L.A. Care Health Plan is the Los Angeles County local initiative and the largest Medi-Cal plan in the state — 2,078,171 members in August 2026. For its directly enrolled Medi-Cal members, BHT is run in-house: "BHT services are provided through L.A. Care’s directly contracted BHT network," not through the member’s medical group and not through Carelon (which handles mild-to-moderate mental health for Medi-Cal and BHT only for L.A. Care’s commercial lines). L.A. Care also has two Medi-Cal Plan Partners — Anthem Blue Cross and Blue Shield of California Promise Health Plan — whose members may carry a different card; check which plan manages the child before submitting.
A PCP or family starts it: PCPs call 888-347-2264 or email ASDBenefit@lacare.org, or ask the "patient, parent, or caregiver to contact L.A. Care BHT team directly." The authorization form LA5480 (May 2026) says "All 4 criteria must be met for approval" — the member is under 21, has a licensed physician/surgeon/psychologist recommendation "with documentation demonstrating medical necessity," is medically stable with documentation, and needs no 24-hour or ICF-ID care. The functional behavior assessment is "H0032 for initial ABA assessment ONLY," up to "12hours total (48 units) across modifiers." Treatment is requested as hours per month: H2019 direct service (HN/HC/HP modifiers by tier), H0031-HP case supervision (with an optional second tier), S5111-HP for parent education programs, H2014 social skills group only if contracted. HN-level staff need a transcript and attestation. FBA, progress and closing reports must use L.A. Care’s mandatory BHT Reporting Template, which tracks the first appointment offered after FBA approval against a 10-day timeline.[3][5][4][1]
Watch the codes: L.A. Care uses H0032 for the assessment and H0031 for supervision — the reverse of IEHP and CalOptima. Never copy a code grid across plans. The form linked from L.A. Care’s BH Resources page (LA5480 10/25) is a dead link; use the 05/26 version from the Provider Manuals page.[3][5][4][1]
The questions that decide whether a family can start with L.A. Care Health Plan (Medi-Cal), and what they have to bring. Each maps onto something intake should ask on the first call.
Under 21 — "L.A. Care covers BHT for all Members under 21 years of age"; the PCP flyer says "0-21." No minimum age.[1][5]
A licensed physician, surgeon or psychologist — the 2026 manual says "licensed physician or licensed psychologist" in one section and "licensed physician, surgeon, or psychologist" in the BHT chapter.[1][2]
None required for the recommendation. For the FBA and progress reports the template asks for skills assessments "(e.g., VB-MAPP, Vineland, AFFLS, PEAK, etc.)," a preference assessment, and a functional or ABC analysis "Required for all target behaviors being addressed."[4]
A PCP or the family can start it — PCPs call 888-347-2264 or email ASDBenefit@lacare.org, or have the "patient, parent, or caregiver … contact L.A. Care BHT team directly"; supporting documents (CDE, EPSDT results, recommendation) go by fax to 213-438-5054. BHT does not go through the member’s medical group or IPA.[5][1]
L.A. Care’s 2026 manual counts days from receipt (day 0) but publishes numeric decision times only for its D-SNP line, so the state rule governs its Medi-Cal BHT requests: APL 21-011 — standard decisions within five business days of receiving the information reasonably necessary, never more than 14 calendar days, and 72 hours expedited — capped from January 1, 2026 at 7 calendar days by 42 CFR 438.210(d). Separately, L.A. Care tracks the provider’s first appointment offer within 10 days of FBA approval. Reauthorization: the treatment plan is reviewed at least every six months (APL 23-010).[1][10][11][4]
When another payer is primary, "Providers must follow the primary payor’s billing rules"; secondary claims go to L.A. Care within 180 calendar days of the primary’s determination with its RA or denial, and L.A. Care pays cost-sharing "up to the lower amount of its fee schedule or the Medicare/other insurance-allowed amount." Medi-Cal is payer of last resort (APL 22-027). L.A. Care does not say whether its own BHT authorization is required when commercial insurance is primary — ask the BHT Department.[1][12]
L.A. Care publishes no age limit on the recommendation (checked LA5480, the reporting template and the 2026 manual), and APL 23-010 sets none. Its reporting template requires skills-assessment results "Updated results required annually" and preference assessments every six months.[4][7]
Ask the plan: L.A. Care BHT Department (1-888-347-2264 / ASDbenefit@lacare.org) — how recent the recommendation must be.
No BHT-specific rule. L.A. Care’s general telehealth section requires a participating provider, disallows telehealth "when the Member and participating Provider are in the same physical location," and excludes "texting, facsimile or email only." Beyond that the Medi-Cal telehealth rule applies, which does not settle technician-delivered 97153/H2019 by video.[1][9]
Ask the plan: L.A. Care BHT Department (1-888-347-2264) — which BHT codes it will authorize by telehealth.
Coverage decides whether L.A. Care Health Plan (Medi-Cal) pays. These decide whether the claim survives: how sessions must be staffed and supervised, what may be billed concurrently, the per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.
The only published cap is on the assessment: "up to 12hours total (48 units)." No daily or weekly treatment cap is published — treatment is requested as hours per month — and APL 23-010 prohibits hour caps.[3][7]
Reports (FBA, progress, closing) need a "Qualified Autism Service Provider Signature," credentials and date, plus a statement that the report "has been thoroughly discussed with client’s parent(s)" and the parent’s agreement or disagreement. No session-note rule is published.[4]
Treatment "is typically conducted in children’s homes for hours a day and in other community settings" (PCP flyer); the reporting template has school sections (IEP, coordination with the school) and a "Location(s) of Services" field. The state rule underneath (APL 23-010) covers home, clinic, community and school.[5][4][7]
Case supervision is authorized separately — H0031-HP required, with an optional second tier (HC for BCaBA/master’s, HN for bachelor’s). L.A. Care publishes no supervision ratio.[3]
Ask the plan: L.A. Care BHT Department or your BHT provider contract.
Rendering level rides on the modifier: HP (BCBA-D/BCBA/licensed master’s), HC (BCaBA or master’s), HN (bachelor’s), HQ (group). The form captures the requesting and servicing organization; no NPI or enrollment rule is published.[3]
Ask the plan: Your L.A. Care BHT contract — rendering vs. billing NPI for technician time.
Not published — no L.A. Care rule on billing supervision (H0031) and direct service (H2019) for the same clock time; note L.A. Care authorizes HCPCS codes, not 97153/97155.[3]
Ask the plan: Your L.A. Care BHT contract or Provider Solutions (866-522-2736).
Yes — as Behavioral Health Treatment for Medi-Cal members under 21. No autism diagnosis is needed; a licensed physician, surgeon or psychologist must recommend it, and L.A. Care must authorize it.
Fax form LA5480 (05/26) with the recommendation and documentation to (213) 438-5054, or call the BHT team at 1-888-347-2264. The FBA is requested as H0032, up to 12 hours.
No. For L.A. Care’s direct Medi-Cal members, BHT goes through L.A. Care’s own BHT network, not the IPA. Members on a Plan Partner card (Anthem Blue Cross, Blue Shield Promise) may follow that plan’s process.
State rule: APL 23-010 requires every Medi-Cal plan to offer continued access to out-of-network BHT providers (continuity of care) for up to 12 months under APL 23-022, so ask L.A. Care for a continuity-of-care arrangement before treatment stops. No state document says whether an existing authorization follows the child to a new agency within the plan; ask the plan before switching.
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.
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