Passport by Molina Healthcare is the Kentucky Medicaid MCO with the lightest ABA authorization rule in the state: the assessment codes need none, and treatment codes need prior authorization only once a member has used 48 units (12 hours) in a calendar year. Past that threshold the usual review applies.
Passport’s May 2025 notice reinstated behavioral health authorization "for all members, including children, adolescents, and adults" from July 1, 2025. For ABA it set: "Prior authorization required after 48 units, for any combination of CPT Codes listed, per member per calendar year, beginning 1/1/25," and a member who had already used 48 units before July 1, 2025 needed PA for additional units. Passport’s DMS-approved training deck lists the counted codes as 97153 through 97158, and DMS’s own chart records Passport as "Yes, except for 97151 and 97152." Requests go through Availity Essentials, by phone at (800) 578-0775 or by fax at (833) 454-0641. Non-participating providers need authorization for everything except emergencies.[2][3][4]
Passport’s 2026 manual (last updated June 22, 2026) requires claims "within 365 calendar days after … the Date of Service for outpatient services," with the clock starting at the primary EOB for coordination-of-benefits claims. Providers "have 60 calendar days from the date of our adverse determination to file an Appeal." Credentialing decisions are issued "within 30 calendar days of receiving either a provider’s credentialing request or a completed uniform credentialing form, whichever occurs first." After an adverse determination a provider may request a peer-to-peer within five business days. Passport uses MCG and shares the clinical indications through MCG Cite for Guideline Transparency in Availity.[1]
Passport’s 2026 manual adds that "Corrected Claims must be sent within 365 calendar days of the date of service of the Claim," through Availity Essentials or EDI with the frequency code and original claim number. It publishes no separate check-run schedule.[1]
The questions that decide whether a family can start with Passport by Molina Healthcare, and what they have to bring. Each maps onto something intake should ask on the first call.
No age limit: the reinstated authorization rules apply to "children, adolescents, and adults," and the state regulation sets no ABA age limit.[2][7]
No referral is required by Passport’s ABA rules or the state regulation; the gate is the 48-unit PA threshold.[3][7]
Passport’s manual allows behavioral health covered services by telehealth from participating providers, coded under its reimbursement policies, 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).[1][8][15]
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.[6][10]
Passport: "Medicaid is always the payer of last resort"; bill the primary and submit its EOB, and the filing clock for COB claims starts on the primary EOB date. 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.[1][6][11]
Not stated by Passport.[1]
Ask the plan: Passport Utilization Management, (800) 578-0775.
Not stated by Passport. Kentucky law excludes diagnosis from the practice of ABA (KRS 319C.010(8)).[1][14]
Ask the plan: Passport Utilization Management, (800) 578-0775.
Not stated by Passport; MCG criteria are licensed.[1]
In licensed criteria: Passport Utilization Management, (800) 578-0775, or MCG Cite in Availity.
Coverage decides whether Passport by Molina Healthcare 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.
Passport 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.[1][7][13]
No ABA cap is published. The 48-units-per-calendar-year figure is a prior-authorization trigger for 97153–97158, not a limit.[3][2]
Passport 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.[1][7]
Passport 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.[9][1]
Ask the plan: Passport Provider Services, (800) 578-0775: confirm 97153 + 97155 concurrent payment and whether concurrent units count toward the 48-unit threshold.
Passport publishes no ABA setting rule. Its telehealth terms say services "are not permitted when the Member and Participating Provider are in the same physical location."[1][7]
Ask the plan: Passport Provider Services, (800) 578-0775: ask which place-of-service codes it pays for ABA.
Passport publishes no ABA-specific rendering rule.[1]
Ask the plan: Passport Provider Services, (800) 578-0775: ask whether RBT services are billed under the supervising licensed behavior analyst with modifier UC as on the DMS fee schedule.
No. 97151 and 97152 are excluded from Passport’s ABA authorization rule.
After a member has used 48 units (12 hours) of 97153–97158 in the calendar year, counted from January 1, 2025.
365 calendar days from the date of service; appeals within 60 calendar days of the adverse determination.
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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