---
title: "Humana Healthy Horizons in Kentucky ABA coverage: the intake guide."
url: "https://carelu.com/payers/humana-healthy-horizons-kentucky"
markdown_url: "https://carelu.com/payers/humana-healthy-horizons-kentucky.md"
state: KY (Kentucky)
payer: Humana Healthy Horizons in Kentucky
kind: Medicaid managed care plan (MCO)
parent_program: Kentucky Medicaid (managed care)
description: "How Humana Healthy Horizons in Kentucky covers ABA for Kentucky Medicaid members: prior authorization on all eight ABA codes, the diagnosis codes claims must carry, decision clocks, filing limits and appeals."
last_reviewed: October 2026
---

# Humana Healthy Horizons in Kentucky ABA coverage: the intake guide.

_Payer Guide · Humana Healthy Horizons · Kentucky · Last updated October 2026 · 13 primary sources_

> Kentucky Medicaid MCO: all eight ABA codes on the PA list since 7/1/2025; claims need an F84/F88/F89 diagnosis.

Humana Healthy Horizons in Kentucky is a Kentucky Medicaid MCO (a Medicaid product of Humana Health Plan, Inc.). It reinstated behavioral health prior authorization on July 1, 2025 and lists every ABA code on its 2026 prior authorization list. Its June 2025 billing reminder is the clearest statement in Kentucky of which diagnosis codes an ABA claim must carry.

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

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Yes. Humana’s Kentucky Medicaid Prior Authorization and Notification List (eff. 1/1/2026) names 97151 and 97152 with the treatment codes under "Applied behavioral analysis (ABA)" [1][2]
- **Prior auth for treatment**: Yes, 97153–97158, reinstated July 1, 2025; submit through Availity Essentials, fax or phone with all pertinent clinical information [1][2]
- **Autism diagnosis required?**: Yes. "ABA services are considered medically necessary when delivered to an individual with autism"; claims need F84.0, F84.2, F84.3, F84.5, F84.8, F84.9, F88 or F89 or they deny [3]

## At a glance

- **Covers ABA?:** Yes, when delivered to an individual with autism
- **Prior auth:** Required on 97151–97158 (PAL eff. 1/1/2026, rev. 2/16/2026)
- **Diagnosis codes:** F84.0, F84.2, F84.3, F84.5, F84.8, F84.9, F88, F89
- **Decision clock:** Standard PA notice within 2 business days of the request (manual); contract: 5 days after necessary information
- **Timely filing:** 365 calendar days; claim appeals within 60 calendar days
- **Licensure:** Kentucky license required (KRS 319C)

## Prior authorization and the diagnosis rule

Following DMS’s April 2025 guidance, Humana said that "Effective July 1, 2025 … Humana Healthy Horizons in Kentucky will reinstate all PA requirements for behavioral health services," and its preauthorization list names "Applied Behavioral Analysis (ABA) 97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158." The current list (effective January 1, 2026, revised February 16, 2026) carries the same eight codes. Requests go through Availity Essentials, fax or phone; approvals are delivered in Availity, and denials verbally, in Availity, by fax and by mail. [2][1][3]

Humana’s June 5, 2025 reminder ties payment to diagnosis: "ABA services are considered medically necessary when delivered to an individual with autism. Claims submitted without a diagnosis code indicating autism or likely autism diagnosis will be denied." The accepted codes are F84.0, F84.2, F84.3, F84.5, F84.8, F84.9, F88 and F89. The reminder applies to provider types 01 through 95, including licensed behavior analysts (63). Denials can be appealed with medical records through Availity or in writing. [2][1][3]

## Claims, decision clocks and appeals

Humana’s 2025 provider manual (the edition still posted in October 2026) requires claims and corrected claims within 365 calendar days of the date of service and claim appeals within 60 calendar days of the reduction or denial, and says Humana pays 90 percent of clean claims within 30 days and 99 percent within 90. For standard PA decisions it notifies the provider "no later than 2 business days following the authorization request date," extendable up to 14 calendar days. After exhausting internal appeal rights a provider may request external independent review under 907 KAR 17:035; the reviewer decides within 30 calendar days, and either side may then request an administrative hearing within 30 calendar days. Taxonomy is required for all rendering providers, in box 24J of the CMS-1500. [4]

## Intake gates

The questions that decide whether a family can start with Humana Healthy Horizons in Kentucky, and what they have to bring.

- **Age limit**: No age limit: the reinstated PA list applies to all Medicaid members, and the state regulation sets no ABA age limit. [2][8]
- **Referral required?**: No referral for ABA appears in Humana’s ABA documents or the state regulation; prior authorization is the gate. [1][8]
- **Telehealth**: Humana’s manual covers telehealth only through its MDLIVE virtual urgent care and publishes no ABA telehealth rule, so the state rule applies. 907 KAR 3:170 makes its telehealth policies "supersede any in-person requirement established within KAR Title 907" (unless a law, licensing board, professional criteria or the billing code itself requires in-person), applies them to fee-for-service and to MCO coverage alike, and defines place of service as wherever the patient is, "including … the patient’s home or office, or a clinic, school, or workplace." A service is reimbursable by telehealth when it is appropriate and safe for the technology, not prohibited by the provider’s licensing board, and delivered by an enrolled provider; reimbursement is at least 100 percent of the in-person rate (an MCO may negotiate otherwise), telehealth must be denoted "by place of service or other means," and referral rules are the same as in person. Neither DMS nor any Kentucky MCO document read publishes an ABA-specific telehealth code list or modifier. The licensing board requires a Kentucky license for anyone delivering ABA by telehealth to a client located in Kentucky (201 KAR 43:100, Section 2). [4][9][16]
- **Prior-auth decision time**: Humana’s manual: for standard PA decisions it notifies the provider "no later than 2 business days following the authorization request date," extendable up to 14 calendar days. Kentucky’s MCO contract (§ 18.6) is stricter than the federal floor: a standard prior authorization is decided "no later than five (5) Days after receiving the necessary information" (contract "Day" means calendar day; "necessary information" is as defined in KRS 304.17A-607), extendable up to 14 days at the provider’s or enrollee’s request; expedited decisions within 24 hours of all necessary information; and "an untimely service authorization constitutes a Denial" that can be appealed. Federal law caps standard MCO decisions at 7 calendar days from the request for rating periods starting on or after January 1, 2026. [4][7][11]
- **Other insurance (who pays first)**: Humana’s manual repeats that Kentucky Medicaid is the payer of last resort and lets codes on its commercial bypass list go straight to Humana without an EOB. Medicaid pays last. The MCO contract (§ 14.2) says Medicaid "shall be used as a source of payment for Covered Services only after all other sources of payment have been exhausted," and when another resource is known the plan "shall avoid payment by ‘cost avoiding’ (denying) the Claim and redirecting the provider to bill the other Third Party Resource as a primary payer" (42 CFR 433.139). So bill the commercial plan first and follow its ABA prior authorization. [4][7][12]
- **Diagnosis recency** _(ask the plan)_: Not stated by Humana. [3]
  - Ask the plan: Humana Healthy Horizons behavioral health UM, 800-444-9137.
- **Who may diagnose** _(ask the plan)_: Not stated by Humana. Kentucky law excludes diagnosis from the practice of ABA (KRS 319C.010(8)). [3][15]
  - Ask the plan: Humana Healthy Horizons behavioral health UM, 800-444-9137.
- **Diagnostic tools required** _(ask the plan)_: Not stated by Humana; the manual says it uses "nationally recognized criteria" without naming the ABA criteria set. [4]
  - Ask the plan: Humana Healthy Horizons behavioral health UM, 800-444-9137: ask which criteria and instruments it applies to ABA.

## Delivery and billing rules

Coverage decides whether Humana Healthy Horizons in Kentucky 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**: Humana publishes no ABA supervision rule of its own; the state rule applies. 907 KAR 15:010, Section 3(3)(r)4 says ABA "shall be provided by" a licensed behavior analyst, a licensed assistant behavior analyst, or an approved behavioral health practitioner (or one under supervision) "with documented training in applied behavior analysis," and that "a registered behavior technician under the supervision of an appropriate practitioner" may provide "support services." No numeric supervision ratio is set. The documentation rules carry the supervision: notes by a practitioner working under supervision must be co-signed and dated by the supervising professional within 30 days, with a monthly supervisory note on the case. 907 KAR 15:005 defines the RBT by BACB training, competency assessment and exam, within six months of hire. [4][8][14]
- **Session-note signature**: Humana publishes no ABA-specific note rule; the state rule applies. Under 907 KAR 15:010, Section 6, service notes must be made within 48 hours of each visit, say whether the service was face-to-face or telehealth, state a start and end time, and be "recorded and signed by the rendering behavioral health practitioner" with the practitioner’s professional title; "initials, typed signatures, or stamped signatures shall not be accepted" (compliant electronic signatures are allowed under Section 9). Notes by a practitioner under supervision are co-signed by the supervisor within 30 days, and the plan of care is reviewed at least every six months. [4][8]
- **Bill as provider**: Electronic claims report the rendering provider NPI in loop 2310B, and taxonomy is required for "All rendering providers" (box 24J with qualifier ZZ on a CMS-1500). The state rule bills the practitioner who provided the service or under whose supervision it was rendered, or the group. [4][8]
- **Concurrent billing (97153 + 97155)** _(plan-dependent)_: Humana publishes no ABA concurrent-billing rule. DMS allows 97155 concurrently with 97153 from December 2, 2025 when the patient is present and the professional is directing the technician; the letter is addressed to providers. [10][4]
  - Ask the plan: Humana Healthy Horizons Provider Services, 800-444-9137: confirm 97153 + 97155 concurrent payment.
- **Daily limits / MUEs** _(ask the plan)_: Humana publishes no ABA unit or hour limit; units are set by the authorization. [1][4]
  - Ask the plan: Humana Healthy Horizons behavioral health UM, 800-444-9137.
- **Place of service** _(ask the plan)_: Humana publishes no ABA setting rule; the state regulation sets no ABA setting restriction. [4][8]
  - Ask the plan: Humana Healthy Horizons Provider Services, 800-444-9137: ask which place-of-service codes it pays for ABA.

## What intake should collect for Humana Healthy Horizons in Kentucky

- **Member ID:** Confirm Humana Healthy Horizons in Kentucky on the date of service.
- **Diagnosis code:** One of F84.0, F84.2, F84.3, F84.5, F84.8, F84.9, F88 or F89, or the claim denies.
- **Clinical packet for PA:** Assessment and treatment plan for all eight ABA codes, submitted before services start.
- **Other insurance:** Kentucky Medicaid is the payer of last resort; bill the primary first unless the code is on the commercial bypass list.

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

## Common questions

### Does Humana Healthy Horizons in Kentucky require prior authorization for ABA?

Yes. Since July 1, 2025 all eight ABA codes (97151–97158) are on its prior authorization list.

### Which diagnosis codes does Humana accept on Kentucky ABA claims?

F84.0, F84.2, F84.3, F84.5, F84.8, F84.9, F88 and F89. ABA claims without an autism-range code are denied.

### How long do I have to appeal a Humana Kentucky claim denial?

60 calendar days from the reduction or denial notice, then external independent review once internal appeals are exhausted.

## Primary sources

1. [Humana Healthy Horizons in Kentucky — Prior Authorization and Notification List (eff. Jan. 1, 2026; rev. Feb. 16, 2026)](https://assets.humana.com/is/content/humana/KY%20MCD%20PAL%20Dpdf)
2. [Humana Healthy Horizons in Kentucky — Behavioral health authorization reinstatement (notice May 30, 2025; eff. July 1, 2025)](https://assets.humana.com/is/content/humana/Behavioral%20health%20authorization%20reinstatementpdf)
3. [Humana Healthy Horizons in Kentucky — Applied Behavior Analysis Reminder (June 5, 2025): ABA claims need an autism-range diagnosis code](https://assets.humana.com/is/content/humana/ABA%20Services%20Reminder%2006.05.25pdf)
4. [Humana Healthy Horizons in Kentucky — Provider Manual 2025 (the edition posted on the documents page in October 2026)](https://assets.humana.com/is/content/humana/2025_KY_Provider_Manualpdf)
5. [Kentucky DMS — Managed Care Plans Prior Authorization Requirements and Billing Limits by Behavioral Health Service (revised August 2025)](https://www.chfs.ky.gov/agencies/dms/Documents/Kentucky%20Managed%20Care%20Plans%20Prior%20Authorization%20by%20Behavioral%20Health%20Service%20%28Revised%208.2025%29.pdf)
6. [Kentucky DMS Provider Letter (April 8, 2025) — rescinds March 14, 2025 letter; HB 695 § 20 reinstates all BH prior authorization in place on Jan. 1, 2020 (eff. June 25, 2025)](https://www.chfs.ky.gov/agencies/dms/ProviderLetters/Behavioral%20Health%20Prior%20Authorization.pdf)
7. [Kentucky Medicaid Managed Care Contract, Attachment C (Aetna/SKY version 5, record date 12/22/2025, term to 12/31/2026) — §§ 14.2, 16.3, 18.6, 25.10, 27.1–27.2](https://www.chfs.ky.gov/agencies/dms/dhpo/Documents/CY2026Aetna.pdf)
8. [907 KAR 15:010 — Coverage of behavioral health services by individual practitioners, provider groups and multi-specialty groups (Section 3(3)(r) applied behavior analysis; eff. 1-3-2020)](https://apps.legislature.ky.gov/law/kar/titles/907/015/010/)
9. [907 KAR 3:170 — Telehealth service coverage and reimbursement (eff. 6-2-2022)](https://apps.legislature.ky.gov/law/kar/titles/907/003/170/)
10. [Kentucky DMS Provider Letter (December 3, 2025) — Concurrent billing of ABA codes 97153 and 97155 (eff. Dec. 2, 2025)](https://www.chfs.ky.gov/agencies/dms/ProviderLetters/ABAConcurrentBilling.pdf)
11. [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)
12. [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)
13. [Humana Healthy Horizons in Kentucky — Communications and network notices (provider notices archive)](https://provider.humana.com/medicaid/kentucky-medicaid/communications-network-notices)
14. [907 KAR 15:005 — Definitions for 907 KAR Chapter 15 (approved behavioral health practitioner incl. licensed behavior analyst; registered behavior technician)](https://apps.legislature.ky.gov/law/kar/titles/907/015/005/)
15. [KRS 319C.010 — Definitions (practice of applied behavior analysis excludes diagnosis)](https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=31292)
16. [201 KAR 43:100 — Telehealth and telepractice (Kentucky Applied Behavior Analysis Licensing Board; eff. 10-4-2022)](https://apps.legislature.ky.gov/law/kar/titles/201/043/100/)

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.