Louisiana Medicaid covers applied behavior analysis under the Medicaid State Plan for members under 21, and Chapter 4 of the Medicaid Services Manual (issued August 22, 2025) is the rulebook. One sentence in it decides the workflow: "ABA services are provided through Managed Care Organizations (MCOs)." There is no fee-for-service ABA path to bill; every request, authorization and claim goes to the child’s Healthy Louisiana plan, and the plans follow the state manual closely.
Two things changed in 2026. UnitedHealthcare Community Plan left Healthy Louisiana on March 31, 2026, and Healthy Blue leaves on December 31, 2026; its members pick or are assigned a new plan from January 1, 2027. From then the plans are Aetna Better Health, AmeriHealth Caritas Louisiana, Humana Healthy Horizons in Louisiana and Louisiana Healthcare Connections. And since November 2025 the plans use one uniform ABA authorization form and hold ABA requests for children with other insurance until the primary insurer’s decision arrives.
ABA is available to Medicaid members under 21 who show behavior excesses or deficits "that significantly interfere with home or community activities (e.g., aggression, self-injury, elopement, etc.)," have been diagnosed by a qualified health care professional (QHCP) with a condition ABA is recognized to treat, "including autism spectrum disorder," have had a comprehensive diagnostic evaluation (CDE) by a QHCP, and have a prescription from a QHCP (not needed when the CDE recommends ABA). Aetna Better Health’s guidance for evaluators puts the consequence plainly: "Unlike many private health plans, the Louisiana Medicaid program does NOT require that the eligible member be diagnosed with autism or ASD," and does not require specific instruments such as the ADOS or Vineland.[1][11]
The CDE needs a clinical history with the caregiver, direct observation, a record review, a DSM-5 diagnosis, a rationale for referring or not referring to ABA, and recommendations. Pediatricians can diagnose on the MCHAT-R/F; the other QHCPs are pediatric neurologists, developmental pediatricians, psychologists, psychiatrists, team-based pediatricians, supervised nurse practitioners and experienced SLPs, LCSWs or LPCs. The CDE never goes stale on its own: plans "shall not deny services based solely on the age of the CDE," and if a plan wants a new one it must arrange it and keep services going meanwhile.[1][11]
All ABA must be prior authorized by the child’s MCO, in two steps. First the provider asks to conduct a functional assessment and write the behavior treatment plan, attaching the CDE (only on the first request per member per provider). Then a separate request asks for treatment, with the CDE, the treatment plan, the IEP, and the waiver Plan Profile Table and schedule if the child is on a waiver and services overlap. Reassessments happen at least every six months, and no assessment or treatment authorization runs longer than 180 days. Services delivered without authorization are not paid, except for retroactive eligibility. The treatment plan must show the weekly hours and locations, the direct observation, parent training goals and the PCP’s contact details; LDH’s plan-of-care template in Appendix D is optional, but its content is not. If a request is not approved as asked, the provider can request reconsideration from the MCO. Families may change ABA providers every 180 days, sooner for good cause.[1][9][10][24]
Since November 2025 the plans accept one uniform ABA authorization form. It asks whether there is a primary payer, whether the child is in school and whether an IEP exists, and it lists everything to attach for an initial assessment, initial treatment and continued treatment. For "subsequent treatment requests" it asks for "Objective measures of clinically significant progress (measurable and functional improvement) toward each stated treatment goal," an updated plan with goals and timelines, progress or lack of it with earlier interventions, the IEP or IFSP, titration and discharge plans, the schedule by location and provider, and the functional behavioral assessment ("Please advise the assessment tool utilized and include baseline data graph and progress"). So graphed baseline and progress data are expected on renewals. LDH’s plan-of-care instructions add that a renewal must "list the present level of performance for skills under treatment and any goals mastered during the previous authorization period," and must not describe baselines with "idiosyncratic, proprietary assessment instrument results."[1][9][10][24]
Louisiana Medicaid publishes one ABA fee schedule, effective for dates of service on or after July 1, 2022, and the manual makes it a floor for the plans: "MCO reimbursement rates shall be no less than the rates published" there. Per 15-minute unit: 97151 $25.00 (TF line $20.00); 97152 $11.00; 0362T $23.00; 97153 $12.50; 0373T $23.00; 97154 $4.50; 97155 $22.50 (TF $17.50); 97156 $22.50 (TF $17.50); 97157 $9.00 (TF $7.00); 97158 $10.00 (TF $7.50). The schedule’s columns are LBA, SCABA and technician, and modifiers mark the credential of the person delivering the service (HN bachelor’s level, TF intermediate level of care). Parents trained in ABA are not paid to treat their own child in place of an RLT, though a parent employed by an ABA provider can be. Code set: the schedule and the manual’s telehealth list use only CPT 97151–97158, 0362T and 0373T, with credential modifiers; no HCPCS H-code (H0031, H0032, H2019) is an ABA code in Louisiana Medicaid.[2][1]
Medicaid ABA must be provided by, or supervised by, a behavior analyst "currently licensed by the Louisiana Behavior Analyst Board," or a licensed psychologist or medical psychologist. To enroll, an LBA needs $1,000,000/$3,000,000 professional liability coverage, a clean BCBA or BCBA-D certification and license, and a criminal background check (renewed every five years). CaBAs must be certified by the board and supervised under a written agreement; RLTs must be registered with the board and supervised by an LBA, with background checks at hire. Providers send each MCO a list of their RLTs at enrollment and every quarter.[1][18][19][20]
A BCBA licensed only in another state cannot treat a Louisiana Medicaid member: the manual requires the Louisiana license, and state law makes unlicensed practice of behavior analysis a misdemeanor. Louisiana’s Telehealth Access Act tells each board to set up licensing or registration for out-of-state providers serving patients located in Louisiana; the board’s rule could not be read for this guide, so ask the board which route applies.[1][18][19][20]
Each plan sets its own claims rules within its LDH contract. The plans’ current manuals agree on a 365-day filing limit from the date of service (AmeriHealth Caritas Louisiana, Humana Healthy Horizons, Healthy Blue, Aetna Better Health). AmeriHealth Caritas Louisiana’s manual states the contract’s payment standard: 90% of clean claims paid or denied within 15 calendar days and all of them within 30. Provider claim disputes go first to the plan as an independent review reconsideration within 180 days of the remittance advice, then to LDH’s independent review within 60 days of the plan’s decision; a member appeal of a denied authorization is due within 60 calendar days of the notice. LDH’s electronic visit verification program covers personal care and home health services; ABA is not among the services it names.[13][14][15][12][17]
UnitedHealthcare’s participation in Louisiana Medicaid ended March 31, 2026, and its members moved to other plans on April 1, 2026. Healthy Blue ends its contract December 31, 2026. Its members have a special enrollment period from October 15 to November 16, 2026 and are otherwise auto-assigned, with new plans starting January 1, 2027. For ABA families the key rule is continuity: "HBL prior authorizations will be honored for up to 60 days (or through the authorization end date, whichever occurs first) by the receiving MCO," which may not deny solely because the provider is out of network. Providers must submit new requests to the new plan before that window closes, and Healthy Blue keeps paying claims through its 365-day filing window. Providers contracted only with Healthy Blue should contract with at least one of the four remaining plans.[6][8][5][7]
The questions that decide whether a family can start with Louisiana Medicaid (Healthy Louisiana), and what they have to bring. Each maps onto something intake should ask on the first call.
Under 21. ABA is covered for "Medicaid beneficiaries under 21 years of age" who meet the manual’s criteria.[1]
No expiry. "MCOs shall not deny services based solely on the age of the CDE," and "The CDE only needs to be included in the first PA request per member per provider." The MCO "shall deny service if no CDE exists," and if it asks for a new CDE it "shall not deny or delay available ABA services while waiting for a CDE." A family that switches ABA providers needs the CDE sent again with the new provider’s first request.[1]
A qualified health care professional (QHCP). Pediatricians may diagnose using the MCHAT-R/F and clinical judgment (a score of 8 or more lets them diagnose independently; 3–7 means a follow-up interview, then diagnose or refer). The subspecialists are a pediatric neurologist, developmental pediatrician, psychologist or medical psychologist, psychiatrist, a pediatrician working with a qualified interdisciplinary team, a nurse practitioner supervised by one of those specialists, or a licensed SLP, LCSW or LPC whose scope includes ASD differential diagnosis and who has two years of diagnostic experience or works under a QHCP who co-signs the CDE.[1]
No named instrument is required. The CDE must include a clinical history, direct observation, record review, a DSM-5 (or current edition) diagnosis, the rationale for referral or non-referral to ABA, and recommendations. Only when screening is borderline or the diagnosis or need is unclear must it add autism-specific, general psychopathology, cognitive/developmental and adaptive-behavior assessments. Pediatricians may diagnose on the MCHAT-R/F.[1][11]
Yes: a prescription for ABA "ordered by a QHCP," but "If there is a recommendation in the comprehensive diagnostic evaluation (CDE) for ABA therapy, a separate prescription is not needed." The behavior treatment plan must name the child’s PCP, be sent to the PCP, and progress notes go to the PCP every six months with each renewal. The chapter sets no expiry date for the prescription and does not say the prescriber must appear on the claim; ask the MCO.[1]
Yes, with prior authorization. The LDH manual lists 97151–97158 as codes that "can be performed via telehealth," with reimbursement rules otherwise unchanged; services must be "rendered or directed by a RLT, LBA, or CaBA" over "an interactive audio/visual telecommunications system." Reassessments and treatment plans may be done remotely "only if the same standard of care can be met," and RLT supervision "may be conducted via telehealth in lieu of the LBA/CaBA being physically present." 0362T and 0373T are not on the telehealth list. "Telehealth requires PA for services," and approved PAs can be amended to add units or reflect reassessment goals. The chapter names no telehealth place-of-service code or modifier, so each MCO’s billing rules decide those.[1]
The LDH ABA manual sets no clock of its own. The plans’ manuals print the contract standard: standard outpatient requests decided within 2 business days of receiving the needed information and no later than 7 calendar days after the request, extendable by 14 days; expedited requests within 72 hours. Federal law caps a Medicaid managed care standard authorization decision at 7 calendar days for rating periods starting on or after January 1, 2026 (one 14-day extension allowed).[13][14][21]
Medicaid pays last (42 CFR 433.139). The LDH manual lets the MCO "bypass the prior authorization (PA) process and acknowledge the PA granted by the primary insurer" when another insurer covers ABA. The MCOs tightened this in November 2025: with the new uniform ABA form, if the primary insurance covers ABA, "Medicaid will remain the payor of last resort, and the authorization will be placed in a pending status until primary coverage is confirmed," so send the primary insurer’s approval or denial with the Medicaid request.[22][1][10]
Coverage decides whether Louisiana Medicaid (Healthy Louisiana) 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.
Louisiana Medicaid sets the ratio in the ABA manual chapter: supervision "shall be approved on a 2:10 basis; that is two hours of supervision for every ten hours of therapy," part of it "must be done in the presence of the beneficiary" and the CaBA or registered line technician (RLT), and it "will not be approved if the licensed supervising professional is delivering the direct therapy." The licensed supervising professional "shall supervise no more than 24 technicians a day" (more if a CaBA is on the team) and "no more than 10 CaBAs." If technician services are in the plan, supervision by a licensed behavior analyst must be part of it.[1]
Yes. The LDH manual says: "One-on-one supervision may by be conducted and billed simultaneously and concurrently with one-on-one therapeutic behavioral services. Supervision can only occur when a non-licensed professional is providing the therapeutic behavioral services." In practice that is 97155 alongside 97153 when an RLT or CaBA is delivering the session.[1]
Start and stop times are required "for every code billed" (at the start of the session, after any break of 12 minutes or more, and on a switch of billing code). "The person delivering the service must sign, date, and include their credentials in the documentation for each day and distinct session," and the daily log must also carry the "Name, signature, and credentials for supervising BCBA who is also rendering provider for billing." For an RLT session, recorded data can replace the narrative. Records are kept at least six years.[1]
Services "must be provided in a natural setting (e.g., home and community-based settings, including clinics and school)," and school-based ABA by ABA providers is allowed. A treatment plan that puts services in a school "will not be approved until an IEP is provided" to the MCO. Sessions at a "non-ABA facility" (any place other than the home that does not offer ABA as a primary service) need an addendum explaining why they cannot happen at home or at the ABA facility. A change of setting mid-authorization needs a treatment-plan addendum. Overlap with other therapies (speech, OT, PT, waiver services): ABA may be delivered "simultaneously with another service, if allowed per medically unlikely edits and coding guidelines," only when "the other service in question must not have a restriction that keeps it from being performed at the same time as another service," and the treatment-plan addendum must give the frequency and duration of sessions when the ABA provider and the other provider are both present and what the other provider needs to implement the skill.[1]
The supervisor. "When billing for ABA services, the rendering provider on the claim form must be the provider that provided supervision for those services and signed documentation indicating that they supervised the services being billed for on the claim," and "Payment for services must be billed by the licensed professional" (an LBA, licensed psychologist or licensed medical psychologist). RLTs are not billed as rendering providers.[1]
The LDH manual publishes no daily unit cap. Hours are set per authorization from the treatment plan’s weekly schedule, and each authorization runs no more than 180 days. Plans may apply their own unit logic: Healthy Blue has told providers it will pay ABA against weekly approved units.[1][25]
Ask the plan: The member’s MCO utilization management line: ask how ABA units are authorized (weekly or total) and which unit edits its claims system applies.
Yes, for members under 21, through the child’s Healthy Louisiana plan. The child needs a comprehensive diagnostic evaluation from a qualified health care professional and a diagnosis ABA is recognized to treat; autism is the usual one but not the only one.
No. The LDH manual says ABA services are provided through the MCOs, and every request and claim goes to the child’s plan. There is no fee-for-service ABA billing path.
The state fee schedule (effective July 1, 2022) pays per 15 minutes: 97151 $25.00, 97152 $11.00, 97153 $12.50, 97154 $4.50, 97155 and 97156 $22.50, 97157 $9.00, 97158 $10.00, 0362T and 0373T $23.00, with lower TF-modifier lines. Plans must pay at least these rates.
Not on a BCBA certificate or another state’s license alone. Medicaid requires a behavior analyst licensed by the Louisiana Behavior Analyst Board (or a licensed psychologist), and state law makes unlicensed practice a misdemeanor. Louisiana law tells the board to provide a licensing or registration route for out-of-state telehealth providers; ask the board which applies.
Only if coding rules and medically unlikely edits allow it and the other service has no restriction on being performed at the same time. The treatment plan needs an addendum with the frequency and duration of the joint sessions and what the other provider needs to carry out the skill.
The all-plan uniform ABA form asks renewals to include the functional behavioral assessment with a baseline data graph and progress, plus objective measures of progress toward each goal.
No. Plans may not deny services based solely on the age of the CDE, and it only has to be sent with the first request to each provider. A plan that wants a new one must arrange it without pausing services.
Healthy Blue leaves Medicaid on December 31, 2026. The new plan must honor Healthy Blue authorizations for up to 60 days or until they end, whichever comes first, even if the provider is out of network. Submit a new request to the new plan before then.
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.
Carelu collects all of this automatically.
Every ID, document, and detail this payer requires — gathered conversationally the moment a family reaches out, with insurance verified before your team touches the file.
Get a Demo