---
title: Blue Cross Blue Shield of Arizona Health Choice ABA coverage (AHCCCS plan).
url: "https://carelu.com/payers/health-choice-arizona"
markdown_url: "https://carelu.com/payers/health-choice-arizona.md"
state: AZ (Arizona)
payer: Blue Cross Blue Shield of Arizona Health Choice
kind: Medicaid managed care plan (MCO)
parent_program: AHCCCS (Arizona Medicaid)
description: "How Blue Cross Blue Shield of Arizona Health Choice (formerly branded \"Health Choice Arizona\") handles AHCCCS ABA — the AMPM 320-S state baseline, the frequently-updated PA grids that answer the code-level questions, and the northern-Arizona footprint."
last_reviewed: October 2026
vob_data_updated: 2026-10-15
---

# Blue Cross Blue Shield of Arizona Health Choice ABA coverage (AHCCCS plan).

_Payer Guide · BCBSAZ Health Choice · Last updated October 2026 · 27 primary sources_

> Now officially "Blue Cross Blue Shield of Arizona Health Choice"; grid-driven PA, no published ABA policy.

Blue Cross Blue Shield of Arizona's Medicaid vehicle is officially branded "Blue Cross Blue Shield of Arizona Health Choice" — AHCCCS's own current health plan list (revised 6/30/2026) uses this full name, not the older "Health Choice Arizona" branding this guide previously used; the coverage and mechanics below are unaffected by the naming update. Its strongest presence is in northern Arizona (Apache, Coconino, Mohave, Navajo, Yavapai) plus Maricopa, Gila, and Pinal — post-Care1st-merger, it competes mainly with Arizona Complete Health in the north. It publishes no distinct ABA clinical policy; its operational tool is the PA grid, updated frequently (versions have shipped effective 1/2024 through 5/2026). That makes the current grid, not a policy PDF, the document that answers the 9715x questions for this plan.

This plan administers the **AHCCCS (Arizona Medicaid)** ABA benefit: the state rules are the floor, and this page covers what the plan layers on top. Read it together with the [AHCCCS (Arizona Medicaid) guide](https://carelu.com/payers/arizona-ahcccs).

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment:** Not published / unverified. Verify via: The current PA Guidelines grid on healthchoiceaz.com — read the 97151 and 97152 rows (the grids revise several times a year), or the PA line 1-800-322-8670 / fax 480-760-4732. [10][11]
- **Prior auth for treatment:** Not published / unverified. Verify via: The current PA Guidelines grid on healthchoiceaz.com — read the 97153-97158 rows (the grids revise several times a year), or the PA line 1-800-322-8670 / fax 480-760-4732. [10]
- **Autism diagnosis required?**: No distinct plan policy published — AMPM 320-S baseline applies (autism dx not strictly required) [11][10]

## At a glance

- **Plan name:** Blue Cross Blue Shield of Arizona Health Choice (formerly "Health Choice Arizona")
- **Plan type:** ACC — northern GSA counties + Maricopa, Gila, Pinal (BCBSAZ)
- **Clinical rules:** No distinct published ABA policy — AMPM 320-S baseline
- **PA source of truth:** The current PA grid on healthchoiceaz.com — updated several times a year
- **Assessment/treatment PA:** Not published as a standing rule — check the grid rows for 97151–97158
- **PA contacts:** Fax 480-760-4732 · phone 1-800-322-8670
- **Portal:** providerportal.healthchoiceaz.com
- **Fee schedule:** Contract rate — AHCCCS’s fixed ABA rates are fee-for-service only; plans and providers negotiate

## Grid-driven PA on a state-baseline plan

Health Choice runs prior authorization from PA Guidelines grids rather than a published ABA program document, and the grids revise often — at least seven versions between January 2024 and May 2026. We could not verify the current grid rows for 97151 or 97153–97158, so the intake rule for this plan is procedural: pull the newest grid from healthchoiceaz.com (or ask via the PA line, 1-800-322-8670 / fax 480-760-4732) and read the 9715x rows before booking. Clinically, assume the AMPM 320-S baseline — no strict autism-diagnosis requirement, BHP-recommended services, 6-month progress reports — since no evidence suggests Health Choice layers distinct criteria on top. [10][11]

## Footprint: the northern-Arizona play

Health Choice's ACC footprint centers on the five northern counties — Apache, Coconino, Mohave, Navajo, Yavapai — where, after Care1st folded into Arizona Complete Health, the practical plan choice is Health Choice vs. AzCH, plus its Maricopa/Gila/Pinal presence. Providers building northern-Arizona intake should have both plans' machinery mapped, because families in those counties will split between exactly these two. [9]

## Can an out-of-state BCBA treat an Arizona member, including by telehealth?

Arizona licenses the practice: “A person who wishes to practice as a behavior analyst must be licensed pursuant to this article” (A.R.S. § 32-2091.02, Board of Psychologist Examiners), and practicing unlicensed is a class 2 misdemeanor (§ 32-2091.12). Arizona is unusual in giving out-of-state clinicians a telehealth-only route: under A.R.S. § 36-3606 a health care provider “who is not licensed in this state may provide telehealth services to a person located in this state” after registering with the board that licenses the comparable profession, holding “a current, valid and unrestricted license to practice in another state that is substantially similar,” carrying malpractice coverage that includes Arizona telehealth, and following Arizona’s scope and standard-of-care rules. Behavior analysts are licensed under Title 32, chapter 19.1, which § 36-3601 includes in the definition of “health care provider.” A registered provider may not open an Arizona office (except within a multistate group that includes an Arizona-licensed provider) or see Arizona patients in person without an Arizona license. Fewer than ten telehealth encounters a year, or care in consultation with an Arizona-licensed provider who keeps ultimate authority, is exempt from registration. [16][17][18][19][11][20][21]

AHCCCS ties ABA to the Arizona license: AMPM Policy 320-S defines a Behavior Analyst as “A person who is licensed pursuant to A.R.S §32-2091,” and A.R.S. § 32-2091.14 directs AHCCCS to recognize “a behavior analyst who is licensed pursuant to this article” as a behavioral health professional eligible for reimbursement. A § 36-3606 telehealth registration is not that license, so for AHCCCS work plan on full Arizona licensure. [16][17][18][19][11][20][21]

Federal rules make the state Medicaid enrollment rule binding on the plan: the state “must screen and enroll, and periodically revalidate, all network providers” of Medicaid managed care plans (42 CFR 438.602(b)(1)). So a BCBA in Health Choice’s network has to be enrolled with AHCCCS as well. [16][17][18][19][11][20][21]

## Claims: filing deadline, disputes and EVV

Six months to file, twelve to get it clean. A.R.S. § 36-2904(G) bars AHCCCS from paying a claim “initially submitted more than six months after the date of the service for which payment is claimed or after the date that eligibility is posted, whichever date is later,” or one not submitted as a clean claim within twelve months — and the same subsection applies the identical limits to the health plans that contract with AHCCCS, so Health Choice Arizona cannot pay a claim outside those windows either. The FFS billing manual restates it: a claim first received inside six months has until twelve months from the date of service to reach clean-claim status or be adjusted, after which “AHCCCS is not liable for payment.” [22][23][8][7][6][4][24][25][26]

Health Choice’s own manual uses the same windows. Chapter 7: “An initial claim for services provided to an AHCCCS member must be received no later than 6 months after the date of service unless the claim involves retro-eligibility,” and a resubmission of a claim denied for any reason other than timeliness “must be received within twelve (12) months from the date of service.” To correct or replace a claim, send the whole claim again with “A” or “7” in field 22 and the claim reference number (CRN) from the remittance advice; without it the claim is treated as new “and may be denied for timely filing limits exceeded.” After a recoupment you have the greatest of 12 months from the date of service or 60 days from the adverse action. When another insurer is primary (Chapter 14), the initial claim is still due within six months of the date of service “regardless of the primary insurance coverage,” and the clean claim with the primary carrier’s Explanation of Benefits within 12 months. [22][23][8][7][6][4][24][25][26]

Payment. Health Choice applies quick-pay discounts and interest “in accordance with the methodology outlined in the AHCCCS Contractor Operations Manual, Policy 203.” AHCCCS ACOM 203 binds the plan “unless a subcontract specifies otherwise”: 95% of clean claims adjudicated within 30 days of receipt and 99% within 60, with interest at 10% a year from the 46th day on a non-hospital clean claim paid after 45 days. The manual publishes no weekly submission cutoff or check-run day. [22][23][8][7][6][4][24][25][26]

Disputes. AHCCCS requires claim disputes in writing within twelve months of the date of service, twelve months of the date eligibility is posted, or sixty days after the denial of a timely claim, whichever is later (A.R.S. § 36-2903.01(B)(4); A.A.C. R9-34-401 et seq.). Disputes for fee-for-service members go to AHCCCS’s Office of General Counsel (or through the AHCCCS Solutions Center); for Health Choice Arizona members the dispute is filed with Health Choice Arizona. An unfavourable Notice of Decision can be taken to a state fair hearing within 30 days of receipt. [22][23][8][7][6][4][24][25][26]

EVV. AMPM 540 (revised effective 08/06/26) applies Electronic Visit Verification to “personal care and home health services” under 42 U.S.C. 1396b(l), for ACC, DDD and fee-for-service alike, and AHCCCS’s EVV page names those services as attendant care, personal care, homemaker, habilitation, respite and in-home skilled nursing. ABA is not among them. A visit is subject to EVV only when the provider type, the service code and the place of service all match AHCCCS’s published list, so an agency that also bills habilitation in the home should check that list. [22][23][8][7][6][4][24][25][26]

## Intake gates

The questions that decide whether a family can start with Blue Cross Blue Shield of Arizona Health Choice, and what they have to bring.

- **Age limit**: Follows the AHCCCS rule — BCBSAZ Health Choice publishes no distinct ABA clinical policy, running prior authorization from frequently revised PA grids instead: AMPM 320-S sets no age bound of its own. Behavior Analysis Services are covered "for individuals with Autism Spectrum Disorder (ASD) and/or other diagnoses as justified by medical necessity," and the policy applies across ACC, ALTCS E/PD, DCS/CMDP, DES/DDD, the RBHA contracts and fee-for-service programs without an age criterion. In practice children reach the benefit through EPSDT, and nothing in the policy text excludes adults — screen on medical necessity, not birthday. [11][10]
- **Diagnosis recency**: Follows the AHCCCS rule — BCBSAZ Health Choice publishes no distinct ABA clinical policy, running prior authorization from frequently revised PA grids instead: None at the state level. AMPM 320-S imposes no recency clock on the diagnostic evaluation — and no autism diagnosis at all is strictly required. What must be current is the assessment: services are "prescribed or recommended in specific dosages, frequency, intensity, and duration by a qualified BHP as the result of an assessment of the member." Plan-level overlays can be stricter, so check the per-plan guide before telling a family an old evaluation still counts. [11][10]
- **Who may diagnose**: Follows the AHCCCS rule — BCBSAZ Health Choice publishes no distinct ABA clinical policy, running prior authorization from frequently revised PA grids instead: AMPM 320-S gates on who recommends ABA, not on who diagnoses: services must be "prescribed or recommended... by a qualified BHP." A Behavioral Health Professional is defined as an individual licensed under A.R.S. Title 32, Chapter 33 whose scope allows independent behavioral health practice (or practice under direct supervision, except a licensed substance abuse technician); a psychiatrist (A.R.S. § 36-501); a psychologist (A.R.S. § 32-2061); a physician; a Behavior Analyst (A.R.S. § 32-2091); a registered nurse practitioner licensed as an adult psychiatric and mental health nurse; or a registered nurse with psychiatric-mental health certification or one year of behavioral health experience. [11][10]
- **Diagnostic tools required**: Follows the AHCCCS rule — BCBSAZ Health Choice publishes no distinct ABA clinical policy, running prior authorization from frequently revised PA grids instead: No single instrument is mandated. "Behavior Analysis Services shall be based upon assessment(s) that include Standardized and/or Non-standardized instruments through both direct and indirect methods." Standardized examples named in the policy: the Pervasive Developmental Disabilities Behavior Inventory, the Brigance Inventory of Early Development and the Vineland Adaptive Behavior Scales. Non-standardized examples: curriculum-referenced assessments and stimulus preference assessment procedures. [11][10]
- **Referral required?**: Follows the AHCCCS rule — BCBSAZ Health Choice publishes no distinct ABA clinical policy, running prior authorization from frequently revised PA grids instead: A prescription or recommendation from a qualified Behavioral Health Professional, based on an assessment of the member, is the referral — AMPM 320-S requires nothing else and sets no prior-authorization rules of its own, leaving PA to the Contractors. The two largest plans both skip PA on the assessment codes: Mercy Care states no PA is needed for 97151 and 97152, and Optum's Arizona orientation states "All ABA services require prior authorization except 97151 and 97152." [11][14][13][10]
- **Telehealth**: Health Choice’s manual adds no ABA telehealth coding of its own (Chapter 18 sets telemedicine consent and confidentiality rules and points to AMPM 320-I), so the rule is the AHCCCS rule: AMPM 320-I binds ACC, ALTCS and DDD Contractors by its own terms. All eight ABA CPT codes (97151–97158) are on the AHCCCS Telehealth Code Set (sheet effective 06/01/2026) for interactive audio-video with the GT modifier; none carries the audio-only FQ modifier, and 0362T and 0373T are not listed. The place of service on the claim is the originating site, where the member is (12 home, 03 school, 11 office): “AHCCCS will not be utilizing POS 02 and POS 10 for telehealth” unless another primary payer requires them. AMPM 320-S requires the treatment plan to “identify the modality by which the service will be delivered (whether in person or via telehealth, or in-group or individual setting, or combination thereof),” so name telehealth in the plan you submit for authorization. [3][2][11][5]
- **Prior-auth decision time**: Health Choice’s Ch. 6 (rev. December 2025) already runs the 7-day clock: "'Standard': up to 7 calendar days" and "'Expedited': up to 72 hours", each extendable by 14 days, with adverse decisions sent "within 7 calendar days for Standard request (excluding situations in which a 14-days extension is exercised)." The same chapter still carries an older 28-day/17-day total, so confirm if a decision runs long. Nothing ABA-specific and no ABA reauth lead time (its "seven days prior" rule covers inpatient, BHRF and therapeutic foster care only). [28][29]
- **Other insurance (who pays first)**: Health Choice pays last: bill Medicare and all private insurers first — "primary insurance and/or other credible coverage must be billed first, regardless of primary benefit coverage" — or the claim is denied; initial claims within 6 months and the clean claim with the primary EOB within 12 months. It pays first and recovers later for "Preventive pediatric services, including EPSDT services and administration of vaccines" (VFC) and absent-parent support. The manual does not say whether its own PA is waived when it is secondary; AHCCCS policy (ACOM 434) bars a secondary PA only when the other insurer approved the service as medically necessary. Under federal rules TRICARE pays before Medicaid, and CHAMPVA pays first when the child is also Medicaid-eligible. [6][28][30][31][32]

## Delivery and billing rules

Coverage decides whether Blue Cross Blue Shield of Arizona Health Choice 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**: Follows the AHCCCS rule — BCBSAZ Health Choice publishes no distinct ABA clinical policy, running prior authorization from frequently revised PA grids instead: A duty with no number attached. "Behavior Analysis Services shall be directed and overseen by Behavior Analysts and supported, where applicable, by Behavior Analysis Trainees and/or Behavior Technicians." The Behavior Analyst "is responsible for all aspects of clinical direction, supervision, and provider-level case management," for training Trainees and Technicians, for ensuring that "the extent, kind, and quality" of what they deliver matches their training and experience, and for their compliance with the policy and A.R.S. § 32-2091. A Behavior Analysis Trainee needs "direct and ongoing supervision consistent with the standards set by a nationally recognized Behavior Analyst certification board." AMPM 320-S publishes no supervision percentage and no caseload cap, so for RBT-credentialed staff the BACB floor is the operative number. [11][10]
- **Bill as provider**: Follows the AHCCCS rule — BCBSAZ Health Choice publishes no distinct ABA clinical policy, running prior authorization from frequently revised PA grids instead: The claim line has to say who actually delivered the service. AHCCCS pays credential-tiered rates through modifiers — HM below bachelor's (technician level), HN bachelor's, HO master's, HP doctoral — and AMPM 320-S points to the Behavioral Health Services Billing Matrix for "modifiers for Behavior Analysis Trainee billing." Whose NPI goes in the rendering field is set per Contractor: UnitedHealthcare Community Plan, for instance, requires the rendering provider's 10-digit NPI in box 24J, "must be an active AHCCCS registered provider (The rendering provider is the BCBA/Licensed Clinician)." [11][12][13][10]
- **Daily limits / MUEs** _(plan-dependent)_: No per-day unit number is published, but claims are edited against unit maxima. AMPM 320-S sets no ceiling (services are prescribed “in specific dosages, frequency, intensity, and duration” by the recommending BHP). Health Choice’s claims system checks that “The services billed don’t exceed maximum units,” and the plan “follows Medicare’s Correct Coding Initiative (CCI) policy and performs CCI edits and audits on Fee-For-Service claims for the same provider, same member, and same date of service.” The manual does not print the unit table; the public Medicaid MUE for 97153 is 32 units per claim line, and the authorization sets the units you can bill. [11][7][8][1]
  - Ask the plan: The current Health Choice PA grid and your authorization for units per code; Health Choice provider services for the unit edit applied to 97153.
- **Concurrent billing (97153 + 97155):** Not published / unverified. Verify via: The current PA guidelines grid on healthchoiceaz.com, or the PA line 1-800-322-8670 / fax 480-760-4732 — the grids revise several times a year, so read the live version. [11][10]

## What intake should collect for Blue Cross Blue Shield of Arizona Health Choice

- **Diagnosis (any qualifying):** AMPM 320-S baseline — ASD or another diagnosis justified by medical necessity.
- **Current PA grid rows for 9715x:** The grid revises several times a year — check the live version, not a saved copy.
- **County:** Northern counties are a Health Choice / AzCH duopoly — confirm which of the two the family actually holds.
- **Portal access:** providerportal.healthchoiceaz.com for submissions; PA phone and fax as fallback.

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

## Verification of benefits (VOB) data

How Blue Cross Blue Shield of Arizona Health Choice ABA benefits route and read on an eligibility check. Data last updated 2026-10-15.

### EDI routing

- **Payer ID (pVerify):** 00233 — pVerify 00233 = "Health Choice Arizona" (Elig Y / Claim Y); 06042 = "Health Choice Pathway". Now branded "Blue Cross Blue Shield of Arizona Health Choice".
- **Payer ID (Availity):** 62179 — Availity 62179 = "HEALTHCHOICE OF ARIZONA"; azblue.com Medicaid EDI confirms Payer ID 62179 via Availity. Optum RTE = HECHA.
- **Payer ID (Change Healthcare / Optum):** 62179
- **Supports 270/271 eligibility:** Yes
- **Behavioral health administrator:** none (integrated — BCBSAZ)
- **ABA rides on:** medical benefit
- **Two-hop verification required:** No

### Code-level coverage

| Code | Covered | Prior auth | Unit cap | Place of service | Telehealth | Modifiers |
| --- | --- | --- | --- | --- | --- | --- |
| 97151 | Yes | — | — | office/clinic, home (POS 12 — pays a ~10–11.5% premium on the AHCCCS schedule), school, community, telehealth (modality allowed under AMPM 320-S; ABA-specific POS/modifier not itemized) | — | HM (below bachelor's / BT-RBT), HN (bachelor's / BCaBA), HO (master's / BCBA), HP (doctoral / BCBA-D) |
| 97152 | Yes | — | — | office/clinic, home (POS 12 — pays a ~10–11.5% premium on the AHCCCS schedule), school, community, telehealth (modality allowed under AMPM 320-S; ABA-specific POS/modifier not itemized) | — | HM (below bachelor's / BT-RBT), HN (bachelor's / BCaBA), HO (master's / BCBA), HP (doctoral / BCBA-D) |
| 97153 | Yes | — | — | office/clinic, home (POS 12 — pays a ~10–11.5% premium on the AHCCCS schedule), school, community, telehealth (modality allowed under AMPM 320-S; ABA-specific POS/modifier not itemized) | — | HM (below bachelor's / BT-RBT), HN (bachelor's / BCaBA), HO (master's / BCBA), HP (doctoral / BCBA-D) |
| 97154 | Yes | — | — | office/clinic, home (POS 12 — pays a ~10–11.5% premium on the AHCCCS schedule), school, community, telehealth (modality allowed under AMPM 320-S; ABA-specific POS/modifier not itemized) | — | HM (below bachelor's / BT-RBT), HN (bachelor's / BCaBA), HO (master's / BCBA), HP (doctoral / BCBA-D) |
| 97155 | Yes | — | — | office/clinic, home (POS 12 — pays a ~10–11.5% premium on the AHCCCS schedule), school, community, telehealth (modality allowed under AMPM 320-S; ABA-specific POS/modifier not itemized) | — | HM (below bachelor's / BT-RBT), HN (bachelor's / BCaBA), HO (master's / BCBA), HP (doctoral / BCBA-D) |
| 97156 | Yes | — | — | office/clinic, home (POS 12 — pays a ~10–11.5% premium on the AHCCCS schedule), school, community, telehealth (modality allowed under AMPM 320-S; ABA-specific POS/modifier not itemized) | — | HM (below bachelor's / BT-RBT), HN (bachelor's / BCaBA), HO (master's / BCBA), HP (doctoral / BCBA-D) |
| 97157 | Yes | — | — | office/clinic, home (POS 12 — pays a ~10–11.5% premium on the AHCCCS schedule), school, community, telehealth (modality allowed under AMPM 320-S; ABA-specific POS/modifier not itemized) | — | HM (below bachelor's / BT-RBT), HN (bachelor's / BCaBA), HO (master's / BCBA), HP (doctoral / BCBA-D) |
| 97158 | Yes | — | — | office/clinic, home (POS 12 — pays a ~10–11.5% premium on the AHCCCS schedule), school, community, telehealth (modality allowed under AMPM 320-S; ABA-specific POS/modifier not itemized) | — | HM (below bachelor's / BT-RBT), HN (bachelor's / BCaBA), HO (master's / BCBA), HP (doctoral / BCBA-D) |
| 0362T | Yes | — | — | office/clinic, home (POS 12 — pays a ~10–11.5% premium on the AHCCCS schedule), school, community, telehealth (modality allowed under AMPM 320-S; ABA-specific POS/modifier not itemized) | — | HM (below bachelor's / BT-RBT), HN (bachelor's / BCaBA), HO (master's / BCBA), HP (doctoral / BCBA-D) |
| 0373T | Yes | — | — | office/clinic, home (POS 12 — pays a ~10–11.5% premium on the AHCCCS schedule), school, community, telehealth (modality allowed under AMPM 320-S; ABA-specific POS/modifier not itemized) | — | HM (below bachelor's / BT-RBT), HN (bachelor's / BCaBA), HO (master's / BCBA), HP (doctoral / BCBA-D) |

Code notes:

- **97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, 0362T, 0373T:** Blue Cross Blue Shield of Arizona Health Choice runs PA from frequently-updated PA-Guidelines grids (≥7 versions Jan 2024–May 2026), not a published ABA policy — pull the current grid rows for 97151–97158 from healthchoiceaz.com (PA line 1-800-322-8670 / fax 480-760-4732). AMPM 320-S covers ASD "and/or other diagnoses as justified by medical necessity" — no strict autism-dx requirement. Per-code daily unit caps are not published (AzCH uses hour bands, not caps).

### Medicaid rates

Source: Not separately published by Blue Cross Blue Shield of Arizona Health Choice. AHCCCS ACC/DDD plans are capitated, but ABA tracks the AHCCCS physician fee schedule (see arizona-ahcccs rates) as the public benchmark — Blue Cross Blue Shield of Arizona Health Choice's actual contracted rate is not published (and is NOT a statutory floor, unlike New Mexico). Effective 2023-11-01 (AHCCCS benchmark).

| Code | Rate | Unit | Modifier tiers |
| --- | --- | --- | --- |
| 97151 | Benchmark: $30.06 (HN) / $35.78 (HO) / $44.73 (HP) office — see arizona-ahcccs | 15min | — |
| 97152 | Benchmark: $21.49 (HM) / $25.58 (HN) / $28.43 (HO/HP) office — see arizona-ahcccs | 15min | — |
| 97153 | Benchmark: $17.91 (HM) / $21.32 (HN) / $23.69 (HO/HP) office — see arizona-ahcccs | 15min | — |
| 97154 | Benchmark: $4.48 (HM) / $5.33 (HN) / $5.92 (HO/HP) office — see arizona-ahcccs | 15min | — |
| 97155 | Benchmark: $25.05 (HN) / $29.82 (HO) / $37.28 (HP) office — see arizona-ahcccs | 15min | — |
| 97158 | Benchmark: $6.26 (HN) / $7.46 (HO) / $9.32 (HP) office — see arizona-ahcccs | 15min | — |

### Contacts

- **Benefits by phone:** Yes
- **Provider services phone:** 1-800-322-8670
- **Hours:** Monday–Friday, 8:00 a.m.–5:00 p.m. (except holidays)
- **Portal:** [Health Choice Arizona Provider Portal](https://providerportal.healthchoiceaz.com)
- **Fax:** 1-877-422-8120 (Medical PA fax)

Questions to ask on a verification call:

- Per the current PA-Guidelines grid, does 97151/97152 need prior authorization for this member?
- What’s the current unit/hour cap for 97153–97155 on the PA grid?
- Is telehealth allowed for ABA codes, and what modifier is required?
- What POS codes do you accept for home vs. clinic ABA visits?

### VOB data sources

- https://www.azblue.com/medicaid/providers/claims (accessed 2026-07-23)
- https://pverify.com/wp-content/uploads/2026/03/pVerifyPayers_All-Payers-List-3-2026.pdf (accessed 2026-07-23)
- https://essentials.availity.com/availity/documents/payer_list_wShortNames.pdf (accessed 2026-07-23; source document older than 18 months)
- https://www.optum.com/ (accessed 2026-07-23)
- https://www.azahcccs.gov/Resources/Downloads/EDIchanges/AZ270_271_CG.pdf (accessed 2026-07-23)
- https://www.healthchoiceaz.com/providers/pa-guidelines (accessed 2026-07-23)
- https://www.azahcccs.gov/shared/Downloads/MedicalPolicyManual/300/320S.pdf (accessed 2026-07-23)
- https://www.azahcccs.gov/AHCCCS/Downloads/PublicNotices/rates/FinalPublicNotice_RateChanges_20231101_ABA.pdf (accessed 2026-07-23)
- https://azahcccs.gov/PlansProviders/Downloads/FFSrates/ABA/FY26_Final_ABA_FeeSchedule.xlsx (accessed 2026-07-23)
- https://azblue.com/medicaid/providers/pa-guidelines/ (accessed 2026-07-23)
- https://providerportal.healthchoiceaz.com/Home/Contact (accessed 2026-07-23)
- https://assets.azblue.com/m/2f23756dddee042e/original/BCBS_HCM_Eligibility-Fax-Blast-2026-02.pdf (accessed 2026-10-14)

## Common questions

### Does Blue Cross Blue Shield of Arizona Health Choice cover ABA?

Yes — as an AHCCCS ACC plan, on the AMPM 320-S baseline. It publishes no distinct ABA clinical policy; PA requirements live in its frequently-updated PA grids.

### Does BCBSAZ Health Choice require PA for ABA codes?

Not published as a standing rule — check the current PA grid rows for 97151–97158 on healthchoiceaz.com, or call the PA line at 1-800-322-8670. Grids have revised at least seven times since early 2024.

### Is Health Choice Arizona now Blue Cross Blue Shield of Arizona Health Choice?

Yes — AHCCCS's official health plan roster (revised 6/30/2026) lists it as "Blue Cross Blue Shield of Arizona Health Choice." It has been a BCBSAZ subsidiary since BCBSAZ acquired Steward Health Choice Arizona; the plan's AHCCCS contract, coverage, and mechanics are unchanged by the naming update.

### What is BCBSAZ Health Choice’s fee schedule for ABA?

There is no public plan fee schedule. AHCCCS says its fixed ABA rates (effective November 1, 2023) apply only to fee-for-service programs and have “no impact on the contracts that AHCCCS health plans negotiate with their providers”: “MCOs and providers may negotiate any contracted rate that is agreed to by both parties.” Your rate is in your contract with BCBSAZ Health Choice; the AHCCCS fee-for-service schedule does not bind the plan.

### Can an out-of-state BCBA treat Health Choice members in Arizona, including by telehealth?

Arizona requires a license (A.R.S. § 32-2091.02) but lets an out-of-state provider deliver telehealth after registering under A.R.S. § 36-3606. AHCCCS defines a Behavior Analyst as one licensed under A.R.S. § 32-2091, so plan on an Arizona license for Medicaid work.

### What is Health Choice Arizona’s timely filing limit for AHCCCS ABA claims?

Six months from the date of service (or from the date eligibility is posted, if later), and twelve months to reach clean-claim status. A.R.S. § 36-2904(G) sets those limits for every AHCCCS contracted health plan, and Health Choice’s own manual states the same six and twelve months. Corrected claims go back whole with resubmission code A or 7 and the original CRN.

### How fast does Health Choice Arizona pay a clean ABA claim?

Health Choice follows AHCCCS ACOM 203: 95% of clean claims adjudicated within 30 days and 99% within 60 unless your contract says otherwise, with interest on non-hospital clean claims paid after 45 days. No weekly cutoff or check-run day is published.

## Primary sources

1. [CMS — Medicaid NCCI Edit Files (practitioner MUE table effective 10/1/2026)](https://www.cms.gov/medicare/coding-billing/ncci-medicaid/medicaid-ncci-edit-files)
2. [AHCCCS Telehealth Code Set (guidelines eff. 01/01/2026; code sheet eff. 06/01/2026)](https://www.azahcccs.gov/PlansProviders/Downloads/MedicalCodingResources/TelehealthCodeSet.xlsx)
3. [AMPM 320-I — Telehealth (AHCCCS)](https://www.azahcccs.gov/shared/Downloads/MedicalPolicyManual/300/320-I.pdf)
4. [AHCCCS ACOM 203 — Claims Processing (eff. 10/01/22)](https://www.azahcccs.gov/Shared/Downloads/ACOM/PolicyFiles/200/203v2.pdf)
5. [BCBSAZ Health Choice Provider Manual, Chapter 18 — Behavioral Health Services (rev. 4/2026)](https://assets.azblue.com/m/50282557ee9de438/original/Chapter_18_BH-Services_HCA.pdf)
6. [BCBSAZ Health Choice Provider Manual, Chapter 14 — Medicare and Other Insurance Liability](https://assets.azblue.com/m/5e7343737596d6eb/original/Chapter_14-Medicare-and-Other-Ins-Liability_HCA.pdf)
7. [BCBSAZ Health Choice Provider Manual, Chapter 11 — Claims Processing (rev. 3/24/2026)](https://assets.azblue.com/m/48cf28371552143e/original/Chapter_11_Claims_Processing_HCA.pdf)
8. [BCBSAZ Health Choice Provider Manual, Chapter 7 — General Billing Rules](https://assets.azblue.com/m/2514517577f46956/original/Chapter_07_General_Billing_Rules_HCA.pdf)
9. [AHCCCS — Available Health Plans list (lists "Blue Cross Blue Shield of Arizona Health Choice")](https://www.azahcccs.gov/Members/Downloads/Resources/ENGLISH_HealthPlanList.pdf)
10. [Health Choice Arizona — PA guidelines (grids)](https://www.healthchoiceaz.com/providers/pa-guidelines)
11. [AMPM 320-S — Behavior Analysis Services (AHCCCS)](https://www.azahcccs.gov/shared/Downloads/MedicalPolicyManual/300/320S.pdf)
12. [AHCCCS — Final Public Notice, FFS rate changes 11/1/2023 (ABA codes)](https://www.azahcccs.gov/AHCCCS/Downloads/PublicNotices/rates/FinalPublicNotice_RateChanges_20231101_ABA.pdf)
13. [Optum — Arizona AHCCCS Autism/ABA Program provider orientation (BH4129)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/autismABA/azaba/azABA_Provider_Orient.pdf)
14. [Mercy Care — Applied Behavior Analysis provider page](https://www.mercycareaz.org/providers/applied-behavior-analysis.html)
15. [AHCCCS — Rate Setting for Applied Behavioral Analysis (ABA) Services FAQ (10/31/2023)](https://www.azahcccs.gov/PlansProviders/Downloads/FFSrates/ABA_RateSettingFAQs.pdf)
16. [A.R.S. § 32-2091.02 — a behavior analyst must be licensed](https://www.azleg.gov/ars/32/02091-02.htm)
17. [A.R.S. § 32-2091.12 — unlicensed practice is a class 2 misdemeanor](https://www.azleg.gov/ars/32/02091-12.htm)
18. [A.R.S. § 36-3606 — interstate telehealth services; registration of out-of-state providers](https://www.azleg.gov/ars/36/03606.htm)
19. [A.R.S. § 36-3601 — telehealth definitions (“health care provider” includes Title 32, ch. 19.1 licensees)](https://www.azleg.gov/ars/36/03601.htm)
20. [A.R.S. § 32-2091.14 — AHCCCS recognizes licensed behavior analysts as behavioral health professionals](https://www.azleg.gov/ars/32/02091-14.htm)
21. [eCFR — 42 CFR 438.602(b)(1): the state must screen and enroll all managed care network providers](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-438/subpart-H/section-438.602)
22. [A.R.S. § 36-2904 — AHCCCS contracts; claim submission time limits (subsection G)](https://www.azleg.gov/ars/36/02904.htm)
23. [AHCCCS FFS Provider Billing Manual, Chapter 4 — General Billing Rules (rev. 11/03/2025)](https://www.azahcccs.gov/PlansProviders/Downloads/FFSProviderManual/FFS_Chap04GeneralBillingRules.pdf)
24. [AHCCCS — Provider Claim Disputes](https://www.azahcccs.gov/PlansProviders/RatesAndBilling/ManagedCare/claimdisputes.html)
25. [AMPM 540 — Electronic Visit Verification (effective 08/06/26)](https://www.azahcccs.gov/shared/Downloads/MedicalPolicyManual/500/540.pdf)
26. [AHCCCS — Electronic Visit Verification (What is EVV?, updated Oct. 22, 2025)](https://www.azahcccs.gov/AHCCCS/Initiatives/EVV/)
27. [Blue Cross Blue Shield of Arizona Health Choice — Medicaid provider announcements (recent + archived notices)](https://www.azblue.com/medicaid/providers/provider-announcements)
28. [Health Choice Arizona — Provider Manual Ch. 6, Authorizations and Notifications (rev. 12/19/2025)](https://assets.azblue.com/m/3791bc8d4445267e/original/Chapter_06_Authorizations-and-Notifications_HCA.pdf)
29. [42 CFR 438.210(d) — Medicaid managed care authorization decision timeframes](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-438/subpart-D/section-438.210)
30. [AHCCCS ACOM 434 — Coordination of Benefits and Third-Party Liability (eff. 5/2/2025)](https://www.azahcccs.gov/shared/Downloads/ACOM/PolicyFiles/400/434.pdf)
31. [32 CFR 199.8 — TRICARE double coverage (secondary to other plans, primary to Medicaid)](https://www.ecfr.gov/current/title-32/subtitle-A/chapter-VII/subchapter-M/part-199/section-199.8)
32. [VA — CHAMPVA Guidebook (updated 1/1/2025), CHAMPVA as secondary payer](https://www.va.gov/files/2025-12/CHAMPVA-Guidebook.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.