail to VHA Office of Integrated Veteran Care, CHAMPVA Beneficiary Claims, P.O. Box 500, Spring City, PA 19475. [2]

Two exceptions to the pre-authorization requirement are published. Services listed as requiring pre-authorization do not require it when provided through CITI, the CHAMPVA In-house Treatment Initiative at a VA medical center — and CITI services are also exempt from beneficiary cost sharing. And where other health insurance has already authorized the service, CHAMPVA does not require its own pre-authorization; but if that other insurer denies for failure to follow its rules or for lack of medical necessity, CHAMPVA will deny as well. [2]

## What the CHAMPVA Operational Policy Manual says about ABA

The detailed rules sit in the CHAMPVA Operational Policy Manual, Chapter 2, Section 18.6 (Psychological Testing), last changed by Transmittal 152 in May 2025. The child “must be diagnosed with ASD using the current Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria.” Pre-authorization “must include an ABA TP,” and once CHAMPVA has the plan, “preauthorization may be granted for one year of ABA services.” [11][12][13]

Who may provide it: BCBAs, BCBA-Ds or other qualified CHAMPVA-authorized independent providers with a master’s degree or above and a current state licence (or BACB certification where the state does not license), who employ or contract with assistant behavior analysts (LABA, BCaBA, QASP) and technicians (RBT, ABAT, BCAT) and supervise them directly. “Only one authorized ABA provider is authorized to provide ABA services for each beneficiary at a time,” and that provider “is the sole provider authorized to bill for ABA services.” [11][12][13]

Unit caps: none per code. The manual sets no daily or weekly maximum for any ABA code; the limit is what the one-year pre-authorization approves. The mental-health section records that on “May 30, 2024, quantitative limits are removed for covered mental health and substance use disorder (SUD) care,” with documentation available on request to support the level of care. [11][12][13]

What is excluded: ABA for any diagnosis other than ASD; diagnoses and referrals from nurse practitioners or physician assistants; training of the technicians; billing for e-mails, driving, or office and therapeutic supplies; “Billing for multiple providers’ time during one ABA session with a child when more than one ABA provider is present”; educational ABA and school tuition; restraints; custodial, personal and child care; group ABA with three or more children and one or two providers; and indirect supervision. [11][12][13]

Claims: the claims chapter (Ch. 3 Sec. 1.1) asks for the provider’s name and address, remittance address, the physical location where services were rendered, the individual provider’s professional status, TIN and NPI. A referring provider and a taxonomy code are not on that list; the referring provider’s name belongs in the assessment and treatment plan. [11][12][13]

Licensure: “If a state requires licensure or certification, the ABA provider is required to possess that state licensure or certification to be a CHAMPVA-authorized provider,” and where the state does not license, current BCBA or BCBA-D certification from the BACB qualifies. [11][12][13]

Renewals and progress data: the manual sets no progress-report format and does not ask for graphs. On the plan itself it says pre-authorization “must include an ABA TP,” that it “may be granted for one year of ABA services” once the TP is received, and that “The TP and updates shall contain signatures by the authorized ABA supervisor and the parent/caregiver.” The TP is defined as setting out “the identified behaviors targeted for improvement, the ABA specialized interventions to achieve improvement, and the short-term and long-term ABA TP objectives and goals.” Assessments and TPs must also carry the date of the initial assessment and TP and the referring provider’s name. Ask the CHAMPVA pre-authorization reviewer if the yearly renewal needs anything more. [11][12][13]

Codes and EVV: Section 18.6 publishes no ABA CPT code list, so the codes are whatever the pre-authorization approves. What it rules out is group ABA (“three or more children with one or two providers”), “Indirect supervision” and billing for more than one provider’s time in a session. It contains no electronic visit verification requirement. [11][12][13]

## What the family pays

Where CHAMPVA is the primary payer, ABA carries the standard outpatient split: the patient pays the annual deductible of $50 per individual or $100 per family, then a 25% cost-share, and CHAMPVA pays 75% of the allowable amount. Yearly catastrophic cap protection limits beneficiary cost sharing to $3,000 annually, after which CHAMPVA covers 100% of allowable costs for the rest of the year. [2]

Where CHAMPVA is secondary or tertiary — which is common, because CHAMPVA is a payer of last resort behind most other coverage — the Guidebook states the patient pays nothing in most cases and CHAMPVA pays up to 100% of the allowable amount. Intake should therefore always capture other coverage first: with a commercial plan in front, the CHAMPVA question is usually about the residual, not the whole episode. And note the Guidebook’s own caveat: services listed as a covered benefit do not guarantee payment, because there may be specific coverage guidelines behind the line item. [2]

## What CHAMPVA does not publish — and what to ask

The honest inventory of gaps: the Guidebook does not state an ASD diagnosis requirement or a recency rule; it does not name required assessment instruments or outcome measures; it does not state how long an ABA authorization runs or what a reauthorization requires; it does not define who may render or supervise ABA, or set a supervision ratio; it does not publish per-day unit limits, concurrent-billing rules or a place-of-service policy; and it does not publish an ABA-specific medical-necessity policy. Detailed operating rules live in the CHAMPVA Operational Policy Manual rather than the Guidebook. [2][1]

So the pre-authorization call is also your policy call. Ask, and get it in writing: what diagnosis documentation they want and how recent; what the authorization period is and what a renewal needs; which provider credentials they will recognise for the rendering and supervising roles; whether any settings are excluded; and whether the family has other health insurance that would change the pre-authorization posture entirely. Do not assume TRICARE’s answers apply — different department, different statute, different rules. [2][1]

## Does CHAMPVA restrict an out-of-state BCBA delivering ABA by telehealth?

CHAMPVA publishes no telehealth rule for ABA, and no rule tying the provider’s licence to the state where the beneficiary lives. What it does publish is a licence test. The CHAMPVA regulation defines an authorized non-VA provider as one that “Is licensed or certified by a state to provide the medical services and supplies.” It also accepts one that, “Where a state does not offer licensure or certification, is otherwise certified by an appropriate national or professional association that sets standards for the specific medical provider.” The Guidebook says: “We generally consider any provider to be authorized if they are performing services within the scope of their license.” Neither says which state’s licence counts when the BCBA and the child are in different states. [4][3][5][7]

So the answer runs through two checks. The first is state law. CHAMPVA’s test is scope of licence, so confirm that the BCBA’s licence, or the child’s state’s rules, actually allow practice into the state where the child is. The second is CHAMPVA itself. ABA treatment needs pre-authorization, so name the delivery mode and the provider’s licence state in the request and get the answer in writing. On telehealth in general, a 2024 final rule (effective May 30, 2024) removed CHAMPVA’s exclusion of audio-only care. Telephone services on or after May 12, 2020 “are not excluded when the services are otherwise covered CHAMPVA services provided through this modality and are medically necessary and appropriate.” Detailed operating rules sit in the CHAMPVA Policy Manual, which is behind a VA sign-in. [4][3][5][7]

## Will CHAMPVA authorize ABA retroactively?

Plan on pre-authorization before the first treatment session. The Guidebook lists “Applied behavior analysis (ABA) for treatment only (not the evaluation)” among services that require pre-authorization and describes no back-dating route. The regulation has one narrow retrospective path: “CHAMPVA will perform a retrospective medical necessity review during the coordination of benefits process if: (1) It is determined that CHAMPVA is the responsible payer for services and supplies but CHAMPVA preauthorization was not obtained prior to delivery of the services or supplies; and, (2) The claim for payment is filed within the appropriate one-year period.” That is a review of a claim in the coordination-of-benefits process, not a way to authorize treatment after the fact. The Guidebook’s filing limit is one year after the date of service. Where other health insurance is primary and has authorized the service, CHAMPVA requires no pre-authorization of its own. [6][3]

## Filing CHAMPVA ABA claims: deadline, where they go, and appeals

The filing limit is one year. The Guidebook: “You have one year after the date of service to file any claims,” claims filed late “will be denied,” and a timely-filing denial is challenged through the appeal process. Where CHAMPVA eligibility was granted retroactively, claims for dates on or after the effective date are due within 180 days of the first CHAMPVA card. With other insurance in front, file there first and send CHAMPVA that plan’s EOB. [3][8]

VA’s CHAMPVA provider page gives the route: electronic 837 claims to payer ID 84146 through VA’s clearinghouse (Optum Insight), or paper claims to VHA Office of Integrated Veteran Care, CHAMPVA Claims, PO Box 30750, Tampa, FL 33630-3750. Its claim tips ask for the complete nine-digit EIN/TIN, both the billing address and the physical address where services were provided, and each service and date of service on its own line. The same page lists 833-930-0816 for preauthorization requests. VA publishes no ABA rule on whose NPI goes on the claim (see the billing field below). [3][8]

Appeals: a decision review is available when CHAMPVA decided the claim within the last year, through a higher-level review, a supplemental claim with new evidence, or a Board of Veterans’ Appeals appeal. A denied pre-authorization has its own route: “you have one year from the date of the VA notification to submit in writing why you believe the decision is incorrect,” to CHAMPVA Appeals, P.O. Box 600, Spring City, PA 19475. [3][8]

## How CHAMPVA works state by state

The clinical policy above is national, but three state-level layers change what a family's card actually buys: the state autism mandate (what fully-insured plans must cover), the carrier's state Medicaid plans (which follow the state Medicaid rules, not this commercial policy), and plan funding type (self-funded ERISA plans can carve benefits differently).

- **Georgia** (mandate: Ava’s Law (O.C.G.A. § 33-24-59.10)): fully-insured CHAMPVA plans issued in Georgia sit under the state mandate. State Medicaid baseline: [Georgia Medicaid guide](https://carelu.com/payers/georgia-medicaid).
- **North Carolina** (mandate: N.C.G.S. § 58-3-192 (autism coverage)): fully-insured CHAMPVA plans issued in North Carolina sit under the state mandate. State Medicaid baseline: [North Carolina Medicaid guide](https://carelu.com/payers/north-carolina-medicaid).
- **Indiana** (mandate: Indiana autism insurance mandate (IC 27-8-14.2)): fully-insured CHAMPVA plans issued in Indiana sit under the state mandate. State Medicaid baseline: [Indiana Medicaid (IHCP) guide](https://carelu.com/payers/indiana-medicaid).
- **Virginia** (mandate: Virginia autism insurance mandate (§ 38.2-3418.17)): fully-insured CHAMPVA plans issued in Virginia sit under the state mandate. State Medicaid baseline: [Virginia Medicaid (DMAS) guide](https://carelu.com/payers/virginia-medicaid).
- **Tennessee** (mandate: Tenn. Code Ann. § 56-7-2367 (neurological parity)): fully-insured CHAMPVA plans issued in Tennessee sit under the state mandate. State Medicaid baseline: [TennCare (Tennessee Medicaid) guide](https://carelu.com/payers/tenncare-tennessee-medicaid).
- **Ohio** (mandate: Ohio autism insurance mandate (R.C. 3923.84)): fully-insured CHAMPVA plans issued in Ohio sit under the state mandate. State Medicaid baseline: [Ohio Medicaid guide](https://carelu.com/payers/ohio-medicaid).
- **New Jersey** (mandate: P.L. 2009, c.115 (N.J.S.A. 17:48-6ii et al.)): fully-insured CHAMPVA plans issued in New Jersey sit under the state mandate. State Medicaid baseline: [NJ FamilyCare (New Jersey Medicaid) guide](https://carelu.com/payers/new-jersey-medicaid).
- **Maryland** (mandate: Habilitative services mandate (Md. Ins. § 15-835 + COMAR 31.10.39.03)): fully-insured CHAMPVA plans issued in Maryland sit under the state mandate. State Medicaid baseline: [Maryland Medicaid (Medical Assistance) guide](https://carelu.com/payers/maryland-medicaid).
- **Colorado** (mandate: Colorado autism insurance mandate (C.R.S. § 10-16-104(1.4))): fully-insured CHAMPVA plans issued in Colorado sit under the state mandate. State Medicaid baseline: [Health First Colorado (Colorado Medicaid) guide](https://carelu.com/payers/colorado-medicaid).
- **Utah** (mandate: Utah autism insurance mandate (Utah Code § 31A-22-642; caps removed 2020)): fully-insured CHAMPVA plans issued in Utah sit under the state mandate. State Medicaid baseline: [Utah Medicaid guide](https://carelu.com/payers/utah-medicaid).
- **Arizona** (mandate: Steven’s Law (A.R.S. § 20-826.04; dollar caps repealed by SB 1590, 2025)): fully-insured CHAMPVA plans issued in Arizona sit under the state mandate. State Medicaid baseline: [AHCCCS (Arizona Medicaid) guide](https://carelu.com/payers/arizona-ahcccs).
- **New York** (mandate: NY autism mandate (Ins. Law §§ 3216(i)(25), 3221(l)(17), 4303(ee))): fully-insured CHAMPVA plans issued in New York sit under the state mandate. State Medicaid baseline: [New York Medicaid (NYS DOH / eMedNY) guide](https://carelu.com/payers/new-york-medicaid).
- **New Mexico** (mandate: New Mexico autism insurance mandate (NMSA 1978 § 59A-22-49)): fully-insured CHAMPVA plans issued in New Mexico sit under the state mandate. State Medicaid baseline: [New Mexico Medicaid (Turquoise Care) guide](https://carelu.com/payers/new-mexico-medicaid).
- **Missouri** (mandate: Missouri autism insurance mandate (RSMo § 376.1224)): fully-insured CHAMPVA plans issued in Missouri sit under the state mandate. State Medicaid baseline: [MO HealthNet (Missouri Medicaid) guide](https://carelu.com/payers/missouri-medicaid).
- **Texas** (mandate: Texas autism mandate (Tex. Ins. Code § 1355.015)): fully-insured CHAMPVA plans issued in Texas sit under the state mandate. State Medicaid baseline: [Texas Medicaid (THSteps-CCP) guide](https://carelu.com/payers/texas-medicaid).
- **Massachusetts** (mandate: ARICA — Ch. 207, Acts of 2010 (M.G.L. c. 175 § 47AA et al.)): fully-insured CHAMPVA plans issued in Massachusetts sit under the state mandate. State Medicaid baseline: [MassHealth (Massachusetts Medicaid) guide](https://carelu.com/payers/masshealth-massachusetts-medicaid).
- **Florida** (mandate: Steven A. Geller Autism Coverage Act (§ 627.6686, Fla. Stat.)): fully-insured CHAMPVA plans issued in Florida sit under the state mandate. State Medicaid baseline: [Florida Medicaid — Behavior Analysis Services (AHCA) guide](https://carelu.com/payers/florida-medicaid).
- **Kansas** (mandate: Kansas autism insurance mandate (K.S.A. 40-2,194)): fully-insured CHAMPVA plans issued in Kansas sit under the state mandate. State Medicaid baseline: [KanCare (Kansas Medicaid) guide](https://carelu.com/payers/kansas-medicaid).
- **Nebraska** (mandate: Neb. Rev. Stat. § 44-7,106 (autism coverage, 25 hr/wk cap)): fully-insured CHAMPVA plans issued in Nebraska sit under the state mandate. State Medicaid baseline: [Nebraska Medicaid (Heritage Health) guide](https://carelu.com/payers/nebraska-medicaid).
- **Idaho** (mandate: No autism statute — DOI Bulletin 18-02 (habilitative-parity floor, plan years from 2019)): fully-insured CHAMPVA plans issued in Idaho sit under the state mandate. State Medicaid baseline: [Idaho Medicaid guide](https://carelu.com/payers/idaho-medicaid).
- **Iowa** (mandate: Iowa autism mandates (Iowa Code §§ 514C.31, 514C.28; caps and age limits removed by H.F. 330 from 1/1/2026)): fully-insured CHAMPVA plans issued in Iowa sit under the state mandate. State Medicaid baseline: [Iowa Medicaid (IA Health Link) guide](https://carelu.com/payers/iowa-medicaid).
- **Oklahoma** (mandate: Nick’s Law (36 O.S. § 6060.21; age and hour caps removed 2022)): fully-insured CHAMPVA plans issued in Oklahoma sit under the state mandate. State Medicaid baseline: [Oklahoma Medicaid (SoonerCare / SoonerSelect) - Oklahoma Health Care Authority guide](https://carelu.com/payers/oklahoma-medicaid).
- **Michigan** (mandate: Michigan autism mandate (MCL 500.3406s, 550.1416e; through age 18, $50K/$40K/$30K caps allowed)): fully-insured CHAMPVA plans issued in Michigan sit under the state mandate. State Medicaid baseline: [Michigan Medicaid guide](https://carelu.com/payers/michigan-medicaid).
- **Hawaii** (mandate: Luke’s Law (HRS § 431:10A-133; under 14, $25,000/yr ABA cap)): fully-insured CHAMPVA plans issued in Hawaii sit under the state mandate. State Medicaid baseline: [Hawaii Medicaid (Med-QUEST / QUEST Integration) guide](https://carelu.com/payers/hawaii-medicaid).
- **California** (mandate: SB 946 autism mandate (H&S § 1374.73, Ins. Code § 10144.51; no age or dollar caps)): fully-insured CHAMPVA plans issued in California sit under the state mandate. State Medicaid baseline: [Medi-Cal (California Medicaid) guide](https://carelu.com/payers/medi-cal-california-medicaid).
- **Pennsylvania** (mandate: Act 62 of 2008 (40 P.S. § 764h; under 21, CPI-adjusted cap $51,908 for 2026)): fully-insured CHAMPVA plans issued in Pennsylvania sit under the state mandate. State Medicaid baseline: [Pennsylvania Medicaid (Medical Assistance) guide](https://carelu.com/payers/pennsylvania-medicaid).
- **New Hampshire** (mandate: RSA 417-E:2 autism coverage (HB 569, 2010; no age or dollar caps in current text)): fully-insured CHAMPVA plans issued in New Hampshire sit under the state mandate. State Medicaid baseline: [New Hampshire Medicaid guide](https://carelu.com/payers/new-hampshire-medicaid).
- **Wisconsin** (mandate: Wis. Stat. § 632.895(12m) + Ins 3.36 (intensive start ages 2–9; 2026 floors $74,240 / $37,119)): fully-insured CHAMPVA plans issued in Wisconsin sit under the state mandate. State Medicaid baseline: [Wisconsin Medicaid (ForwardHealth) guide](https://carelu.com/payers/wisconsin-medicaid).
- **South Carolina** (mandate: Ryan’s Law (S.C. Code § 38-71-280; group plans, dx by age 8, under 16, $73,400 behavioral-therapy cap for 2026)): fully-insured CHAMPVA plans issued in South Carolina sit under the state mandate. State Medicaid baseline: [South Carolina Healthy Connections Medicaid guide](https://carelu.com/payers/south-carolina-medicaid).
- **Kentucky** (mandate: KRS 304.17A-142 autism coverage (no age, annual-benefit or visit caps since 2019)): fully-insured CHAMPVA plans issued in Kentucky sit under the state mandate. State Medicaid baseline: [Kentucky Medicaid guide](https://carelu.com/payers/kentucky-medicaid).
- **Washington** (mandate: Mental health parity (RCW 48.44.341 et al.; RCW 48.43.766 from 2027); no stand-alone autism statute): fully-insured CHAMPVA plans issued in Washington sit under the state mandate. State Medicaid baseline: [Washington Apple Health (Medicaid) guide](https://carelu.com/payers/washington-medicaid).
- **Connecticut** (mandate: Conn. Gen. Stat. §§ 38a-514b / 38a-488b (behavioral therapy under 21, under 26 from 1/1/2027; no dollar cap)): fully-insured CHAMPVA plans issued in Connecticut sit under the state mandate. State Medicaid baseline: [Connecticut Medicaid (HUSKY Health) guide](https://carelu.com/payers/connecticut-medicaid).
- **Illinois** (mandate: Illinois autism mandate (215 ILCS 5/356z.14; under 21, $36,000/yr CPI-adjusted)): fully-insured CHAMPVA plans issued in Illinois sit under the state mandate. State Medicaid baseline: [Illinois Medicaid (HFS) guide](https://carelu.com/payers/illinois-medicaid).
- **Louisiana** (mandate: La. R.S. 22:1050 (under 21, $36,000/yr cap)): fully-insured CHAMPVA plans issued in Louisiana sit under the state mandate. State Medicaid baseline: [Louisiana Medicaid (Healthy Louisiana) guide](https://carelu.com/payers/louisiana-medicaid).
- **Oregon** (mandate: Oregon Laws 2013, ch. 771, § 2 (ABA up to 25 hr/wk, first requested under 9) + ORS 743A.168 parity): fully-insured CHAMPVA plans issued in Oregon sit under the state mandate. State Medicaid baseline: [Oregon Health Plan (Medicaid) guide](https://carelu.com/payers/oregon-medicaid).
- **Minnesota** (mandate: Minn. Stat. § 62A.3094 (large-employer plans, children under 18)): fully-insured CHAMPVA plans issued in Minnesota sit under the state mandate. State Medicaid baseline: [Minnesota Medical Assistance (EIDBI) guide](https://carelu.com/payers/minnesota-medicaid).
- **Maine** (mandate: Maine autism mandate (24-A M.R.S. §§ 2768, 2847-T, 4259; age 10 and under, $36,000/yr ABA cap allowed)): fully-insured CHAMPVA plans issued in Maine sit under the state mandate. State Medicaid baseline: [MaineCare (Maine Medicaid) guide](https://carelu.com/payers/maine-medicaid).
- **Vermont** (mandate: 8 V.S.A. § 4082 (formerly § 4088i; birth to 21, no dollar or hour cap)): fully-insured CHAMPVA plans issued in Vermont sit under the state mandate. State Medicaid baseline: [Vermont Medicaid (Green Mountain Care / DVHA) guide](https://carelu.com/payers/vermont-medicaid).
- **Alabama** (mandate: Riley Ward Act (Ala. Code § 27-54A-2; large group, 18 and under, ABA caps $40K/$30K/$20K by age)): fully-insured CHAMPVA plans issued in Alabama sit under the state mandate. State Medicaid baseline: [Alabama Medicaid guide](https://carelu.com/payers/alabama-medicaid).
- **South Dakota** (mandate: SDCL 58-17-154 to -162 (ABA; annual floors $36,000/$25,000/$12,500 through age 18; ACA individual/small-group exempt)): fully-insured CHAMPVA plans issued in South Dakota sit under the state mandate. State Medicaid baseline: [South Dakota Medicaid guide](https://carelu.com/payers/south-dakota-medicaid).
- **Nevada** (mandate: NRS 689B.0335 autism mandate (under 18, or 22 in high school; $72,000/yr ABA cap)): fully-insured CHAMPVA plans issued in Nevada sit under the state mandate. State Medicaid baseline: [Nevada Medicaid guide](https://carelu.com/payers/nevada-medicaid).
- **Montana** (mandate: Montana autism mandate (MCA 33-22-515; group plans, through age 18, caps of $50,000/yr to age 8 and $20,000/yr ages 9–18 allowed)): fully-insured CHAMPVA plans issued in Montana sit under the state mandate. State Medicaid baseline: [Montana Medicaid guide](https://carelu.com/payers/montana-medicaid).
- **Alaska** (mandate: AS 21.42.397 autism coverage (under 21; no visit or dollar caps; small groups of 20 or fewer exempt)): fully-insured CHAMPVA plans issued in Alaska sit under the state mandate. State Medicaid baseline: [Alaska Medicaid guide](https://carelu.com/payers/alaska-medicaid).
- **North Dakota** (mandate: No autism statute — Insurance Dept. Bulletin 2018-1 (insured plans may not exclude ABA as experimental; federal parity limits)): fully-insured CHAMPVA plans issued in North Dakota sit under the state mandate. State Medicaid baseline: [North Dakota Medicaid guide](https://carelu.com/payers/north-dakota-medicaid).
- **Arkansas** (mandate: Ark. Code § 23-99-418 (Act 196 of 2011; ABA under 18 and $50,000/yr as enacted)): fully-insured CHAMPVA plans issued in Arkansas sit under the state mandate. State Medicaid baseline: [Arkansas Medicaid guide](https://carelu.com/payers/arkansas-medicaid).
- **Rhode Island** (mandate: R.I. Gen. Laws ch. 27-20.11 (group plans; until age 15; no dollar cap in current text)): fully-insured CHAMPVA plans issued in Rhode Island sit under the state mandate. State Medicaid baseline: [Rhode Island Medicaid guide](https://carelu.com/payers/rhode-island-medicaid).
- **Wyoming** (mandate: No autism statute — DOI Bulletin 01-2019 (mental-health parity, W.S. 26-20-701; no ABA exclusions from 7/1/2019)): fully-insured CHAMPVA plans issued in Wyoming sit under the state mandate. State Medicaid baseline: [Wyoming Medicaid guide](https://carelu.com/payers/wyoming-medicaid).
- **West Virginia** (mandate: W. Va. Code § 33-24-7k et al. (group plans; ages 18 months–18, dx by 8, $30,000/yr ABA cap for 3 years then $2,000/month)): fully-insured CHAMPVA plans issued in West Virginia sit under the state mandate. State Medicaid baseline: [West Virginia Medicaid (BMS) guide](https://carelu.com/payers/west-virginia-medicaid).
- **District of Columbia** (mandate: D.C. Code §§ 31-3271–31-3272 (habilitative services incl. autism, under 21; ABA named in DC EHB benchmark)): fully-insured CHAMPVA plans issued in District of Columbia sit under the state mandate. State Medicaid baseline: [District of Columbia Medicaid guide](https://carelu.com/payers/district-of-columbia-medicaid).
- **Mississippi** (mandate: Miss. Code Ann. § 83-9-26 (HB 885, 2015; ABA may stop at age 8 and 25 hr/wk unless medically necessary)): fully-insured CHAMPVA plans issued in Mississippi sit under the state mandate. State Medicaid baseline: [Mississippi Medicaid guide](https://carelu.com/payers/mississippi-medicaid).
- **Delaware** (mandate: Delaware autism mandate (18 Del. C. §§ 3366, 3570A; under 21, CPI-adjusted ABA cap $38,601.65 for 2026)): fully-insured CHAMPVA plans issued in Delaware sit under the state mandate. State Medicaid baseline: [Delaware Medicaid (DMAP / Diamond State Health Plan) guide](https://carelu.com/payers/delaware-medicaid).

## Intake gates

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

- **Age limit**: No ABA-specific age limit is published; what bounds the case is dependent eligibility. A dependent child can remain eligible from 18 to 23 while enrolled in school, and a child who is permanently unable to support themselves because of a disability that began before age 18 can remain eligible beyond that. Eligibility runs to the spouse or dependent child of a veteran rated permanently and totally disabled from a service-connected disability, and to the surviving spouse or child of a veteran who died from — or was rated permanently and totally disabled from — a service-connected disability. [1][2]
- **Who may diagnose**: The CHAMPVA Operational Policy Manual’s ABA section excludes “Diagnoses and referrals from Nurse Practitioners (NPs), Physician Assistants (PAs), or other providers not having the qualifications listed in Operational Policy.” It does not list the qualifying diagnosing credentials itself; the mental-health section lists the qualified mental-health providers as physicians (MD/DO), clinical psychologists, certified psychiatric nurse specialists, certified clinical social workers, certified marriage and family therapists, TRICARE-certified mental health counselors, and pastoral or mental health counselors under a physician’s supervision. Do not apply TRICARE’s ACD list. [11][12]
- **Referral required?**: The split is the operationally useful fact, and it is published twice. ABA appears among the services requiring pre-authorization as “Applied behavior analysis (ABA) for treatment only (not the evaluation),” and again in the Behavioral Health Services benefit table as “Autism – Applied Behavioral Analysis (ABA) requires pre-authorization for treatment only (not evaluation).” So a family can be evaluated without waiting on CHAMPVA. Treatment requests go directly to CHAMPVA by phone on 800-733-8387, by email to VHAHAC.preauthorizationFM@va.gov, or by mail to the VHA Office of Integrated Veteran Care. Two published exceptions remove the requirement entirely: services provided through CITI, the CHAMPVA In-house Treatment Initiative at a VA medical center (also exempt from beneficiary cost sharing), and services another health insurer has already authorized — though if that insurer denies for failure to follow its rules or for lack of medical necessity, CHAMPVA will deny as well. There is no separate physician-order form; the referral travels inside the treatment plan. The CHAMPVA Operational Policy Manual requires the ABA assessment and treatment plan to show the “Date the initial ABA assessment and initial TP was completed, and name of the referring provider,” and excludes “Diagnoses and referrals from Nurse Practitioners (NPs), Physician Assistants (PAs), or other providers not having the qualifications listed.” No validity period for the referral is set. [2][11]
- **Other insurance (who pays first)**: CHAMPVA pays last: “CHAMPVA only pays first if you have one of four types of these other health insurance …: Medicaid; Indian Health Services; State Victims of Crime Compensation Program; CHAMPVA supplemental health insurance. If you have any other type of other health insurance, CHAMPVA will pay secondary.” File with the other plan first, then send CHAMPVA the claim with the other plan’s EOB and the provider’s itemized bill — “CHAMPVA benefits will generally not be paid until the claim has been filed with the OHI and the OHI has issued a final payment determination.” The practical upside: “When other health insurance has authorized a service listed under ‘Services that require pre-authorization’ … we do not require pre-authorization for that service.” The catch: “If other health insurance denies coverage because their rules for coverage were not followed or medical necessity was not established, we will also deny coverage.” [3][9]
- **Diagnosis recency** _(ask the plan)_: Not set. The CHAMPVA Operational Policy Manual’s ABA section requires an ASD diagnosis “using the current Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria” but sets no maximum age for the diagnostic evaluation. Capture the evaluation date and the diagnosing provider anyway; the assessment and treatment plan must name the referring provider. [11][2]
  - Ask the plan: CHAMPVA customer service and pre-authorization line, 800-733-8387, or VHAHAC.preauthorizationFM@va.gov. Ask when you request pre-authorization and get the answer in writing.
- **Diagnostic tools required** _(ask the plan)_: None required. The CHAMPVA Operational Policy Manual’s ABA section requires a DSM diagnosis of ASD and names no required instrument. It defines the PDDBI (an informant rating scale for ages 2–18.5) in its descriptions but does not make it a condition of coverage, and none of the ACD’s outcome-measure regime applies. [11]
  - Ask the plan: CHAMPVA customer service and pre-authorization line, 800-733-8387, or VHAHAC.preauthorizationFM@va.gov. Ask when you request pre-authorization and get the answer in writing.
- **Telehealth** _(ask the plan)_: Not settled for ABA. The CHAMPVA Operational Policy Manual describes ABA specialized interventions as delivered “during one-on-one in-person (i.e., face to face) interactions with the beneficiary.” The mental-health section says “Mental health services or advice provided as telehealth, including by audio-only telephone, are a covered benefit,” and psychological testing by telehealth is covered. No ABA code list, modifier or POS is published, so ask before delivering any ABA code remotely. [11][12]
  - Ask the plan: CHAMPVA pre-authorization line, 800-733-8387: name the codes and the delivery mode in the request and get the answer in writing.
- **Prior-auth decision time** _(ask the plan)_: CHAMPVA requires pre-authorization for “Applied behavior analysis (ABA) for treatment only (not the evaluation).” Once CHAMPVA has the treatment plan, “preauthorization may be granted for one year of ABA services” (Operational Policy Manual Ch. 2 Sec. 18.6). Neither the manual, the Guidebook nor 38 CFR 17.273 states how long VA has to decide, and no reauthorization lead time is published. When the child’s other insurance is primary and has authorized the service, CHAMPVA does not require its own pre-authorization. [3][11][6]
  - Ask the plan: CHAMPVA pre-authorization line (833-930-0816 / 800-733-8387): ask the decision turnaround and how far ahead to submit each renewal.

## Delivery and billing rules

Coverage decides whether CHAMPVA 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**: Authorized ABA providers “serve as direct supervisors of the assistant behavior analysts and BTs and ensure that the quality of the ABA services provided by assistant behavior analysts and BTs meets the minimum standards of recommendations and rules promulgated by the applicable certifying body” (CHAMPVA Operational Policy Manual Ch. 2 Sec. 18.6). Qualified assistants are LABAs, BCaBAs and QASPs; technicians are high-school-level paraprofessionals such as RBTs, ABATs and BCATs. “Indirect supervision” is excluded, and so is “Training of the BTs.” No CHAMPVA supervision ratio or percentage is set beyond the certifying body’s. [11]
- **Concurrent billing (97153 + 97155)**: No overlapping provider time. The CHAMPVA Operational Policy Manual’s ABA section (Ch. 2 Sec. 18.6) excludes “Billing for multiple providers’ time during one ABA session with a child when more than one ABA provider is present,” so a BCBA’s 97155 cannot be billed for the same session time as the technician’s 97153. It also excludes “Indirect supervision” and “Group ABA services, which are defined as multiple beneficiaries with fewer providers, such as three or more children with one or two providers.” Do not import TRICARE’s ACD matrix — CHAMPVA is a separate VA program. [11]
- **Daily limits / MUEs**: No per-code unit cap is published. The CHAMPVA Operational Policy Manual’s ABA section (Ch. 2 Sec. 18.6, Transmittal 152, May 2025) sets no daily or weekly maximum for 97151–97158; it says pre-authorization “must include an ABA TP” and “may be granted for one year of ABA services,” so the ceiling is the weekly hours CHAMPVA approves on the treatment plan. The mental-health section (Ch. 2 Sec. 18.1) adds: “May 30, 2024, quantitative limits are removed for covered mental health and substance use disorder (SUD) care. Documentation may be requested to determine medical necessity and to support the level of care.” Psychological testing is “not counted against the number of weekly hours allowed for ABA.” Bill only the units on the approval letter. [11][12]
- **Bill as provider**: The authorized ABA provider bills. Under the CHAMPVA Operational Policy Manual (Ch. 2 Sec. 18.6), authorized ABA providers are BCBAs, BCBA-Ds “or other qualified CHAMPVA-authorized independent providers” who employ or contract with assistant behavior analysts and behavior technicians and “serve as direct supervisors” of them. “Only one authorized ABA provider is authorized to provide ABA services for each beneficiary at a time,” and that primary provider “is the sole provider authorized to bill for ABA services,” even when it consults another. The general rule for employees (Ch. 2 Sec. 15.4) is the same: “The authorized provider must bill for the services rendered by the employees.” The claims chapter asks for the provider’s NPI, TIN, professional status and the physical location of service; it does not say whether a technician’s own NPI also goes on the line. [11][14][13]
- **Session-note signature** _(ask the plan)_: No session-note signature rule is published. The CHAMPVA Operational Policy Manual’s ABA section sets a signature rule for the treatment plan instead: “The TP and updates shall contain signatures by the authorized ABA supervisor and the parent/caregiver,” and the assessment and TP must show the date they were completed and the name of the referring provider. [11]
  - Ask the plan: CHAMPVA pre-authorization line, 800-733-8387: ask what session-note content and signatures CHAMPVA expects on a records request.
- **Place of service** _(ask the plan)_: No list of allowed settings is published. The CHAMPVA Operational Policy Manual’s ABA section excludes “Educational/academic and vocational rehabilitation,” “Educational ABA services,” school tuition that includes ABA, and “Custodial care, personal care, and/or child care.” Services delivered in a VA medical center under CITI are exempt from pre-authorization and cost sharing (Guidebook). [11][2]
  - Ask the plan: Confirm allowable settings in the pre-authorization decision before scheduling home, school or community sessions; CHAMPVA 800-733-8387

## What intake should collect for CHAMPVA

- **CHAMPVA vs. TRICARE, settled:** Confirm the family is not eligible for or enrolled in TRICARE. The two are mutually exclusive, and a retiree or a spouse of a veteran killed in action is a TRICARE beneficiary.
- **Other health insurance:** CHAMPVA behaves very differently as secondary payer — patient generally pays nothing — and an OHI authorization can remove the CHAMPVA pre-authorization requirement. Capture the primary plan first.
- **Beneficiary category and the child’s age:** Which eligibility route the family qualifies under, and for a dependent child whether they are under 18, 18–23 in school, or permanently incapable of self-support since before 18.
- **Evaluation on hand:** The evaluation does not require pre-authorization, so there is no reason to wait. Capture the diagnosing provider and the report date, and expect to send them with the treatment request.
- **Pre-authorization confirmation in writing:** Phone, email or mail the request, and record the reference and the stated authorization period, credential expectations and setting limits — none of that is published.

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

## Common questions

### Does CHAMPVA require EVV or exclude any ABA codes?

The CHAMPVA Operational Policy Manual’s ABA section has no EVV requirement and no ABA code list. It excludes group ABA (three or more children with one or two providers), indirect supervision, and billing more than one provider’s time in one session. Bill the codes and units on the pre-authorization.

### Does CHAMPVA require graphs for an ABA renewal?

No format is published. The CHAMPVA Operational Policy Manual requires an ABA treatment plan with the target behaviors, the interventions and the short- and long-term objectives and goals. Pre-authorization can then run for one year, and the plan and each update must be signed by the ABA supervisor and the parent or caregiver. Ask the pre-authorization reviewer whether the renewal needs anything beyond that.

### Does CHAMPVA require a taxonomy code on ABA claims?

CHAMPVA publishes no taxonomy rule. Its Operational Policy Manual claims chapter lists the provider information a claim needs (name and address, remittance address, physical location of service, professional status, TIN and NPI) and taxonomy is not among them. Ask the pre-authorization unit if a claim rejects.

### Does CHAMPVA cover ABA therapy?

Yes. Applied behavior analysis appears in the CHAMPVA Guidebook as a covered behavioral health benefit, with pre-authorization required for treatment only, not for the evaluation.

### Is CHAMPVA the same as TRICARE?

No. CHAMPVA is a VA program and TRICARE is the Department of Defense program. They are mutually exclusive: a person eligible for or enrolled in TRICARE cannot receive CHAMPVA benefits. None of the TRICARE Autism Care Demonstration rules apply to CHAMPVA.

### What does a CHAMPVA family pay for ABA?

When CHAMPVA is the primary payer, the annual deductible of $50 per individual or $100 per family, then a 25% cost-share, with CHAMPVA paying 75% of the allowable amount. Beneficiary cost sharing is capped at $3,000 a year. When CHAMPVA is secondary or tertiary, the patient pays nothing in most cases.

### Does CHAMPVA have a provider network?

No. The VA states that CHAMPVA does not have a network of health care providers and beneficiaries can visit most authorized providers. Pre-authorization, not network status, is the gate for ABA treatment.

### How long does a CHAMPVA ABA authorization last?

Up to a year. The CHAMPVA Operational Policy Manual says pre-authorization for ABA "must include an ABA TP" and, once CHAMPVA has it, "may be granted for one year of ABA services." Ask on 800-733-8387 what the renewal needs.

### What are CHAMPVA’s maximum unit caps for ABA?

CHAMPVA publishes no per-code daily or weekly unit cap. Its Operational Policy Manual approves ABA for up to a year on the treatment plan, so the cap is the weekly hours on the approval letter, and its mental-health section says quantitative limits were removed for covered mental health care from May 30, 2024. It does exclude billing two providers’ time in the same session and group ABA with three or more children per one or two providers.

### Does CHAMPVA require the referring provider on ABA claims?

Not as a claim field. The CHAMPVA claims chapter lists the provider’s name, address, service location, professional status, TIN and NPI, with no referring provider. The referring provider’s name must appear in the ABA assessment and treatment plan instead, and CHAMPVA excludes diagnoses and referrals from nurse practitioners and physician assistants.

### Can a BCBA licensed in another state provide ABA by telehealth to a CHAMPVA family?

CHAMPVA publishes no rule on it. Its test is that the provider is licensed or certified by a state (or nationally certified where the state does not license) and works within the scope of that licence. Whether the licence reaches a child in another state depends on the state laws involved. Name the delivery mode and licence state in the pre-authorization request and get CHAMPVA’s answer in writing.

### Does CHAMPVA allow retroactive authorization for ABA?

Not as a routine. ABA treatment needs pre-authorization before it starts. The regulation allows a retrospective medical-necessity review only in coordination of benefits: when CHAMPVA turns out to be the responsible payer, pre-authorization was not obtained, and the claim is filed within one year.

### What is CHAMPVA’s timely filing limit for ABA claims?

One year after the date of service. Claims filed after that are denied, and a timely-filing denial goes through CHAMPVA’s appeal process. If eligibility was granted retroactively, there are 180 days from the first CHAMPVA card to file for the earlier dates.

### Does CHAMPVA want ABA claims billed under the supervising BCBA or the rendering technician?

Under the authorized ABA provider. CHAMPVA’s Operational Policy Manual makes the BCBA, BCBA-D or other authorized independent provider the only one who may bill: technicians and assistants work under that provider, and the primary authorized ABA provider "is the sole provider authorized to bill for ABA services." The manual does not say whether a technician’s own NPI also goes on the line, so ask the pre-authorization unit (833-930-0816) before the first claim.

### How do we appeal a CHAMPVA ABA denial?

For a claim decided in the last year, request a higher-level review, file a supplemental claim with new evidence, or appeal to the Board of Veterans’ Appeals. For a denied pre-authorization, write to CHAMPVA Appeals within one year of the VA notice with the denial letter and any new documentation.

## Primary sources

1. [VA — CHAMPVA](https://www.va.gov/family-and-caregiver-benefits/health-and-disability/champva/)
2. [CHAMPVA Guidebook (updated Jan. 1, 2025) (PDF)](https://www.va.gov/COMMUNITYCARE/docs/pubfiles/programguides/CHAMPVA-Guide.pdf)
3. [VA — CHAMPVA Guidebook (March 2026 posting)](https://www.va.gov/files/2026-03/CHAMPVA-Guidebook_3-2026.pdf)
4. [eCFR — 38 CFR 17.270, General provisions (definition of authorized non-VA provider)](https://www.ecfr.gov/current/title-38/section-17.270)
5. [eCFR — 38 CFR 17.272, Benefits limitations/exclusions](https://www.ecfr.gov/current/title-38/section-17.272)
6. [eCFR — 38 CFR 17.273, Preauthorization](https://www.ecfr.gov/current/title-38/chapter-I/part-17/subject-group-ECFRd3f6f5d27d7b5ae/section-17.273)
7. [Federal Register — CHAMPVA Coverage of Audio-Only Telehealth, Mental Health Services, and Cost Sharing for Certain Contraceptive Services (final rule, Apr. 30, 2024)](https://www.govinfo.gov/content/pkg/FR-2024-04-30/html/2024-09072.htm)
8. [VA Community Care — CHAMPVA (provider eligibility, preauthorization and claims)](https://www.va.gov/COMMUNITYCARE/revenue-ops/FM-Care-Claims.asp)
9. [eCFR — 38 CFR 17.276, Claim filing deadline (§17.276(d): CHAMPVA is the last payer to OHI)](https://www.ecfr.gov/current/title-38/chapter-I/part-17/section-17.276)
10. [VA Community Care — Provider Advisor Bulletin (index of bulletins)](https://department.va.gov/vha/community-care/provider-advisor/)
11. [CHAMPVA Operational Policy Manual, Ch. 2 Sec. 18.6, Psychological Testing (ABA) — Transmittal 152, 5/22/2025](https://www.vha.cc.va.gov/system/templates/selfservice/va_ssnew/help/customer/locale/en-US/portal/554400000001036/content/554400000009345/02-18-06-PSYCHOLOGICAL-TESTING)
12. [CHAMPVA Operational Policy Manual, Ch. 2 Sec. 18.1, Treatment of Mental Disorders — Transmittal 153, 6/12/2025](https://www.vha.cc.va.gov/system/templates/selfservice/va_ssnew/help/customer/locale/en-US/portal/554400000001036/content/554400000009341/02-18-01-TREATMENT-OF-MENTAL-DISORDERS)
13. [CHAMPVA Operational Policy Manual, Ch. 3 Sec. 1.1, Claims Processing — General (Transmittal 139)](https://www.vha.cc.va.gov/system/templates/selfservice/va_ssnew/help/customer/locale/en-US/portal/554400000001036/content/554400000009404/03-01-01-CLAIMS-PROCESSING-GENERAL)
14. [CHAMPVA Operational Policy Manual, Ch. 2 Sec. 15.4, Services Rendered by Employees of Authorized Independent Professional Providers](https://www.vha.cc.va.gov/system/templates/selfservice/va_ssnew/help/customer/locale/en-US/portal/554400000001036/content/554400000009010/02-15-04-SERVICES-RENDERED-BY-EMPLOYEES-OF-AUTHORIZED-INDEPENDENT-PROFESSIONAL-PROVIDERS)

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.

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