---
title: "First Choice by Select Health ABA coverage: the intake guide."
url: "https://carelu.com/payers/first-choice-select-health-south-carolina"
markdown_url: "https://carelu.com/payers/first-choice-select-health-south-carolina.md"
state: SC (South Carolina)
payer: First Choice by Select Health of South Carolina
kind: Medicaid managed care plan (MCO)
parent_program: South Carolina Healthy Connections Medicaid
description: "How First Choice by Select Health of South Carolina covers ABA: prior authorization for all ASD services including assessments, InterQual plus the SCDHHS ASD manual, the one-year diagnostic report rule, decision times and claims limits."
last_reviewed: October 2026
---

# First Choice by Select Health ABA coverage: the intake guide.

_Payer Guide · First Choice by Select Health · South Carolina · Last updated October 2026 · 12 primary sources_

> AmeriHealth Caritas’ SC Medicaid plan: PA on all ASD services incl. assessments, InterQual + the SCDHHS manual, and a diagnostic report from the last year.

First Choice is the Medicaid plan of Select Health of South Carolina, a wholly owned subsidiary of AmeriHealth Caritas, and one of the five Healthy Connections MCOs. Its August 2026 provider manual covers ASD services for members under 21, requires prior authorization for every ASD service including the assessment, and says it will "adhere to InterQual criteria and medical necessity requirements as outlined for each service in the SCDHHS Autism Spectrum Disorder Services Manual." Its treatment checklist adds a rule the state manual does not have: the diagnostic report must be from within the last year.

This plan administers the **South Carolina Healthy Connections Medicaid** ABA benefit: the state rules are the floor, and this page covers what the plan layers on top. Read it together with the [South Carolina Healthy Connections Medicaid guide](https://carelu.com/payers/south-carolina-medicaid).

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Yes: "Prior authorization is required for all ASD services, including assessments and treatments" [1][5]
- **Prior auth for treatment**: Yes, through NaviNet or the ASD Treatment Request form faxed to Behavioral Health UM (1-888-796-5521) [1][3][4]
- **Autism diagnosis required?**: Yes: the initial request needs a diagnostic evaluation/report completed by a qualified LPHA "within the last year," signed and meeting the SCDHHS ASD manual’s content requirements [2][1]

## At a glance

- **Covers ABA?:** Yes, ASD services for members under 21
- **Prior auth:** All ASD services, including assessments
- **Submit via:** NaviNet, or ASD Treatment Request form to BH UM fax 1-888-796-5521 (phone 1-866-341-8765)
- **Diagnosis:** Report by a qualified LPHA within the last year
- **Decision clock:** Manual: 14 calendar days nonurgent, 3 days urgent
- **Timely filing:** 365 days; claims after a primary’s EOB within 60 days of it

## Coverage, criteria and prior authorization

Select Health covers ASD services "for members under 21 years of age," delivered by BCBAs, BCaBAs and RBTs, and by licensed independent practitioners for non-ABA treatment. Services "must be recommended by a licensed psychologist (PhD, PsyD) developmental pediatrician, or an LPES," and individual ASD providers must be located within the SCMSA. "Prior authorization is required for all ASD services, including assessments and treatments," and the plan "will adhere to InterQual criteria and medical necessity requirements as outlined for each service in the SCDHHS Autism Spectrum Disorder Services Manual." Requests go through NaviNet (preferred) or the ASD Treatment Request form, faxed to Behavioral Health Utilization Management at 1-888-796-5521 (questions 1-866-341-8765). [1][2][3][4][5]

The plan’s checklist for an initial request: the completed treatment request form; a "Diagnostic evaluation/report" completed by a qualified Licensed Practitioner of the Healing Arts "within the last year, signed by the LPHA," meeting the SCDHHS content requirements; and, if the child was already in treatment with you, the behavior plan, progress summary with cumulative graphs, a sample schedule, caregiver goals and a summary of contact with other providers and the school. The form makes care-coordination documentation mandatory. One caution: Select Health’s March 2026 claim filing instructions still list the retired Category III codes (0359T, 0364T, 0368T and so on) in their ASD section; bill the current CPT codes the SCDHHS manual and the request form use. [1][2][3][4][5]

## Claims and decision times

Claims are due "within 365 calendar days from the date services were rendered," and resubmissions within 365 days; when a primary insurer delays the claim, submit within 60 days of the primary’s EOB. First Choice is "the payer of last resort." The manual says nonurgent preservice decisions are made within 14 calendar days and urgent ones within three calendar days; federal rules cap standard managed-care decisions at 7 calendar days for rating periods starting on or after January 1, 2026, so ask which clock applies. [1][9][5]

The March 2026 claim filing instructions add the payment side: "Please allow for normal processing time (30 days for clean claims) before resubmitting a claim," denied claims must be resubmitted as corrected claims (frequency code 7 or 8 with the original claim number) within 365 calendar days of the date of service, and "Select Health of South Carolina runs three provider payment cycles per week (Mondays, Wednesdays, and Fridays)," with one or two runs in holiday weeks. No submission cut-off time for a given cycle is published. [1][9][5]

## Intake gates

The questions that decide whether a family can start with First Choice by Select Health of South Carolina, and what they have to bring.

- **Age limit**: Under 21 ("members under 21 years of age"; elsewhere "ages 0 to 21"). [1]
- **Diagnosis recency**: Within the last year: the checklist requires a diagnostic evaluation/report "completed by a qualified Licensed Practitioner of the Healing Arts (LPHA) within the last year." This is stricter than the SCDHHS manual, which sets no expiry. [2]
- **Who may diagnose**: A "qualified" LPHA whose report meets "the content requirements outlined in the ASD Services Provider Manual," which limits the diagnosis to MD/DO, PhD/PsyD or LPES, in person. Services must be recommended by a licensed psychologist, developmental pediatrician or LPES. [2][1][6]
- **Diagnostic tools required**: Through the SCDHHS content requirements it adopts: an in-person ADI-R, ADOS or CARS, a DSM checklist with severity levels and a cognitive or developmental measure. [2][6]
- **Referral required?**: Yes: services "must be recommended by a licensed psychologist (PhD, PsyD) developmental pediatrician, or an LPES." [1]
- **Other insurance (who pays first)**: "Medicaid is always the payer of last resort," and First Choice considers the primary’s payment when calculating what it owes. Note that "Prior authorization requirements are applicable to secondary claims." Claims with a primary EOB go in within 60 days of that EOB. [1][4][10]
- **Telehealth** _(plan-dependent)_: Select Health publishes no ABA telehealth rule but follows the SCDHHS ASD manual’s medical-necessity requirements per service. The state rule: Under the SCDHHS ASD manual (July 1, 2026), only two ABA codes may be delivered by telehealth: 97156 (family guidance), with the GT modifier and no extra authorization, and 97155 (protocol modification), only when the QIO approves it during prior authorization, for up to 25% of authorized and rendered 97155 units, for a member receiving in-home ABA in a rural location with limited access. Telehealth must be synchronous audio and video, GT goes in the secondary modifier position, and POS is 02 or 10. "The BIA can not be completed by telehealth," and 97152, 97153, 97154, 97157, 97158, 0362T and 0373T are not deliverable by telehealth. An ASD diagnosis made by telehealth is not valid. [1][6]
  - Ask the plan: Select Health Behavioral Health UM, 1-866-341-8765: confirm the July 2026 telehealth limits and its modifier rules.
- **Prior-auth decision time** _(plan-dependent)_: The manual says nonurgent preservice decisions "within 14 calendar days" and urgent "no later than three calendar days." Federal rules cap standard managed-care decisions at 7 calendar days for rating periods starting on or after January 1, 2026. [1][9]
  - Ask the plan: Select Health Behavioral Health UM, 1-866-341-8765.

## Delivery and billing rules

Coverage decides whether First Choice by Select Health of South Carolina 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**: Select Health applies the medical-necessity requirements "outlined for each service in the SCDHHS Autism Spectrum Disorder Services Manual," which sets: BACB supervision applies: "each RBT must be supervised for a minimum of 5% of the hours spent providing ABA services per month," with at least two face-to-face, real-time contacts a month, one of which observes the RBT with the member; that professional supervision is not billable. Caseload caps: a BCBA may carry 12 cases (16 with a BCaBA), a BCaBA 12, where 30–40 hours a week is one case, 10–25 hours half a case and under 10 hours a quarter case. A behavior technician gets one 90-day grace period to earn the RBT credential, and may work only in a clinic with a BCBA on site during it. [1][6]
- **Daily limits / MUEs**: The ASD Treatment Request form prints "limitation reminders" matching the SCDHHS limits, e.g. 97151 32 units a year, 97152 21 units a day, 97153 160 units a week, 97154 24 units a day. [3][6]
- **Place of service**: Services "may be provided in the member’s home, clinical setting, or other settings authorized by SCDHHS," and individual ASD providers must be located within the SCMSA. [1]
- **Concurrent billing (97153 + 97155)** _(plan-dependent)_: Select Health publishes no rule of its own; the SCDHHS manual it follows bars concurrent 97153 billing except as section 8 allows (97155 with 97153 when both deliver a direct service; 97153 with 97156 in separate spaces). On ABA alongside other therapies, Select Health publishes nothing of its own; the state baseline: the SCDHHS ASD manual's non-covered list is explicit — "Concurrent billing of 97153 with any other service or therapy is excluded except as detailed in Section 8," and Section 8's exceptions are ABA-with-ABA only. It also excludes "ABA services while the member is at another medical appointment," and, in the other direction, ABA treatment "that precludes, or requires the member's family to stop engaging with other critical supports … speech therapy, occupational therapy, or IDEA recommended school-based curriculum and supports." So speech and ABA can both continue, but not on the same clock time as a billed 97153 unit. The manual also binds providers to the National Correct Coding Initiative edits and related coding policy unless it says otherwise. [1][6][13]
  - Ask the plan: Select Health Behavioral Health UM, 1-866-341-8765: confirm it pays concurrent 97153/97155 claims under the state rule.
- **Session-note signature** _(plan-dependent)_: Select Health publishes no ABA note rule of its own; under the SCDHHS manual each note is signed by the enrolled BCBA/BCaBA and the rendering BT/RBT before the claim is filed. [1][6]
  - Ask the plan: Select Health Behavioral Health UM, 1-866-341-8765, or the plan’s medical-record guidelines.
- **Bill as provider** _(plan-dependent)_: Not stated for ABA. The treatment request form lists each provider’s credential (BCBA, BCaBA, RBT); the SCDHHS manual has RBT services bill under a BCBA-D, BCBA or BCaBA. [3][6]
  - Ask the plan: Select Health Claims, 1-800-575-0418: ask which NPI goes in box 24J for RBT services.

## What intake should collect for First Choice by Select Health of South Carolina

- **Diagnostic report from the last year:** Signed by a qualified LPHA and meeting the SCDHHS content rules; an older report will not satisfy the checklist.
- **School and therapy coordination:** Hours and targets of school, early intervention and other therapies; the form makes this section required.
- **Prior ABA records:** If the child was already in treatment: progress summary with graphs, sample schedule and caregiver goals.
- **Other insurance:** First Choice pays last; secondary claims go in within 60 days of the primary’s EOB.

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

## Common questions

### When does First Choice (Select Health) pay claims?

It runs three payment cycles a week, on Mondays, Wednesdays and Fridays (fewer in holiday weeks), and asks providers to allow 30 days for a clean claim before resubmitting. No cut-off time for each cycle is published.

### Does First Choice by Select Health need prior authorization for the ABA assessment?

Yes. Select Health requires prior authorization for all ASD services, assessments included.

### How recent must the autism evaluation be for First Choice?

Within the last year, signed by a qualified LPHA and meeting the SCDHHS ASD manual’s content requirements.

### Do I need First Choice authorization if the child’s commercial plan is primary?

Select Health says its prior-authorization requirements apply to secondary claims, so get its authorization too.

### What is First Choice’s timely filing limit?

365 calendar days from the date of service; claims delayed by a primary insurer within 60 days of the primary’s EOB.

## Primary sources

1. [Select Health of South Carolina (First Choice) — Health Care Professional and Provider Manual (updated October 2026)](https://www.selecthealthofsc.com/content/dam/first-choice/selecthealthofsc/pdf/provider/provider-manual.pdf.coredownload.inline.pdf)
2. [Select Health of South Carolina — ASD Provider Checklist for Treatment Authorization Requests](https://www.selecthealthofsc.com/content/dam/first-choice/selecthealthofsc/pdf/provider/forms/autism-spectrum-disorder-provider-checklist.pdf.coredownload.inline.pdf)
3. [Select Health of South Carolina — ASD Treatment Request Form](https://www.selecthealthofsc.com/content/dam/first-choice/selecthealthofsc/pdf/provider/forms/autism-spectrum-disorder-treatment-request-form.pdf.coredownload.inline.pdf)
4. [Select Health of South Carolina — 2026 Prior Authorization Information (revised January 2026)](https://www.selecthealthofsc.com/pdf/provider/resources/prior-authorization-grid.pdf)
5. [Select Health of South Carolina — Claim Filing Instructions (March 2026)](https://www.selecthealthofsc.com/content/dam/first-choice/selecthealthofsc/pdf/provider/claim-filing-manual.pdf.coredownload.inline.pdf)
6. [SCDHHS — Autism Spectrum Disorder (ASD) Services Provider Manual (July 1, 2026)](https://www.scdhhs.gov/sites/dhhs/files/documents/ASD%20Services%20Provider%20Manual%207.1.26.pdf)
7. [SCDHHS Medicaid Bulletin MB# 26-015 — Updates to ASD Services Provider Manual (May 15, 2026; effective July 1, 2026)](https://www.scdhhs.gov/communications/updates-asd-services-provider-manual)
8. [SCDHHS — Managed Care Carve-in (Jan. 1, 2026; MCO prior-authorization and provider help lines)](https://scdhhs.gov/partners/managed-care/managed-care-carve)
9. [42 CFR 438.210(d) — Medicaid managed care authorization timeframes (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-438/subpart-D/section-438.210)
10. [42 CFR 433.139 — Medicaid third-party liability (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-433/subpart-D/section-433.139)
11. [BACB — U.S. Licensure of Behavior Analysts (South Carolina not listed)](https://www.bacb.com/u-s-licensure-of-behavior-analysts/)
12. [First Choice by Select Health — Provider newsletters and updates (provider alerts index)](https://www.selecthealthofsc.com/provider/newsletter-and-updates)
13. [SCDHHS — ASD Services Provider Manual Policy Updates, provider training (July 9, 2026)](https://scdhhs.gov/sites/dhhs/files/ASD%20provider%20training%20_%20July%202026%20Update.pdf)

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.