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.
Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed September 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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