---
title: MVP Health Plan ABA coverage (NY Medicaid Managed Care).
url: "https://carelu.com/payers/mvp-health-plan-new-york"
markdown_url: "https://carelu.com/payers/mvp-health-plan-new-york.md"
state: NY (New York)
payer: MVP Health Plan (NY Medicaid)
kind: Medicaid managed care plan (MCO)
parent_program: New York Medicaid
description: "How MVP Health Plan authorizes NY Medicaid ABA — its own named ABA payment policy, prior authorization on both assessment and treatment, the 0362T/0373T Medicaid exclusion, the July 2025 school-setting bar, and a telehealth waiver tied to an expired federal deadline."
last_reviewed: October 2026
vob_data_updated: 2026-10-15
---

# MVP Health Plan ABA coverage (NY Medicaid Managed Care).

_Payer Guide · MVP Health Plan (NY) · Last updated October 2026 · 13 primary sources_

> In-house BH/ABA UM; PA required for both assessment and treatment — but 0362T/0373T are excluded from Medicaid Managed Care reimbursement.

MVP Health Plan — covering roughly 165,151 members per the state's July 2026 enrollment report, across a 30-county Capital Region, Hudson Valley, North Country, and western-NY footprint under its "MVP Medicaid Managed Care" brand (HARP: MVP Harmonious Health Care Plan) — administers behavioral health, including ABA, entirely in-house: no vendor carve-out exists for BH, even though MVP does delegate radiology, musculoskeletal, and post-acute UM to eviCore, Magellan, and naviHealth respectively. MVP publishes an actual named ABA payment policy with real teeth — a firm prior-authorization requirement on assessment and treatment alike, an explicit exclusion of two otherwise-covered codes from Medicaid reimbursement, and a July 2025 school-setting bar — making this one of the better-documented upstate plans in this directory, with only a handful of open questions left for Provider Services.

This plan administers the **New York Medicaid** ABA benefit: the state rules are the floor, and this page covers what the plan layers on top. Read it together with the [New York Medicaid (NYS DOH / eMedNY) guide](https://carelu.com/payers/new-york-medicaid).

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Required — MVP's ABA payment policy requires prior authorization for the assessment, referred by an NYS-licensed, Medicaid-enrolled physician, psychologist, psychiatric NP, pediatric NP, or PA [1][2]
- **Prior auth for treatment**: Required — treatment authorized via MVP's BH authorization request (fax 1-855-853-4850); 0362T and 0373T appear on the covered-code list but are excluded from Medicaid Managed Care reimbursement specifically [1][2]
- **Autism diagnosis required?**: Yes — under 21, ASD/Rett per the state baseline; MVP's 2026 payment-policy update restates the NYS-licensed/Medicaid-enrolled referral rule verbatim, with a 2-year referral validity [1][7]

## At a glance

- **Plan type:** Mainstream MMC (MVP Health Plan, Inc.) — "MVP Medicaid Managed Care"; HARP: MVP Harmonious Health Care Plan
- **Footprint:** 30 counties spanning Capital Region, Hudson Valley, North Country, and parts of Western NY (incl. Albany, Monroe, Orange, Rockland, Westchester)
- **BH/ABA UM:** In-house — MVP wrote its own ABA medical-necessity criteria in 2021; no vendor carve-out (eviCore/Magellan/naviHealth handle only radiology, MSK, and post-acute)
- **Prior auth:** Required for ABA assessment and treatment alike, per MVP's own ABA Payment Policy and its Behavioral Health Authorization Requirements grid
- **Codes excluded from Medicaid:** 0362T and 0373T appear on MVP's general covered-code list but are explicitly excluded from Medicaid Managed Care reimbursement
- **School setting:** ABA (97151–97158, 0362T, 0373T) not reimbursable with Place of Service = School, effective 7/1/2025
- **Fee schedule:** Medicaid, CHP and HARP: the MVP Medicaid Community Fee Schedule, which MVP defines as the NYS Medicaid fee schedule in effect on the date of service (97153 $9.63 from 10/1/2026)

## A named ABA payment policy — with a Medicaid-specific code exclusion

MVP publishes a standalone "Applied Behavior Analysis Services" payment policy (current version effective 4/1/2026), reviewed most recently February 2026 with no changes. It lists the covered codes — 97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, 0362T, and 0373T — but carries a Medicaid-specific carve-out worth flagging for billing: "The following procedures are excluded from Medicaid Managed Care (MMC) plan coverage: Behavior identification supporting assessment (CPT 0362T); Adaptive behavior treatment with protocol modification (0373T)." That exclusion has held across every version of the policy reviewed (2024 through 2026) — so while those two codes are billable on MVP's other lines of business, they are not reimbursable under NY Medicaid Managed Care specifically. Separately, RBT/unlicensed-professional-rendered services are only reimbursable under 97152, 97153, and 97154 — not 97151 or 97155–97158. [1]

## Prior authorization: required on both ends, referral-gated like the state

MVP's Behavioral Health Services and Authorization Requirements grid states plainly that Applied Behavior Analysis for NY Medicaid (including CHP) carries "Auth Required," effective with the Medicaid ABA benefit's own 1/1/2023 start date, for children ages 0–20. The ABA payment policy confirms prior authorization is required "for ABA Assessments and Services" alike, and its current (2026) version adds a Medicaid-specific referral rule matching the state's own: the member must be referred by an NYS-licensed and NYS Medicaid-enrolled physician (including psychiatrist and developmental/behavioral pediatrician), psychologist, psychiatric nurse practitioner, pediatric nurse practitioner, or physician assistant, with the referral valid 2 years and carrying age, diagnosis, date of initial diagnosis, comorbidities, severity, the DSM-5 diagnostic checklist, and a statement of medical necessity. Submit authorization requests by phone (1-800-684-9286), fax (1-855-853-4850) with the clinical support, or by email to BHservices@mvphealthcare.com; MVP's Behavioral Health Authorization and Notification request forms are indexed at mvphealthcare.com/providers/forms. [2][1][8]

What a reauthorization must show. MVP’s ABA Medical Policy authorizes treatment “for 6 months” at a time, and continued treatment requires: documentation of clinical progress showing the approach is effective and reasonably expected to produce significant improvement “in at least two settings (i.e., home, school, community)”; documentation of parent-training progress; documentation that attendance is “appropriate and consistent”; “documentation of monthly assessment of progress for each targeted goal”; and, where a goal is not progressing, an evaluation of the reasons and a revised treatment plan. The policy does not require graphs as such. [2][1][8]

## The school-setting bar, and what to watch on HARP

Effective July 1, 2025, MVP will not reimburse any ABA code (97151–97158, 0362T, 0373T) billed with Place of Service = School — a FastFax notice confirms requests for school-setting delivery are "administratively denied," and treatment plans submitted with a PA request must now specify the place(s) of service. ABA also isn't covered as a substitute for Early Intervention or when delivered under an IEP or Preschool/School Supportive Health Services Program. One item worth confirming directly with MVP: earlier policy versions stated ABA was "not covered... for Health and Recovery Plans (HARP)," but the current policy's scope line now lists HARP among the covered lines of business without an explicit statement reversing the old exclusion — treat HARP-enrolled members' ABA coverage as a call-to-confirm rather than an assumed yes. [3][1]

## What is MVP's fee schedule for Medicaid ABA?

MVP ties its Medicaid ABA rates to the state schedule in writing. Its ABA payment policy says authorized ABA services for Government Program members (Managed Medicaid, CHP and HARP) “will be reimbursed in accordance with the MVP Medicaid Community Fee Schedule provision outlined in the provider’s participation agreement,” and “the MVP Medicaid Community Fee Schedule is the NYS Medicaid Fee Schedule in effect at the time the service was rendered.” So the state's fee-for-service ABA rates apply by date of service: 97151, 97152, 97155 and 97156 at $19.26 per 15-minute unit, and technician-delivered 97153 at $9.63 from October 1, 2026 (NYS Medicaid Update, August 2026; $14.45 before that). Providers serving these members must also be enrolled in Medicaid fee-for-service with a valid MMIS number. For MVP's commercial lines the policy says only to “refer to your provider fee schedule.” [1][14][11]

## Telehealth and billing basics

MVP's ABA payment policy ties telehealth reimbursement to a federal waiver rather than stating a firm standing rule: "MVP shall reimburse ABA services delivered via video-enabled telehealth through March 31, 2025, or until the CMS waiver expires, whichever is later. Following the expiration or change of the waiver, MVP may deny ABA services delivered via telehealth in accordance with applicable state laws or regulations." That waiver-contingent language is unchanged in the current (April 2026) policy, so treat ABA telehealth coverage as unconfirmed and verify current status with Provider Services before scheduling remote sessions — audio-only, fax-only, and e-mail-only delivery are explicitly not reimbursable regardless. On claims: timely filing is 180 days from the date of service (or per contract), with a matching 180-day window to request an adjustment after a denial or incorrect payment; EDI submissions use Payee ID 14165, and paper claims go to MVP Health Care, Attn: Claims Department, PO Box 2207, Schenectady, NY 12301. [1][4]

## Claims: filing floor, payment clock and EVV

MVP Health Care sets its own filing limit in its provider agreement and manual; New York law sets the floor. Ins. Law § 3224-a, which covers New York insurers, Article 43 corporations and Article 44 HMOs, requires claims to be submitted within 120 days of the date of service unless the contract is more favorable to the provider — and for Medicaid managed care contracts lets the parties agree on a different period "but in no event less than ninety days." Undisputed claims must be paid within 30 days of receipt when submitted electronically and 45 days on paper, with interest at the greater of the corporate-tax rate or 12% per annum when paid late. [15][16][9][10][1][11]

Electronic Visit Verification does not reach ABA: the Department of Health’s EVV list for fee-for-service and managed care Medicaid covers personal care and home health care codes (CDPAP, home care, HCBS habilitation and respite) and no ABA code (97151–97158). [15][16][9][10][1][11]

MVP’s own clocks, from its April 2026 Provider Policies: “MVP applies a timely filing limitation of 180 days, or as specified in your contract, from the date(s) of service,” and a Clean Claim “must be submitted no more than 180 days after the date of discharge or 180 days after the date of service rendered.” Secondary claims: “Claims that involve Coordination of benefits where MVP is the secondary payer have a timely filing limitation of 180 days, or as specified in your contract, from the date of the primary EOB but no more than two (2) years after the date of service.” Corrections: “Providers may request an adjustment within 180 days, or as specified in your contract, from the date of MVP’s denial or incorrect payment,” and information requested for a records denial must be resubmitted within 180 days of MVP’s notice. On a clean claim MVP pays “within applicable regulatory timeframes” and gives written notice of any adverse determination within 30 days of receipt. No payment-cycle day or submission cut-off is published. [15][16][9][10][1][11]

For Medicaid managed care specifically, the state’s model contract adds a payment rule: the plan “shall make payments to Participating Providers and to Non-Participating Providers, as applicable, for items and services covered under this Agreement on a timely basis, consistent with the claims payment procedures described in SIL § 3224-a,” and must comply with 42 CFR 447.45(d)(5) and (6). [15][16][9][10][1][11]

Code set: MVP’s ABA payment policy covers CPT 97151–97158 plus 0362T and 0373T, excludes 0362T and 0373T from Medicaid Managed Care reimbursement, and lists no HCPCS H-code for ABA. For a Medicaid member, the state baseline is narrower still: New York Medicaid’s ABA fee schedule (effective October 1, 2026) and the eMedNY manual’s billing table carry only CPT 97151–97158 — no 0362T or 0373T and no HCPCS H-code (H0031, H0032, H2019, H2014). [15][16][9][10][1][11]

## Intake gates

The questions that decide whether a family can start with MVP Health Plan (NY Medicaid), and what they have to bring.

- **Age limit**: MVP states the age band explicitly rather than inheriting it silently: its Behavioral Health Services and Authorization Requirements grid lists Applied Behavior Analysis for NY Medicaid (including CHP) as “Auth Required,” effective with the benefit’s own 1/1/2023 start date, “for children ages 0–20.” That matches the state rule — under 21, no minimum age. One wording conflict to know about: the “New York State Medicaid Variations” paragraph of MVP’s ABA payment policy (effective April 1, 2026) says MVP Medicaid Managed Care members “have coverage for Applied Behavior Analysis (ABA) therapy, regardless of age.” The state manual and MVP’s own authorization grid both stop at 20, so plan on under 21, and get MVP’s answer in writing before starting a member who is 21 or older. [2][7][1]
- **Diagnosis recency**: Follows the New York Medicaid rule: MVP’s 2026 ABA payment policy restates the state referral rule verbatim, including the two-year validity and the requirement to state the date of initial diagnosis. No maximum age is set on the diagnostic evaluation itself, and MVP publishes no separate recency rule. [1][7]
- **Who may diagnose**: Follows the New York Medicaid rule, restated verbatim in MVP’s ABA payment policy: the member must be referred by “an NYS-licensed and NYS Medicaid-enrolled physician (including psychiatrist and developmental/behavioral pediatrician), psychologist, psychiatric nurse practitioner, pediatric nurse practitioner, or physician assistant.” LBAs may not diagnose or self-refer. [1][7]
- **Diagnostic tools required**: Follows the New York Medicaid rule: no instrument is mandated. What the state requires with the referral is the “DSM-5 Diagnostic Checklist for ASD diagnoses” plus the severity level when the referral comes from an ASD-diagnosing provider; the treatment plan need only record the assessment methodology used and, “as appropriate, identify standardized assessment used (e.g., adaptive behavior scales, symptom inventories, aggression ratings) and results.” MVP’s payment policy restates the state’s referral payload — age, diagnosis, date of initial diagnosis, comorbidities, severity, the DSM-5 diagnostic checklist and a statement of medical necessity — and names no instrument of its own. [1][7]
- **Referral required?**: Follows the New York Medicaid rule, restated verbatim by MVP with the two-year validity and the full seven-element payload, but bolted onto a hard prior-authorization gate on both ends: the payment policy requires prior authorization “for ABA Assessments and Services” alike, and the BH authorization grid marks ABA “Auth Required” for Medicaid and CHP from 1/1/2023. Submit by phone (1-800-684-9286), fax (1-855-853-4850) with the clinical support, or email to BHservices@mvphealthcare.com. Treatment plans submitted with a PA request must now specify the place(s) of service. [1][2][7]
- **Prior-auth decision time**: MVP requires prior authorization for ABA assessments and services and, for Medicaid, says it “will render decisions in accordance with established timeframes outlined in the Medicaid Managed Care Model Contract.” That contract sets the clock: a standard request within three business days of the necessary information and no more than 14 days after receipt; expedited within 72 hours; a concurrent request (reauth or more units) within one business day of the necessary information; any of these extendable up to 14 days. Federal rules cap the standard decision at 7 calendar days for plan rating periods starting on or after January 1, 2026. MVP’s own operational rules: submit prior authorization requests “no less than five (5) calendar days prior” to the service, and when MVP asks for missing clinical information it must arrive within 2 business days (24 hours if urgent). No ABA reauth lead time is published. [9][1][10][17]
- **Other insurance (who pays first)**: Bill the other payer first; the claim to MVP must carry the other payer’s approved amount, paid amount and remaining patient liability. MVP’s own authorization rules still apply when it is secondary: “If MVP is the Secondary Payer, the rules and procedures of MVP as stated in the Member’s Subscriber Contract must be followed before MVP will make payment,” and “When billing MVP as the secondary Payer, all MVP primary billing requirements and codes must be followed… regardless of what was billed to the Other Payer.” In practice: get MVP’s ABA prior authorization even when the commercial plan is primary. Underneath is the state rule that Medicaid pays last (“Providers must bill all applicable insurance sources before submitting claims to Medicaid”). MVP’s COB department: 1-800-556-2477, option 2. [9][18]
- **Telehealth** _(ask the plan)_: Published but tied to a lapsed federal deadline, so treat it as open. MVP’s ABA payment policy says it “shall reimburse ABA services delivered via video-enabled telehealth through March 31, 2025, or until the CMS waiver expires, whichever is later. Following the expiration or change of the waiver, MVP may deny ABA services delivered via telehealth in accordance with applicable state laws or regulations” — language unchanged in the April 2026 policy. What is unconditional: audio-only, fax-only and e-mail-only delivery are not reimbursable. MVP’s general Telehealth payment policy in the same April 2026 compendium says MVP “will reimburse Telehealth Services for Medicaid, HARP and Child Health Plus Members in accordance with guidance provided by NY Department of Health” (whose telehealth manual includes NYSED-licensed ABA providers), with POS 02/10 and modifier 95 or GT, but the ABA policy names no ABA code — assessment (97151/97152), 97155 supervision or otherwise — as approved for telehealth, so confirm before delivering any ABA code remotely. [1]
  - Ask the plan: MVP Provider Services — confirm the current telehealth reimbursement status for ABA codes before scheduling remote sessions; the policy’s waiver reference has not been updated since the cited date passed.

## Delivery and billing rules

Coverage decides whether MVP Health Plan (NY Medicaid) 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 New York Medicaid rule, which the state applies to FFS and managed care alike: “an LBA can supervise no more than six CBAAs/unlicensed individuals at a time,” “LBAs are required to supervise unlicensed individuals for a minimum of five percent of the hours the unlicensed individual spends providing behavior analysis services each calendar month,” and “supervision must include at least two face-to-face, real-time contacts per month” with the LBA observing service delivery in at least one. Supervision may run over synchronous audio-and-video where on-site is impractical. 97155 counts toward the 5% “only when the LBA joins the patient and the unlicensed individual during a treatment session to direct the unlicensed individual/technician in implementing a new or modified treatment protocol.” CBAAs need direct supervision, and the supervisor “should assess each patient’s/client’s progress at least every 6 months… and review and sign treatment notes and reports prepared by the CBAA supervisee.” MVP’s own ABA Medical Policy (effective 6/1/2025, in the October 2026 medical-policy compendium) adds a dosage rather than a caseload cap: “Case supervision and clinical direction, completed by the LBA, should occur for 1-2 hours per every 10 hours (1-2:10) of direct treatment. When direct treatment is 10 hours per week or less, a minimum of 1-2 hours per week of case supervision is usually necessary,” and clinical direction concurrent with direct treatment “generally accounts for 50% or more of case supervision.” MVP sets no technician caseload cap beyond the state’s six. It also publishes a rendering restriction that shapes the staffing model: RBT- and unlicensed-professional-rendered services “are only reimbursable under 97152, 97153, and 97154 — not 97151 or 97155–97158,” so supervision, protocol modification and family guidance must be delivered by the analyst. [7][1][8]
- **Daily limits / MUEs**: No per-day unit ceiling or hour cap is published — MVP authorizes rather than capping. The constraint that bites instead is code-level: “the following procedures are excluded from Medicaid Managed Care (MMC) plan coverage: Behavior identification supporting assessment (CPT 0362T); Adaptive behavior treatment with protocol modification (0373T),” an exclusion that has held across every policy version from 2024 through 2026 even though both codes appear on MVP’s general covered-code list. On claims: timely filing is 180 days from the date of service or per contract, with a matching 180-day adjustment window; EDI payee ID 14165. [1]
- **Session-note signature**: Follows the New York Medicaid rule: the LBA supervisor must “review and sign treatment notes and reports prepared by the CBAA supervisee,” and documentation of supervision itself “should be recorded in the patient file.” Clinical documentation must carry the treatment plan with assessment and goals, the goal data, total hours of service per week by who delivered them, and the location(s) of services. Records are kept “for a minimum of six years and, for minors, until the patient turns 22 years of age.” MVP adds no session-note signature rule of its own; its documentation requirements run to the authorization request and the treatment plan, which must specify the place(s) of service. [7][1]
- **Place of service**: The strictest published school rule among New York’s upstate plans. Effective July 1, 2025 MVP will not reimburse any ABA code — 97151–97158, 0362T, 0373T — billed with Place of Service = School; requests for school-setting delivery are “administratively denied,” and treatment plans submitted with a PA request must specify the place(s) of service. ABA is also not covered as a substitute for Early Intervention or when delivered under an IEP or a Preschool/School Supportive Health Services Program. That sits on top of the state rule, which already bars school-setting ABA; home, clinic and community remain available. [3][1][7]
- **Bill as provider**: MVP does not publish an NPI convention, but it does publish the rendering restriction that governs who may bill what: RBT- and unlicensed-professional-rendered services “are only reimbursable under 97152, 97153, and 97154” — not 97151 or 97155–97158. At the fee-for-service layer New York is explicit: LBAs bill “using the LBA’s National Provider Identification (NPI) number for the ‘Billing’ provider and/or ‘Supervising’ provider,” with “the NPI number of the CBAA that provided the ABA service… reported as the ‘Rendering’ provider on each claim”; for unlicensed aides and LBA limited-permit holders the supervising LBA’s NPI fills all three roles. CBAAs cannot bill directly and enroll as OPRA providers. Claims route by EDI to payee ID 14165, or by paper to MVP Health Care, Attn: Claims Department, PO Box 2207, Schenectady, NY 12301. [1][7]
  - Ask the plan: MVP Provider Services for the rendering/supervising NPI convention on managed-care ABA claims.
- **Concurrent billing (97153 + 97155)** _(ask the plan)_: Not published. MVP’s ABA payment policy is explicit about who may render which code and which codes are excluded from Medicaid, but states no same-clock-time rule for 97153 with 97155, and the state manual is silent. [1][7]
  - Ask the plan: MVP Provider Services (behavioral health 1-800-684-9286) — confirm in writing before billing the overlap.

## What intake should collect for MVP Health Plan (NY Medicaid)

- **Complete state-style referral packet:** NYS-licensed, Medicaid-enrolled referring provider; dx + initial dx date, comorbidities, severity, DSM-5 checklist, statement of medical necessity; referral valid 2 years.
- **Place-of-service plan:** ABA is not reimbursable with POS = School as of 7/1/2025 — confirm the delivery setting before submitting the PA request.
- **HARP status confirmation:** If the member is HARP-enrolled, confirm ABA coverage directly with MVP — the policy's scope and its older HARP exclusion haven't been explicitly reconciled in writing.
- **Billing-code check for 0362T/0373T:** Both are Medicaid-excluded at MVP despite appearing covered elsewhere — verify before billing to avoid a denial.
- **Telehealth status per case:** MVP's telehealth ABA language is tied to an expired federal waiver reference — confirm current reimbursement status before delivering remotely.

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

## Verification of benefits (VOB) data

How MVP Health Plan (NY Medicaid) ABA benefits route and read on an eligibility check. Data last updated 2026-10-15.

### EDI routing

- **Payer ID (pVerify):** 00156 — pVerify's only MVP match is explicitly labeled "00156 MVP Health Care (New York) - MVP Child Health Plus," not a general Medicaid Managed Care line — no separate MMC-labeled pVerify entry was found. Treat 00156 as CHP-specific and confirm the MMC-line ID with pVerify onboarding before automating on it for non-CHP Medicaid members.
- **Payer ID (Availity):** 14165 — Verified independent of the (stale, 2012-dated) Availity PDF: MVP's own 2025 Provider Policies document states directly "EDI submissions use Payee ID 14165," which the Availity list also carries as "14165 MVP HEALTH PLAN."
- **Supports 270/271 eligibility:** Yes
- **Behavioral health administrator:** none — in-house BH/ABA UM (MVP wrote its own ABA medical-necessity criteria in 2021); no vendor carve-out for BH specifically
- **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 | Required — MVP's ABA Payment Policy requires PA for both assessment and treatment; referral from an NYS-licensed, Medicaid-enrolled physician/psychologist/psychiatric NP/pediatric NP/PA, valid 2 years | — | home, office/clinic, community, NOT school (POS = School administratively denied eff. 7/1/2025) | Plan-dependent/unverified — MVP's payment policy ties ABA telehealth reimbursement to a CMS waiver referencing 3/31/2025 without a subsequent update; confirm current status with Provider Services | — |
| 97152 | Yes | Required — MVP's ABA Payment Policy requires PA for both assessment and treatment; referral from an NYS-licensed, Medicaid-enrolled physician/psychologist/psychiatric NP/pediatric NP/PA, valid 2 years | — | home, office/clinic, community, NOT school (POS = School administratively denied eff. 7/1/2025) | Plan-dependent/unverified — MVP's payment policy ties ABA telehealth reimbursement to a CMS waiver referencing 3/31/2025 without a subsequent update; confirm current status with Provider Services | RBT/unlicensed-professional-rendered services reimbursable under this code (97152/97153/97154 only, per the payment policy) |
| 97153 | Yes | Required — MVP's ABA Payment Policy requires PA for both assessment and treatment; referral from an NYS-licensed, Medicaid-enrolled physician/psychologist/psychiatric NP/pediatric NP/PA, valid 2 years | — | home, office/clinic, community, NOT school (POS = School administratively denied eff. 7/1/2025) | Plan-dependent/unverified — MVP's payment policy ties ABA telehealth reimbursement to a CMS waiver referencing 3/31/2025 without a subsequent update; confirm current status with Provider Services | RBT/unlicensed-professional-rendered services reimbursable under this code (97152/97153/97154 only, per the payment policy) |
| 97154 | Yes | Required — MVP's ABA Payment Policy requires PA for both assessment and treatment; referral from an NYS-licensed, Medicaid-enrolled physician/psychologist/psychiatric NP/pediatric NP/PA, valid 2 years | — | home, office/clinic, community, NOT school (POS = School administratively denied eff. 7/1/2025) | Plan-dependent/unverified — MVP's payment policy ties ABA telehealth reimbursement to a CMS waiver referencing 3/31/2025 without a subsequent update; confirm current status with Provider Services | RBT/unlicensed-professional-rendered services reimbursable under this code (97152/97153/97154 only, per the payment policy) |
| 97155 | Yes | Required — MVP's ABA Payment Policy requires PA for both assessment and treatment; referral from an NYS-licensed, Medicaid-enrolled physician/psychologist/psychiatric NP/pediatric NP/PA, valid 2 years | — | home, office/clinic, community, NOT school (POS = School administratively denied eff. 7/1/2025) | Plan-dependent/unverified — MVP's payment policy ties ABA telehealth reimbursement to a CMS waiver referencing 3/31/2025 without a subsequent update; confirm current status with Provider Services | — |
| 97156 | Yes | Required — MVP's ABA Payment Policy requires PA for both assessment and treatment; referral from an NYS-licensed, Medicaid-enrolled physician/psychologist/psychiatric NP/pediatric NP/PA, valid 2 years | — | home, office/clinic, community, NOT school (POS = School administratively denied eff. 7/1/2025) | Plan-dependent/unverified — MVP's payment policy ties ABA telehealth reimbursement to a CMS waiver referencing 3/31/2025 without a subsequent update; confirm current status with Provider Services | — |
| 97157 | Yes | Required — MVP's ABA Payment Policy requires PA for both assessment and treatment; referral from an NYS-licensed, Medicaid-enrolled physician/psychologist/psychiatric NP/pediatric NP/PA, valid 2 years | — | home, office/clinic, community, NOT school (POS = School administratively denied eff. 7/1/2025) | Plan-dependent/unverified — MVP's payment policy ties ABA telehealth reimbursement to a CMS waiver referencing 3/31/2025 without a subsequent update; confirm current status with Provider Services | — |
| 97158 | Yes | Required — MVP's ABA Payment Policy requires PA for both assessment and treatment; referral from an NYS-licensed, Medicaid-enrolled physician/psychologist/psychiatric NP/pediatric NP/PA, valid 2 years | — | home, office/clinic, community, NOT school (POS = School administratively denied eff. 7/1/2025) | Plan-dependent/unverified — MVP's payment policy ties ABA telehealth reimbursement to a CMS waiver referencing 3/31/2025 without a subsequent update; confirm current status with Provider Services | — |
| 0362T | No — excluded from Medicaid Managed Care reimbursement specifically (billable on MVP's other lines of business, per the payment policy) | N/A — not reimbursable under MMC | — | home, office/clinic, community, NOT school (POS = School administratively denied eff. 7/1/2025) | Plan-dependent/unverified — MVP's payment policy ties ABA telehealth reimbursement to a CMS waiver referencing 3/31/2025 without a subsequent update; confirm current status with Provider Services | — |
| 0373T | No — excluded from Medicaid Managed Care reimbursement specifically (billable on MVP's other lines of business, per the payment policy) | N/A — not reimbursable under MMC | — | home, office/clinic, community, NOT school (POS = School administratively denied eff. 7/1/2025) | Plan-dependent/unverified — MVP's payment policy ties ABA telehealth reimbursement to a CMS waiver referencing 3/31/2025 without a subsequent update; confirm current status with Provider Services | — |

Code notes:

- **97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158:** Submit PA by phone (1-800-684-9286), fax (1-855-853-4850), or email (BHservices@mvphealthcare.com). Confirm HARP coverage directly — the current policy's scope lists HARP without explicitly reversing an older stated HARP exclusion.
- **0362T, 0373T:** Appears on MVP's general covered-code list but explicitly excluded from Medicaid Managed Care reimbursement — verify before billing to avoid a denial.

### Contacts

- **Benefits by phone:** Yes
- **Provider services phone:** 1-800-684-9286
- **Phone menu path:** TTY 711. Select option 1 for member eligibility, or option 3 then option 1 for claims status.
- **Hours:** Mon-Fri 8:30 a.m.-5:00 p.m. ET
- **Portal:** [Availity Essentials](https://essentials.availity.com)

Questions to ask on a verification call:

- For the servicing provider NPI requested on eligibility calls, can we use the group NPI, or must it be an individual NPI?
- What's the daily/annual unit cap for MVP's ABA codes (97151-97158), and what's the cap period?
- Is ABA telehealth currently reimbursable under MVP, given the payment policy cites an expired CMS waiver (3/31/2025) — and if so, what POS/modifier applies?
- Is the cost share for ABA charged per-visit or per-day, and is it a copay or coinsurance?
- Does MVP's deductible apply to ABA services?
- Which STC bucket (MH/A4/A6/etc.) does MVP return ABA benefits under on a 270/271 check?
- Which pVerify payer ID should be used for Medicaid Managed Care eligibility checks — is 00156 CHP-specific, or is there a separate general MMC ID?

### VOB data sources

- 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.mvphealthcare.com/-/media/project/mvp/healthcare/documents/provider-policies-and-payment-policies/2025/january/mvp-provider-policies-effective-january-1-2025.pdf (accessed 2026-07-23)
- https://www.caqh.org/sites/default/files/CAQH%20CORE%20Eligibility%20Benefits%20(270_271)%20Data%20Content%20Rule%20vEB2.0.pdf (accessed 2026-07-23)
- https://www.mvphealthcare.com/-/media/project/mvp/healthcare/documents/provider-policies-and-payment-policies/2026/april/mvp-payment-policies-effective-april-1-2026.pdf (accessed 2026-07-23)
- https://www.mvphealthcare.com/-/media/project/mvp/healthcare/documents/provider/online-resources/bh-services-and-authorization-requirements (accessed 2026-07-23)
- https://www.mvphealthcare.com/-/media/project/mvp/healthcare/documents/fastfax/2025/2025-16-aba-school-setting-exclusion.pdf (accessed 2026-07-23)
- https://www.mvphealthcare.com/providers/contact-us (accessed 2026-07-23)
- https://www.mvphealthcare.com/providers/eligibility-and-benefits (accessed 2026-10-14)

## Common questions

### Does MVP Health Plan cover ABA therapy?

Yes — MVP carries the NY Medicaid ABA carve-in and publishes its own ABA Payment Policy, with prior authorization required for both assessment and treatment and in-house behavioral health utilization management (no vendor carve-out).

### Are all ABA codes billable to MVP Medicaid?

Not quite — 0362T and 0373T appear on MVP's general covered-code list but are explicitly excluded from Medicaid Managed Care reimbursement specifically. Confirm code-by-code before billing.

### Can ABA be delivered in a school setting for MVP Medicaid members?

No — effective July 1, 2025, MVP administratively denies any ABA code billed with Place of Service = School, across all its lines of business.

### What does MVP pay for Medicaid ABA?

The NYS Medicaid fee schedule in effect on the date of service — MVP's payment policy defines its Medicaid Community Fee Schedule that way for Medicaid, CHP and HARP. That means $19.26 per unit for 97151/97152/97155/97156 and $9.63 for 97153 from October 1, 2026.

### Does MVP require RBT certification for ABA technicians?

No. MVP's payment policy lets services be delivered by an LBA, a CBAA, an RBT “or other unlicensed professionals” under LBA supervision; technician-rendered services are covered only on 97152, 97153 and 97154 and are billed under the supervising LBA.

### Does MVP cover ABA via telehealth?

Unclear as of this review — MVP's payment policy ties telehealth ABA reimbursement to a CMS waiver referencing a March 31, 2025 date without a subsequent update, so confirm current telehealth status with Provider Services before scheduling remote sessions.

### How many RBTs can a BCBA supervise for MVP Health Care Medicaid members in New York?

Six at a time. New York Medicaid, which applies the rule to fee-for-service and managed care alike, says an LBA "can supervise no more than six CBAAs/unlicensed individuals at a time," must supervise each for at least 5% of their monthly service hours, and must hold at least two face-to-face real-time contacts a month, observing service delivery in one. In New York the supervisor must be a NYSED-licensed behavior analyst; BCBA certification alone is not a license.

### What is the timely filing limit for MVP Health Care Medicaid ABA claims?

Your contract sets it, but New York Ins. Law § 3224-a bars a Medicaid managed care contract from setting less than 90 days from the date of service (120 days is the default without a contract term). Clean electronic claims must be paid within 30 days, paper within 45.

### Does MVP Health Care accept H0031 or H0032 for ABA?

No. MVP’s ABA payment policy lists CPT 97151–97158 plus 0362T and 0373T (the last two not payable for Medicaid Managed Care), and no H-codes.

### Does MVP require graphs for ABA reauthorization?

Not graphs as such. MVP authorizes ABA treatment for 6 months at a time; a continued request needs documented progress in at least two settings, parent-training progress, consistent attendance, a monthly progress assessment for each target goal, and an analysis and revised plan for any stalled goal.

## Primary sources

1. [MVP Applied Behavior Analysis Services Payment Policy (eff. 4/1/2026)](https://www.mvphealthcare.com/-/media/project/mvp/healthcare/documents/provider-policies-and-payment-policies/2026/april/mvp-payment-policies-effective-april-1-2026.pdf)
2. [MVP Behavioral Health Services and Authorization Requirements](https://www.mvphealthcare.com/-/media/project/mvp/healthcare/documents/provider/online-resources/bh-services-and-authorization-requirements)
3. [MVP FastFax #2025.16 — ABA School Setting Exclusion](https://www.mvphealthcare.com/-/media/project/mvp/healthcare/documents/fastfax/2025/2025-16-aba-school-setting-exclusion.pdf)
4. [MVP 2025 Provider Policies](https://www.mvphealthcare.com/-/media/project/mvp/healthcare/documents/provider-policies-and-payment-policies/2025/january/mvp-provider-policies-effective-january-1-2025.pdf)
5. [MVP Medicaid Managed Care plan page (30-county service area)](https://www.mvphealthcare.com/plans/medicaid)
6. [NYS DOH Medicaid Managed Care Enrollment Report, July 2026](https://www.health.ny.gov/health_care/managed_care/reports/enrollment/monthly/2026/docs/en07_26.pdf)
7. [eMedNY ABA Provider Policy Manual (state baseline)](https://www.emedny.org/ProviderManuals/ABA/PDFS/ABA_Policy.pdf)
8. [MVP Medical Policy — Applied Behavior Analysis (eff. 6/1/2025; medical-policy compendium, October 2026)](https://www.mvphealthcare.com/-/media/project/mvp/healthcare/documents/provider/mvp-health-care-medical-policies.pdf)
9. [MVP 2026 Provider Policies (eff. April 1, 2026), Claims](https://www.mvphealthcare.com/-/media/project/mvp/healthcare/documents/provider-policies-and-payment-policies/2026/april/mvp-provider-policies-effective-april-1-2026.pdf)
10. [NYS Medicaid Managed Care / FHPlus / HIV SNP / HARP Model Contract (March 1, 2019), §22.6 Timely Payment](https://www.health.ny.gov/health_care/managed_care/docs/medicaid_managed_care_fhp_hiv-snp_model_contract.pdf)
11. [NYS Medicaid ABA Fee Schedule (eMedNY)](https://www.emedny.org/ProviderManuals/ABA/PDFS/ABA_Fee_Schedule.xls)
12. [MVP Health Care — Provider FastFax library (provider notices archive)](https://www.mvphealthcare.com/providers/fastfax)
13. [MVP Health Care — Provider Communications Center (Healthy Practices newsletter)](https://www.mvphealthcare.com/providers/communications-center)
14. [NYS Medicaid Update, August 2026 (Vol 42 No 9) — 97153 reduced to $9.63/unit eff. 10/1/2026](https://www.health.ny.gov/health_care/medicaid/program/update/2026/no09_2026-08.htm)
15. [NY Insurance Law § 3224-a — Standards for prompt, fair and equitable settlement of claims (NY Senate, rev. 9/19/2025)](https://www.nysenate.gov/legislation/laws/ISC/3224-A)
16. [NYSDOH — Electronic Visit Verification (EVV) Applicable Billing Codes (FFS and Managed Care, rev. March 2022)](https://www.health.ny.gov/health_care/medicaid/redesign/evv/repository/app_billing_codes.htm)
17. [eCFR — 42 CFR 438.210(d), timeframe for decisions](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-438/subpart-D/section-438.210)
18. [eMedNY Information for All Providers — General Policy (Version 2022-2)](https://www.emedny.org/ProviderManuals/AllProviders/PDFS/Information_for_All_Providers-General_Policy.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.