---
title: Florida Community Care ABA / BA coverage (specialty plan).
url: "https://carelu.com/payers/florida-community-care"
markdown_url: "https://carelu.com/payers/florida-community-care.md"
state: FL (Florida)
payer: Florida Community Care
kind: Medicaid managed care plan (MCO)
parent_program: Florida Medicaid (AHCA)
description: "How Florida Community Care — the Independent Living Systems specialty plan serving the CIDD population — administers Behavior Analysis: the FCC ABA PA form by fax, email, or portal, in-house UM, and 120-day carve-in continuity."
last_reviewed: October 2026
vob_data_updated: 2026-10-15
---

# Florida Community Care ABA / BA coverage (specialty plan).

_Payer Guide · Florida Community Care · Last updated October 2026 · 8 primary sources_

> CIDD-focused specialty plan; in-house UM, PA by fax, email, or portal; 120-day continuity honored.

Florida Community Care (FCC), operated by Independent Living Systems, is the smallest and most specialized of the nine plans — focused on long-term care and the CIDD (intellectual/developmental disability) population, which makes its membership unusually ABA-relevant per capita. The BA workflow is lightweight and in-house: a dedicated FCC ABA Prior Authorization Request Form submitted by fax, email (unusual among the nine), or the provider portal to FCC's own Utilization Department, on the state clinical criteria.

This plan administers the **Florida Medicaid (AHCA)** ABA benefit: the state rules are the floor, and this page covers what the plan layers on top. Read it together with the [Florida Medicaid — Behavior Analysis Services (AHCA) guide](https://carelu.com/payers/florida-medicaid).

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Required — FCC ABA PA Request Form by fax 305-675-6138, email FCCUMDepartment@FCCHealthPlan.com, or the FCC Provider Portal [2]
- **Prior auth for treatment**: Required — same channels, via FCC's in-house Utilization Department [2]
- **Autism diagnosis required?**: Not under the state BA policy (physician referral + order + CDE, no autism-diagnosis requirement) — but FCC's own ABA PA form asks, for members under 21, for ASD diagnosis documentation from an MD, PhD in Psychology or PsyD within the last 24 months, meeting DSM-5 criteria. Collect it if the family has it. [3][2][4]

## At a glance

- **Plan type:** SMMC specialty plan (Independent Living Systems) — LTC/CIDD focus
- **Clinical rules:** AHCA BA Coverage Policy; no external UM vendor
- **Prior auth:** FCC ABA PA form — fax 305-675-6138, email FCCUMDepartment@FCCHealthPlan.com, or portal
- **Continuity at carve-in:** Ongoing BA auths honored for the full CoC period, minimum 120 days
- **Claims:** Payer ID FLCCR via Availity/clearinghouse; portal at secure.healthx.com
- **Support:** Provider call center 1-833-322-7526

## How FCC runs BA authorization

Submit the Florida Community Care ABA Prior Authorization Request Form to the in-house Utilization Department by fax (305-675-6138), email (FCCUMDepartment@FCCHealthPlan.com — email PA submission is unusual among Florida's plans and handy for small teams), or through the FCC Provider Portal at secure.healthx.com. The clinical criteria are the state's: referral + order + CDE at entry, no autism-diagnosis requirement, Vineland-3/BASC-3 documentation, authorizations up to 6 months. At the February 2025 carve-in, FCC honored ongoing BA authorizations for the entirety of the continuity-of-care period — a minimum of 120 days after enrollment. Claims run under payer ID FLCCR via Availity or your clearinghouse, and the provider call center is 1-833-322-7526. Given the CIDD focus, expect members with rich existing clinical records — leverage them for the CDE and the most specific supporting diagnoses. [2]

## How fast must Florida Community Care pay an ABA claim?

Florida writes the claim clock for Medicaid health plans, Florida Community Care included into statute: “Managed care plans shall comply with ss. 641.315, 641.3155, and 641.513” (§ 409.967(2)(j)). Under § 641.3155 a provider must send the claim to the plan “within 6 months after” the date of service (and to a secondary payer within 90 days of the primary’s final determination). For an electronic claim the plan must acknowledge receipt within 24 hours of the next business day and, within 20 days, pay it or notify the provider that it is denied or contested, with an itemized list of what is missing (the provider then has 35 days to supply it). Every claim must be paid or denied within 90 days of receipt, and failure to do so within 120 days “creates an uncontestable obligation to pay the claim.” Paper claims run 40, 120 and 140 days. Late payments bear 12% simple interest. [1][6][7]

FCC’s provider manual: providers must file “within the time set forth in their Florida Community Care participating provider Agreement(s) unless applicable law requires a greater time period,” and where Florida law applies, “claims must be filed within 180 days after the date of service.” On payment: “Claims are processed daily and combined into a weekly payment. Remittance advices are also generated on a weekly basis,” viewable in Availity for EFT payees. No submission cutoff day or time is published. [1][6][7]

## Intake gates

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

- **Age limit**: Follows the Florida Medicaid rule: BA is for recipients under the age of 21, with EPSDT available above the coverage-policy and fee-schedule limits. FCC’s published BA services page is procedural — which form, which fax, which mailbox — and states no age criterion of its own; the coverage policy forbids a plan from applying more stringent service coverage limits than state policy. [4][2]
- **Diagnosis recency**: The state policy requires no autism diagnosis and sets no diagnosis-recency rule, but FCC’s own ABA prior authorization form does. For members under 21 its Section G asks the provider to “specify ASD diagnosis established and by whom,” marks the documentation mandatory, and states: “Documentation must be within the last 24 months by a MD, PhD in Psychology or PsyD. Diagnosis must meet DSM-5 criterion to diagnose ASD. Validated assessment tools must be included.” Treat a diagnostic report older than 24 months as a likely return. Underneath, the state cycle applies: reassessment and an updated behavior plan at least every six months, and the two core instruments re-administered every 12 months. [3][4]
  - Ask the plan: The FCC Utilization Department (1-833-322-7526): whether a request without a current ASD diagnosis is still reviewed under the state policy, which requires no autism diagnosis.
- **Who may diagnose**: The state rule, which FCC cannot narrow: the referral comes from an independent physician or qualifying practitioner (PCP in family practice, internal medicine or pediatrics; a developmental-behavioral, neurodevelopmental, pediatric-neurology or adult/child-psychiatry specialist; or a child psychologist), and the CDE must be led by a licensed practitioner working within their medical, developmental or psychological scope of practice. Given FCC’s long-term-care and CIDD membership, much of that record usually already exists — mine it rather than re-commissioning it. [4][2]
- **Diagnostic tools required**: The state pair: the Vineland-3 Comprehensive Parent Interview Form for all recipients (plus the Maladaptive Behavior Domain for ages 3 and older) and the BASC-3 PRQ for ages 2 through 18, with complete scoring reports submitted with every prior-authorization request and re-administration every 12 months. FCC publishes no additional instrument requirement. [4][2]
- **Referral required?**: Required — the state gate (independent physician referral, physician’s order for BA services, and a CDE performed to national evidence-based practice standards) applies unchanged. FCC’s contribution is the channel: prior authorization is required after the continuity-of-care period, and requests for new courses of treatment “should be submitted to FCC’s Utilization Department using the Florida Community Care ABA Prior Authorization Request Form,” by fax to 305-675-6138, by email to FCCUMDepartment@FCCHealthPlan.com, or through the FCC Provider Portal — email submission being unusual among Florida’s nine plans. [2][4]
- **Telehealth**: Follows the Florida Medicaid rule: the only telemedicine provision is up to two hours per week of Lead Analyst caregiver training (97156) under Rule 59G-1.057, F.A.C. FCC’s BA services page publishes no telehealth rule, code list or place-of-service guidance. [4][2]
  - Ask the plan: The FCC Utilization Department (FCCUMDepartment@FCCHealthPlan.com) or the provider call centre 1-833-322-7526 before scheduling a remote session other than 97156 caregiver training.
- **Prior-auth decision time**: FCC’s provider handbook: “Staff process pre-service routine requests within 7 calendar days from the date of receipt,” with notice to provider and enrollee in the same 7 days. Urgent pre-service requests are processed “within 48 hours from the date and time of receipt”; providers can mark a request STAT. No BA reauthorization lead time is published. Note the gap with the AHCA contract, which sets 5 days standard and 2 days expedited for MMA plans. Plan around the 7 days FCC publishes. [1][9]
- **Other insurance (who pays first)**: FCC’s provider handbook publishes no coordination-of-benefits procedure of its own, so the state rule governs. Florida Medicaid pays last. Rule 59G-1.052 says: “Florida Medicaid is the payer of last resort. Providers must exhaust all TPL sources of payment, such as Medicare, TRICARE, private health insurance … prior to submitting or resubmitting a claim.” The AHCA contract binds every MMA plan to that rule. Two consequences for intake: Medicaid pays only “the difference between the Florida Medicaid rate and the third-party payment,” and it pays nothing when “the provider’s TPL claim is denied for failing to obtain the appropriate authorization from the third-party.” So get the commercial plan’s own ABA authorization first. [10][9][1]
  - Ask the plan: FCC Utilization Management: whether FCC requires its own BA authorization when a commercial plan pays first.

## Delivery and billing rules

Coverage decides whether Florida Community Care 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**: The state floor: supervision of BCaBAs and RBTs per the Council of Autism Service Providers practice standards, as specified in the supervision plan inside the approved behavior plan, which must name the authorized supervisors; Lead Analyst is a BCBA, FL-CBA or Ch. 490/491 licensee, a BCaBA works under a BCBA, and an RBT under a BCBA or BCaBA. FCC publishes no ratio or caseload cap of its own. [4][2]
- **Concurrent billing (97153 + 97155)**: The state rule is the floor and FCC publishes no variation: the supervisee is not reimbursed when the supervisor is reimbursed for the same time period, and simultaneous services by more than one BA provider are non-covered unless medically necessary, prior authorized and indicated in the approved behavior plan. [4]
  - Ask the plan: The FCC Utilization Department for whether an authorization can carry 97153 and 97155 on the same clock time.
- **Daily limits / MUEs**: The state weekly ceiling: up to 40 hours per week of BA intervention as prior-authorized in the behavior plan, EPSDT available above it, group treatment capped at six participants, and 15-minute units on the CMS 8-minute rule. FCC publishes no per-day unit table: its ABA prior authorization form asks only for the CPT/HCPCS code and the units requested per authorization period. [4][3]
  - Ask the plan: The FCC Utilization Department for any per-day claim edit, plus the current AHCA BA fee schedule for per-assessment unit caps.
- **Session-note signature**: The state rule: “session notes must be signed and dated by the rendering practitioner,” carrying date, time, location, duration, behaviors observed, skills targeted, the recipient’s response, protocol modification or therapist direction, an explanation if the parent or guardian was absent, and the participants; the behavior assessment and behavior plan are signed by the Lead Analyst and the parent or guardian. FCC adds no published signature rule. [4]
- **Place of service**: The state rule: a school-based request must include the IEP, or a 504 plan, or documentation naming the school and explaining that neither is available; 1:1 shadow, personal care assistance, companion and chaperone services are non-covered “regardless of activity or setting,” as are caregiver/childcare services and travel time; BA is non-covered on the same day as behavioral health overlay, therapeutic behavioral on-site, or therapeutic group care. The same-day exclusions deserve a second look on a long-term-care and CIDD population that often carries other Medicaid benefits. [4]
- **Bill as provider**: Claims run under payer ID FLCCR through Availity or your clearinghouse, with the provider portal at secure.healthx.com and a provider call centre at 1-833-322-7526. The state enrollment structure decides whose NPI may render: a professional claim (837P / CMS-1500) under an individually enrolled practitioner — Lead Analyst 392, BCaBA 391, RBT 390 — with 390s and 391s enrollable only as members of an enrolled BA group (393). [2][4]

## What intake should collect for Florida Community Care

- **Referral + order + CDE:** The state eligibility gate applies; no autism diagnosis required — existing CIDD records often cover much of it.
- **Vineland-3 & BASC-3 scoring reports:** The state documentation stack applies to FCC requests.
- **Preferred submission channel:** Fax, email, or portal all work — standardize one internally for tracking.
- **Claims setup:** Payer ID FLCCR via Availity/clearinghouse before the first date of service.

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

## Verification of benefits (VOB) data

How Florida Community Care ABA benefits route and read on an eligibility check. Data last updated 2026-10-15.

### EDI routing

- **Payer ID (Availity):** FLCCR
- **Behavioral health administrator:** Behavioral Services Network (BSN) — network credentialing/contracting partner only
- **BH administrator payer ID:** FLCCR (same as FCC medical — BSN publishes no distinct EDI/claims payer ID; BA prior authorization itself runs through FCC's own in-house Utilization Department, not BSN) — Confirm directly with FCC's Utilization Department (FCCUMDepartment@FCCHealthPlan.com, 1-833-322-7526) or BSN whether BA claims specifically require routing distinct from FLCCR — neither source states one exists, but this is an absence of evidence, not confirmation.
- **ABA rides on:** medical benefit — Same as administratorPayerId.
- **Two-hop verification required:** No — Same as administratorPayerId.

### Code-level coverage

| Code | Covered | Prior auth | Unit cap | Place of service | Telehealth | Modifiers |
| --- | --- | --- | --- | --- | --- | --- |
| 97151 | Yes | Required | 24 units per initial behavior assessment (max); the reassessment variant, billed with modifier TS, caps at 18 units — same $19.05/unit rate either way. per per assessment/reassessment (not daily) — a new authorization is required each time, not a recurring daily allotment. | home (categorical — no CMS POS-code number published anywhere in FL BA documentation, state or plan level), office/clinic (categorical), school (categorical — IEP/504 plan, or a documented explanation, required with the PA request per the coverage policy §7.2), community/other (categorical, per plan PA-form checkboxes) | No — not authorized for this code under the AHCA BA Coverage Policy. Only 97156 (family/caregiver training) has a stated telehealth allowance in Florida Medicaid BA; every other code is telehealth:'No' by policy design, not by omission. | TS — reassessment variant, same $19.05 rate, separate 18-unit cap (vs. 24 for the initial assessment) |
| 97152 | Yes | Required | 8 units per assessment (max). per per assessment (not daily). | home (categorical — no CMS POS-code number published anywhere in FL BA documentation, state or plan level), office/clinic (categorical), school (categorical — IEP/504 plan, or a documented explanation, required with the PA request per the coverage policy §7.2), community/other (categorical, per plan PA-form checkboxes) | No — not authorized for this code under the AHCA BA Coverage Policy. Only 97156 (family/caregiver training) has a stated telehealth allowance in Florida Medicaid BA; every other code is telehealth:'No' by policy design, not by omission. | — |
| 97153 | Yes | Required | No code-specific unit cap on the fee schedule; counts toward the aggregate 40 hrs/week (≈160 units/week) BA-intervention cap set by the coverage policy §4.2.2. per week (aggregate across all treatment codes together, not per-code). | home (categorical — no CMS POS-code number published anywhere in FL BA documentation, state or plan level), office/clinic (categorical), school (categorical — IEP/504 plan, or a documented explanation, required with the PA request per the coverage policy §7.2), community/other (categorical, per plan PA-form checkboxes) | No — not authorized for this code under the AHCA BA Coverage Policy. Only 97156 (family/caregiver training) has a stated telehealth allowance in Florida Medicaid BA; every other code is telehealth:'No' by policy design, not by omission. | XP — concurrent-supervision supervisee line, not separately reimbursed (the supervisor bills 97153/97155/97155-HN instead) |
| 97154 | Yes | Required | Max 6 participants per group (coverage policy §4.2.2); the group also counts toward the aggregate 40 hrs/week cap. Rendered by Lead Analyst, BCaBA, or RBT. per week (aggregate) plus a 6-participant group-size ceiling. | home (categorical — no CMS POS-code number published anywhere in FL BA documentation, state or plan level), office/clinic (categorical), school (categorical — IEP/504 plan, or a documented explanation, required with the PA request per the coverage policy §7.2), community/other (categorical, per plan PA-form checkboxes) | No — not authorized for this code under the AHCA BA Coverage Policy. Only 97156 (family/caregiver training) has a stated telehealth allowance in Florida Medicaid BA; every other code is telehealth:'No' by policy design, not by omission. | UN (2 clients, $7.58/unit), UP (3 clients, $7.08/unit), UQ (4 clients, $6.58/unit), UR (5 clients, $6.08/unit), US (6 clients, $5.58/unit) |
| 97155 | Yes | Required | No code-specific unit cap on the fee schedule; counts toward the aggregate 40 hrs/week cap. per week (aggregate across all treatment codes). | home (categorical — no CMS POS-code number published anywhere in FL BA documentation, state or plan level), office/clinic (categorical), school (categorical — IEP/504 plan, or a documented explanation, required with the PA request per the coverage policy §7.2), community/other (categorical, per plan PA-form checkboxes) | No — not authorized for this code under the AHCA BA Coverage Policy. Only 97156 (family/caregiver training) has a stated telehealth allowance in Florida Medicaid BA; every other code is telehealth:'No' by policy design, not by omission. | HN — BCaBA tier, $15.37/unit (vs. $19.17 Lead Analyst base rate), XP — concurrent-supervision supervisee line, not separately reimbursed |
| 97156 | Yes | Required | No code-specific cap on direct/in-person units; the TELEHEALTH variant (GT modifier) is separately capped at 2 hrs/week (8 units/week). per week (telehealth portion); aggregate 40 hrs/week cap governs the rest. | home (categorical — no CMS POS-code number published anywhere in FL BA documentation, state or plan level), office/clinic (categorical), school (categorical — IEP/504 plan, or a documented explanation, required with the PA request per the coverage policy §7.2), community/other (categorical, per plan PA-form checkboxes) | Yes — the ONLY Florida Medicaid BA code with a confirmed telehealth allowance. GT modifier, up to 2 hrs/week, per Rule 59G-1.057, F.A.C. (coverage policy §4.2.2, FL.CP.BH.500). Not confirmed whether the telehealth allowance extends to BCaBA-rendered (HN-modifier) training — both the coverage policy and Sunshine's clinical policy name the "Lead Analyst" specifically. Separately: Sunshine's general (non-BA) telehealth billing notice instructs POS 02 with NO GT/95/CR modifier appended, which appears to conflict with the BA-specific GT-modifier requirement — an unresolved discrepancy, flagged rather than guessed at; confirm the correct billing combination with each plan before submitting a 97156 telehealth claim. | GT — telemedicine delivery, same $19.05 rate, capped at 2 hrs/wk, HN — BCaBA tier, $15.24/unit (vs. $19.05 Lead Analyst base rate) |
| 97157 | No — absent from both the 2025 and 2026 AHCA Behavior Analysis fee schedules and not listed among the covered service categories in the Dec 2024 coverage policy §4.2.2. Cross-confirmed absent from Sunshine Health's own coding table (FL.CP.BH.500) and Humana's Florida Medicaid PA list too — three independent primary sources agree on the omission. This is NOT a formal written exclusion statement (no document states "97157 is excluded"), so treat this as verified-absent-from-the-billable-set rather than a proven-impossible claim. | N/A — not on the state's billable BA code set per the fee schedule and PA lists reviewed. | N/A per N/A | — | N/A | — |
| 97158 | Yes | Required | Max 6 participants per group; rendered by Lead Analyst or BCaBA only (NOT RBT, per the coverage policy — contrast 97154, which RBTs can render). per week (aggregate) plus a 6-participant group-size ceiling. | home (categorical — no CMS POS-code number published anywhere in FL BA documentation, state or plan level), office/clinic (categorical), school (categorical — IEP/504 plan, or a documented explanation, required with the PA request per the coverage policy §7.2), community/other (categorical, per plan PA-form checkboxes) | No — not authorized for this code under the AHCA BA Coverage Policy. Only 97156 (family/caregiver training) has a stated telehealth allowance in Florida Medicaid BA; every other code is telehealth:'No' by policy design, not by omission. | UN (2 clients, $9.58/unit), UP (3 clients, $9.08/unit), UQ (4 clients, $8.58/unit), UR (5 clients, $8.08/unit), US (6 clients, $7.58/unit) |
| 0362T | Yes | Required, and conditioned on medical necessity for the extra-technician protocol per the coverage policy. | 16 units per initial assessment or reassessment (max). per per assessment/reassessment. | home (categorical — no CMS POS-code number published anywhere in FL BA documentation, state or plan level), office/clinic (categorical), school (categorical — IEP/504 plan, or a documented explanation, required with the PA request per the coverage policy §7.2), community/other (categorical, per plan PA-form checkboxes) | No — not authorized for this code under the AHCA BA Coverage Policy. Only 97156 (family/caregiver training) has a stated telehealth allowance in Florida Medicaid BA; every other code is telehealth:'No' by policy design, not by omission. | — |
| 0373T | Yes | Required, and conditioned on medical necessity for the extra-technician protocol. | No distinct unit cap beyond the underlying code's session limits — the fee schedule doesn't publish one separately for this add-on. | home (categorical — no CMS POS-code number published anywhere in FL BA documentation, state or plan level), office/clinic (categorical), school (categorical — IEP/504 plan, or a documented explanation, required with the PA request per the coverage policy §7.2), community/other (categorical, per plan PA-form checkboxes) | No — not authorized for this code under the AHCA BA Coverage Policy. Only 97156 (family/caregiver training) has a stated telehealth allowance in Florida Medicaid BA; every other code is telehealth:'No' by policy design, not by omission. | — |

Code notes:

- **97151:** Physician referral + order + Comprehensive Diagnostic Evaluation gate the very first assessment request (no autism-diagnosis requirement) — see the guide's prose for the intake sequence. These are the statewide AHCA BA Coverage Policy mechanics, binding on Florida Community Care per the policy's plan-compliance clause (§1.2); Florida Community Care's own documents don't restate full code-level unit-cap/POS detail beyond what's marked 'verified' above — confirm any 'inferred' field with Florida Community Care provider relations before quoting a family.
- **97152, 97156, 97158:** These are the statewide AHCA BA Coverage Policy mechanics, binding on Florida Community Care per the policy's plan-compliance clause (§1.2); Florida Community Care's own documents don't restate full code-level unit-cap/POS detail beyond what's marked 'verified' above — confirm any 'inferred' field with Florida Community Care provider relations before quoting a family.
- **97153:** Billed at the SAME $12.26/unit rate whether rendered by an RBT, BCaBA, or Lead Analyst — Florida does not tier 97153 by staff credential (contrast 97155/97156, which do via the HN modifier). These are the statewide AHCA BA Coverage Policy mechanics, binding on Florida Community Care per the policy's plan-compliance clause (§1.2); Florida Community Care's own documents don't restate full code-level unit-cap/POS detail beyond what's marked 'verified' above — confirm any 'inferred' field with Florida Community Care provider relations before quoting a family.
- **97154:** The modifier documents group size, not staff credential — rate scales DOWN as the group grows. These are the statewide AHCA BA Coverage Policy mechanics, binding on Florida Community Care per the policy's plan-compliance clause (§1.2); Florida Community Care's own documents don't restate full code-level unit-cap/POS detail beyond what's marked 'verified' above — confirm any 'inferred' field with Florida Community Care provider relations before quoting a family.
- **97155:** Rendered by Lead Analyst or BCaBA only — RBTs do not bill 97155 in Florida. These are the statewide AHCA BA Coverage Policy mechanics, binding on Florida Community Care per the policy's plan-compliance clause (§1.2); Florida Community Care's own documents don't restate full code-level unit-cap/POS detail beyond what's marked 'verified' above — confirm any 'inferred' field with Florida Community Care provider relations before quoting a family.
- **97157:** If a family reports a Florida plan authorizing/paying 97157, verify directly with that plan — it would be an accommodation outside the state fee schedule, not the documented default. FCC's BA services page publishes no code-level table of its own — the state-verified absence applies here by the same plan-compliance clause as every other MMA plan. These are the statewide AHCA BA Coverage Policy mechanics, binding on Florida Community Care per the policy's plan-compliance clause (§1.2); Florida Community Care's own documents don't restate full code-level unit-cap/POS detail beyond what's marked 'verified' above — confirm any 'inferred' field with Florida Community Care provider relations before quoting a family.
- **0362T:** Requires an on-site physician/QHP plus 2+ technicians for severe/destructive-behavior assessment support; billed alongside 97151/97151-TS, not standalone. These are the statewide AHCA BA Coverage Policy mechanics, binding on Florida Community Care per the policy's plan-compliance clause (§1.2); Florida Community Care's own documents don't restate full code-level unit-cap/POS detail beyond what's marked 'verified' above — confirm any 'inferred' field with Florida Community Care provider relations before quoting a family.
- **0373T:** Requires an on-site physician/QHP plus 2+ technicians for severe/destructive-behavior exposure treatment; billed alongside 97153/97155. These are the statewide AHCA BA Coverage Policy mechanics, binding on Florida Community Care per the policy's plan-compliance clause (§1.2); Florida Community Care's own documents don't restate full code-level unit-cap/POS detail beyond what's marked 'verified' above — confirm any 'inferred' field with Florida Community Care provider relations before quoting a family.

### Medicaid rates

Source: AHCA Behavior Analysis Fee Schedule (2025 and 2026 — rates identical across both years). No FCC-specific rate schedule is publicly posted — MCOs must not impose limits more stringent than this state schedule, which serves as the reference baseline (AHCA BA Coverage Policy §1.2). Effective 2025-01-01.

| Code | Rate | Unit | Modifier tiers |
| --- | --- | --- | --- |
| 97151 | $19.05 | 15min | TS: $19.05 (reassessment; same rate, 18-unit cap vs. 24 for the initial assessment) |
| 97152 | $12.19 | 15min | — |
| 97153 | $12.26 | 15min | XP: Not reimbursed (concurrent-supervision supervisee line) |
| 97154 | $7.58 (2 clients, UN) | 15min | UN: $7.58 (2 clients); UP: $7.08 (3); UQ: $6.58 (4); UR: $6.08 (5); US: $5.58 (6) |
| 97155 | $19.17 (Lead Analyst) | 15min | HN: $15.37 (BCaBA); XP: Not reimbursed (concurrent-supervision supervisee line) |
| 97156 | $19.05 (Lead Analyst) | 15min | GT: $19.05 (telemedicine — same rate, capped at 2 hrs/week); HN: $15.24 (BCaBA) |
| 97157 | Not on the AHCA fee schedule (2025 or 2026) — not confirmed reimbursable under Florida Medicaid BA. | 15min | — |
| 97158 | $9.58 (2 clients, UN) | 15min | UN: $9.58 (2 clients); UP: $9.08 (3); UQ: $8.58 (4); UR: $8.08 (5); US: $7.58 (6) |
| 0362T | $12.19 | 15min | — |
| 0373T | $12.19 | 15min | — |

### Contacts

- **Benefits by phone:** Yes
- **Provider services phone:** 1-833-322-7526
- **Portal:** [Florida Community Care Provider Portal (HealthX)](https://secure.healthx.com/v3app/publicservice/loginv1/login.aspx?bc=16544617-390b-4625-9657-c7b235c09d3c&serviceid=df6f8096-64ea-498a-a657-7c7b407ae072)
- **Fax:** 305-675-6138

Questions to ask on a verification call:

- Does FCC support real-time 270/271 eligibility checks, and what pVerify payer ID should we use (Availity ID FLCCR)?
- Does BA claims/auth routing require a payer ID distinct from FLCCR, and does ABA ride the medical benefit or a behavioral-health carve-out via BSN?
- Which service-type code do you return ABA benefit details under?
- Does the deductible apply to ABA, and is the cost share a copay or coinsurance?
- Is any copay charged per visit or per day, and does the out-of-pocket max apply to ABA?
- What’s the cap period for 0373T?

### VOB data sources

- https://fcchealthplan.com/ba-services/ (accessed 2026-07-23)
- https://bsnnet.com/ (accessed 2026-07-23)
- https://portal.flmmis.com/FLPublic/Portals/0/StaticContent/Public/COMPANION%20GUIDES/FMMIS_5010_270_271_Companion%20Guide_v4_0_04272023.pdf (accessed 2026-07-23; source document older than 18 months)
- https://www.flrules.org/gateway/readRefFile.asp?refId=17525&filename=Florida%20Medicaid%20Behavior%20Analysis%20Services%20Coverage%20Policy.pdf (accessed 2026-07-23)
- https://ahca.myflorida.com/content/download/26138/file/2025%20Behavior%20Analysis%20Fee%20Schedule.pdf (accessed 2026-07-23)
- https://ahca.myflorida.com/content/download/28096/file/2026%20BA%20Fee%20Schedule.pdf (accessed 2026-09-27)

## Common questions

### How often does Florida Community Care pay ABA claims?

Weekly: FCC processes claims daily and combines them into a weekly payment, with weekly remittance advices (in Availity for EFT payees). File within your agreement’s limit, or 180 days from the date of service where Florida law applies.

### Does Florida Community Care cover ABA?

Yes — the state Behavior Analysis benefit on AHCA criteria (no autism diagnosis required), authorized by FCC's in-house Utilization Department via its ABA PA form.

### How do I submit a BA authorization to FCC?

The FCC ABA Prior Authorization Request Form by fax to 305-675-6138, email to FCCUMDepartment@FCCHealthPlan.com, or through the FCC Provider Portal — email submission is an FCC-specific convenience.

### Is Florida Community Care’s BA network open to new providers?

Not published as a yes or no. Florida law lets MMA plans “limit the providers in their networks based on credentials, quality indicators, and price” (s. 409.975(1), F.S.), so a plan may decline a new BA group. Ask Florida Community Care’s provider relations or contracting team whether it is adding BA groups in your region.

### What happens when a Florida Community Care member switches BA providers?

AHCA’s BA coverage policy, which every MMA plan must follow, says “a full assessment may be requested if there is a change in provider,” and a change in a practitioner’s credential (an RBT becoming a BCaBA) is not grounds for a reassessment. Expect the new agency to request its own assessment and treatment authorization; ask Florida Community Care how it closes the previous provider’s authorization.

### What is the payment turnaround for Florida Community Care ABA claims?

Florida law binds Florida Community Care as an MMA plan (§ 409.967(2)(j) → § 641.3155): pay or send a denial/contest notice within 20 days of an electronic claim (40 for paper), pay or deny within 90 days (120 for paper), and 12% interest on late payments. The statute also requires providers to file within 6 months of the date of service.

### What documents does Florida Community Care need at intake for ABA?

The state packet (an independent physician's referral and order for BA services plus a CDE), submitted on FCC's own ABA Prior Authorization Request Form by fax, email or the provider portal. For members under 21, the form also asks who established the ASD diagnosis: "Documentation must be within the last 24 months by a MD, PhD in Psychology or PsyD. Diagnosis must meet DSM-5 criterion to diagnose ASD. Validated assessment tools must be included." Expect an older diagnostic report to come back.

## Primary sources

1. [Florida Community Care — Provider Manual (FCC210301PNSHBK001F)](https://fcchealthplan.com/wp-content/uploads/2025/01/2M2609-FCC-Prov-Manual-r3.pdf)
2. [Florida Community Care — Behavioral Analysis Services (provider page)](https://fcchealthplan.com/ba-services/)
3. [Florida Community Care — ABA Request for Prior Authorization Form (last updated 7/28/2025)](https://fcchealthplan.com/wp-content/uploads/2025/01/2M2524-FCC-ABA-PriorAuthForm-Final.pdf)
4. [Florida Medicaid BA Services Coverage Policy (Dec 2024)](https://www.flrules.org/gateway/readRefFile.asp?refId=17525&filename=Florida%20Medicaid%20Behavior%20Analysis%20Services%20Coverage%20Policy.pdf)
5. [Fla. Stat. § 409.975 (2026) — Managed care plan accountability (provider networks)](https://www.flsenate.gov/Laws/Statutes/2026/409.975)
6. [Fla. Stat. § 409.967 (2026) — Managed care plan accountability (prompt payment, (2)(j))](https://www.flsenate.gov/Laws/Statutes/2026/409.967)
7. [Fla. Stat. § 641.3155 (2026) — Prompt payment of claims](https://www.flsenate.gov/Laws/Statutes/2026/641.3155)
8. [Florida Community Care — For Providers (Provider Newsletters section, quarterly issues)](https://fcchealthplan.com/providers/)
9. [AHCA SMMC Model Health Plan Contract — Attachment II Core Provisions (update 10/1/2025), §V.6 and §XI.D](https://ahca.myflorida.com/content/download/27248/file/Attachment%20II-%20-%20Core%20Contract%20Provisions%20Oct%202025.pdf)
10. [Rule 59G-1.052, F.A.C. — Third-Party Liability Requirements (AHCA)](https://ahca.myflorida.com/content/download/5929/file/59G_1052_TPL_Requirements.pdf?version=1)

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.