---
title: "Premera Blue Cross ABA coverage in Washington: the intake guide."
url: "https://carelu.com/payers/premera-blue-cross-washington"
markdown_url: "https://carelu.com/payers/premera-blue-cross-washington.md"
state: WA (Washington)
payer: Premera Blue Cross
kind: Commercial insurance
description: "How Premera Blue Cross covers ABA in Washington: medical policy 3.01.510, prior authorization on ABA codes, who may deliver and supervise, school and telehealth rules, Washington’s mental health parity law, DOH licensure and what intake should collect."
last_reviewed: October 2026
---

# Premera Blue Cross ABA coverage in Washington: the intake guide.

_Payer Guide · Premera Blue Cross · Washington · Last updated October 2026 · 25 primary sources_

> Washington’s largest Blue: policy 3.01.510 (May 2026), PA on ABA codes incl. 97151, in-person or video delivery, 2 hrs supervision per 10 hrs, LABAs billed under the LBA.

Premera Blue Cross is the Blue Cross Blue Shield licensee most Washington families with a Blue card will see (Regence BlueShield is the other Blue in the state, with its own guide). Premera publishes a full ABA medical policy, 3.01.510 (effective May 1, 2026), a provider ABA resources page, and monthly code lists that show which ABA codes need prior authorization. Washington’s mental health parity law and DOH licensure sit on top for fully insured plans.

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Yes: Premera’s October 2026 code lists put ABA among behavioral health services requiring prior authorization, and the individual-plan list marks 97151, 0362T and H0031 "Prior Authorization Required" [3][4]
- **Prior auth for treatment**: Yes: 97153, 97154, 97155, 97156, 97158 and 0373T are "Prior Authorization Required" on the individual-plan code list (10/1/2026), and the non-individual list names ABA as requiring PA; submit through Availity [3][4][5]
- **Autism diagnosis required?**: Yes: autism spectrum disorder (DSM-5/DSM-5-TR) or autistic disorder, Asperger’s syndrome or PDD-unspecified (ICD-10), diagnosed by a professional whose scope includes diagnosing psychiatric or neurodevelopmental disorders; "ABA is considered not medically necessary for any other diagnoses or conditions" (policy 3.01.510) [1]

## At a glance

- **Covers ABA?:** Yes, for ASD (incl. autistic disorder, Asperger’s, PDD-NOS), per medical policy 3.01.510
- **Prior auth:** Yes: ABA on the BH PA list; 97151, 97153–97156, 97158, 0362T, 0373T PA required (individual list, 10/1/2026)
- **State mandate:** No stand-alone autism statute: mental health parity (RCW 48.44.341, 48.46.291, 48.21.241 until 1/1/2027; RCW 48.43.766 from 1/1/2027) plus the EHB rule WAC 284-43-5642
- **Mandate age:** No ABA-specific age limit in the statutes; treatment limits on mental health services are allowed only if the same limits apply to medical and surgical care
- **Mandate caps:** No ABA-specific hour or dollar cap in the statutes (same parity test)
- **Exempt from mandate:** Self-funded ERISA employer plans (outside state insurance law)
- **Licensure:** Yes: DOH licenses LBAs and LABAs and certifies CBTs (chapter 18.380 RCW); out-of-state BCBAs need a WA license, reciprocity or a 180-day temporary license
- **Fee schedule:** Not public — rates are in your Premera agreement (Availity shows fee schedules); Microsoft and Amazon groups use the same fee schedule rates

## Policy 3.01.510: who, what and where

Premera’s ABA policy (effective May 1, 2026; last revised April 27, 2026) covers ABA for autism spectrum disorder diagnosed by "a healthcare professional whose legally permitted scope of licensure includes diagnosis of psychiatric disorders or neurodevelopmental disorders." Covered services include initial and periodic functional behavioral analysis, individual and group treatment, and parent or caregiver training, plus non-treatment components (case review, data analysis, coordination with other providers or school staff, supervision, treatment plan development and revision, team conferences). Program managers or lead behavioral therapists direct the care: in states that license behavior analysts, that means a state-licensed behavior analyst (Washington’s LBA), or a licensed psychiatrist, developmental pediatrician, pediatric neurologist, psychiatric ARNP, independently licensed psychologist or mental health clinician, among others. Direct treatment may also be given by supervised behavioral technicians (state-certified where the state requires it, as Washington does), BCaBAs or LaBAs and, in Washington, by "any agency that is licensed by the state Department of Health as a Behavioral Health Agency" whose license includes ABA. [1][2]

Services "may be provided in-person or via secure real-time video and audio telehealth/virtual modalities, or via a combination," most often at home or in a clinic, with community settings as needed. Some direct treatment may happen at school when autism-related difficulties show up there, but it "must consist entirely of bona-fide ABA treatment activities"; acting as a classroom aide or 1:1 teacher, or providing IEP services, is not covered, and some plans exclude school settings altogether. Premera treats as unnecessary duplication more than one lead therapist or more than one agency at a time (with a narrow exception for a short, highly specialized second program), more than one clinician giving direct treatment at once, and ABA delivered in the same session as speech or occupational therapy. [1][2]

## Prior authorization, credentialing and billing

Premera’s code lists (dated October 1, 2026) put "Applied behavioral analysis (ABA)" first among behavioral health services requiring prior authorization for both individual and non-individual plans. The individual-plan list marks 97151, 97153, 97154, 97155, 97156, 97158, 0362T, 0373T, H0031 and H0032 "Prior Authorization Required" and asks for the history and physical, documentation of medical necessity and the procedure report. Non-individual (group) requests and code checks go through Availity; individual-plan requests use the separate site shown on the ID card. [3][4][5][2]

Agencies join by sending an organization credentialing application and W-9 to provider.relations@premera.com; credentialing "may take 30-45 days," and re-credentialing is every three years. "Licensed assistant behavior analysts (LABAs) do not need to get credentialed through Premera. Their services are billed under the credentialed, supervising licensed behavior analyst’s (LBA’s) name." Treatment plans should be updated every six months and kept on file rather than sent unless requested. Customer service for providers: 877-342-5258, option 2. [3][4][5][2]

## The Washington mandate: parity, not an autism statute

Washington has no stand-alone autism insurance statute. ABA reaches state-regulated plans through the mental health parity laws instead. Until January 1, 2027, RCW 48.44.341 (health care service contractors), RCW 48.46.291 (HMOs) and RCW 48.21.241 (group disability insurers) require a plan that covers medical and surgical services to cover "mental health services," defined for plans issued or renewed on or after January 1, 2021 as "medically necessary outpatient and inpatient services provided to treat mental health and substance use disorders covered by the diagnostic categories listed in" the DSM. Autism spectrum disorder is a DSM diagnosis. Cost sharing for mental health services may be no more than for medical and surgical services, and "Treatment limitations or any other financial requirements on coverage for mental health services are only allowed if the same limitations or requirements are imposed on coverage for medical and surgical services." The statutes name no ABA-specific age, hour or dollar limit. For individual and small-group plans, the Insurance Commissioner’s essential health benefit rule (WAC 284-43-5642, effective January 19, 2026) lists "Behavioral treatment for a DSM category diagnosis" among the mental health services every plan must include, and says that when habilitative services treat a DSM diagnosis, "the mental health parity requirements apply." The law changes on January 1, 2027: Chapter 227, Laws of 2025 (E2SHB 1432) repeals those parity sections and replaces them with RCW 48.43.766, which covers DSM diagnoses plus the mental, behavioral and neurodevelopmental chapters of ICD and DC:0-5, and bars utilization review and clinical review criteria that "deviate from generally accepted standards of mental health and substance use disorder care." Regence’s own ABA policy names "Washington’s Mental Health Parity Act (RCW 48.44)" as the Washington basis for its coverage. None of this reaches self-funded employer plans, which answer to ERISA and federal parity law. [6][7][8][9][10][11][26]

## Licensure and out-of-state BCBAs

Washington licenses ABA practitioners at three levels under chapter 18.380 RCW, administered by the Department of Health: licensed behavior analyst (LBA), licensed assistant behavior analyst (LABA) and certified behavior technician (CBT). The BACB’s licensure table lists Washington (2015, WA State Department of Health). "No person may engage in the practice of applied behavior analysis unless he or she holds a license or a temporary license under this chapter," and no one may practice as a technician without DOH certification (RCW 18.380.020). The exemptions in RCW 18.380.030 cover holders of another Washington credential practicing within their own scope (psychologists, for example), federal employees, school employees working only for their school, supervised students and trainees, and supervised family members; none of them exempts a BCBA licensed in another state. DOH may accept national certification in lieu of the education and exam requirements (RCW 18.380.050(3); WAC 246-805-100 accepts current certification from an approved credentialing entity). An out-of-state LBA has two quicker routes: reciprocity where the other state’s standards are "substantially equivalent" (WAC 246-805-510), and a 180-day temporary license for applicants who do not live in Washington and hold an active, unrestricted behavior analyst license elsewhere, which "will not be renewed, reissued, or extended" (WAC 246-805-520). Telehealth does not get around this. Washington’s Uniform Telehealth Act lets an out-of-state practitioner treat a patient located in Washington only with a Washington license, or for a consultation with the treating practitioner, a specialty assessment or recommendation "This does not include the provision of treatment," or follow-up for an established patient temporarily in the state (RCW 18.134.050). Supervision rules come from DOH: a CBT works "under close, ongoing supervision," with at least two face-to-face contacts a month (in person or by video) and direct supervision and observation of at least five percent of the CBT’s hours each month, including seeing the CBT with each client at least once every three months (WAC 246-805-330). [12][13][14][15][1]

Premera’s policy follows the same line: behavior analysts "must be state licensed, or state certified in states that require state licensure or state certification," and BCBA certification alone qualifies only in states that do not license. [12][13][14][15][1]

## Claims operations in Washington: prompt pay, prior-authorization clocks, appeals

Washington sets the claim-side floor for state-regulated plans. Prompt pay: participating-provider contracts must require the carrier to pay 95 percent of the monthly volume of clean claims within 30 days of receipt and to pay or deny 95 percent of all claims within 60 days; clean claims more than 61 days old earn interest at one percent a month (WAC 284-170-431). A denial must give "the specific reason," and a medical necessity denial must, on request, disclose how the claim failed the guidelines. Prior authorization: for health plans issued or renewed on or after January 1, 2024, a carrier must decide an electronic standard request within three calendar days (excluding holidays) and an electronic expedited request within one calendar day; non-electronic requests get five and two calendar days. A request for missing information must come within one calendar day of an electronic submission (five days for a non-electronic standard one), only a licensed physician or licensed health professional may deny on medical necessity, and since 2026 artificial intelligence "shall not be the sole means used to deny, delay, or modify health care services" (RCW 48.43.830). Members can take an adverse decision to a certified independent review organization (RCW 48.43.535). Timely filing limits and appeal windows for providers are set by each carrier’s contract; get them from your agreement. [16][17][19]

## BlueCard: out-of-area Blue members, and where the claim goes

For eligibility, benefits, claims and payment on another Blue plan's member, Premera sends you to Availity: select "Other Blue Plans Premera BlueExchange (FEP, Shared Admin)" as the payer, with the member's plan prefix, ID number, name and date of birth. Premera's BlueCard claims line is 888-261-9562. The out-of-area member's medical policy, pre-certification and pre-authorization requirements are looked up, and pre-service reviews submitted, through Premera's "Medical policy & pre-service review" tool for out-of-area Blue Plan members, so check the home plan's ABA policy there rather than assuming Premera's 3.01.510 applies. [23][24]

Premera pays these claims under your Premera contract: "All BlueCard claims processed by Premera are paid according to the terms of your contract with Premera Blue Cross." Put the complete ID, three-character prefix included, in box 1a. FEP is exempt from BlueCard. Providers practicing in Idaho and Oregon are the exception to filing with the "local" plan, because Premera's service area overlaps another Blue plan there. Use Premera's prefix list and county map to decide where to file. [23][24]

## Intake gates

The questions that decide whether a family can start with Premera Blue Cross, and what they have to bring.

- **Who may diagnose**: A healthcare professional "whose legally permitted scope of licensure includes diagnosis of psychiatric disorders or neurodevelopmental disorders." [1]
- **Referral required?**: Premera requires no physician referral in policy 3.01.510; what it requires is prior authorization with history and physical and medical necessity documentation. Washington’s parity statutes add no referral requirement of their own; they allow a plan to require medical necessity and to manage mental health services only where it applies "a comparable requirement" to medical and surgical services (RCW 48.44.341(3)–(4)). Self-funded ERISA plans sit outside the statute. [1][3][6]
- **Telehealth**: ABA "may be provided in-person or via secure real-time video and audio telehealth/virtual modalities, or via a combination," and supervision may be by telehealth too (3.01.510; Premera ABA resources page). Premera names no code exclusions. For fully insured Washington plans, RCW 48.43.735 requires same-amount reimbursement for covered telemedicine services. [1][2][18]
- **Age limit** _(plan-dependent)_: Policy 3.01.510 sets no age limit. For fully insured Washington plans, the parity statutes allow treatment limitations on mental health services "only if the same limitations or requirements are imposed on coverage for medical and surgical services," and they name no ABA-specific age or dollar limit. Self-funded ERISA plans are outside the statute, so plan funding type decides whether that binds. [1][6]
  - Ask the plan: Availity eligibility and benefits, or Premera customer service, 877-342-5258 option 2: check the member’s benefit booklet for ABA terms and whether the plan is fully insured.
- **Prior-auth decision time** _(plan-dependent)_: Depends on how the plan is funded. Fully insured Washington plans issued or renewed on or after January 1, 2024 fall under RCW 48.43.830: an electronic standard prior-authorization request must be decided "within three calendar days, excluding holidays," an electronic expedited request within one calendar day, a non-electronic standard request within five calendar days and a non-electronic expedited one within two. If information is missing, the carrier must ask within one calendar day of an electronic request (five days for a non-electronic standard request). Self-funded employer (ERISA) plans follow 29 CFR 2560.503-1 instead: pre-service decisions "not later than 15 days after receipt of the claim," with one 15-day extension. Premera publishes no Washington-specific ABA turnaround. [17][21]
  - Ask the plan: At benefits verification ask whether the plan is fully insured in Washington or self-funded (ERISA), whether you are submitting through Premera’s electronic prior-authorization process, and what reauthorization lead time it expects.
- **Other insurance (who pays first)** _(plan-dependent)_: For a child on two plans, Washington’s coordination-of-benefits rule is the birthday rule: unless a court decree says otherwise, "The plan of the parent whose birthday falls earlier in the calendar year is the primary plan" (if both parents share a birthday, the plan that has covered a parent longer); a court decree assigning health coverage controls, and with no decree the custodial parent’s plan pays first (WAC 284-51-205). That binds state-regulated plans; a self-funded plan sets its own order. If the child also has Apple Health, Premera pays first: Apple Health requires providers to bill known third parties and does not pay when third-party benefits are available (WAC 182-501-0200; 42 CFR 433.139). TRICARE pays after this plan (10 U.S.C. 1079(i)(1)); CHAMPVA is the last payer (38 CFR 17.270). [20][27][28][29][30]
  - Ask the plan: Ask Premera at benefits verification for the member’s coordination-of-benefits order (and whether a self-funded plan uses the birthday rule), and record every other coverage the child has.
- **Diagnosis recency** _(ask the plan)_: Policy 3.01.510 states no recency rule for the diagnosis. [1]
  - Ask the plan: Premera behavioral health utilization review via Availity: ask whether an older diagnostic evaluation is accepted for an initial request.
- **Diagnostic tools required** _(ask the plan)_: Policy 3.01.510 names no required diagnostic instrument. [1]
  - Ask the plan: Premera behavioral health utilization review via Availity.

## Delivery and billing rules

Coverage decides whether Premera Blue Cross 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**: Premera’s ABA resources page: technicians "should receive weekly clinical supervision from the program manager/lead behavioral therapist as follows for each patient: Generally, 2 hours for every 10 hours of direct service provision, with a minimum of 2 hours weekly when direct service provision is 10 hours per week or less." Policy 3.01.510 adds that some supervisory time should be direct observation, and supervision may be in person or by real-time video. DOH’s CBT supervision rule (WAC 246-805-330) also applies in Washington. [2][1][13]
- **Concurrent billing (97153 + 97155)**: Yes, during supervision of direct treatment: "When the program manager/lead behavioral therapist is supervising the behavioral technician … while the latter is providing covered direct treatment services, then for only the time during which that is taking place, both the supervision … and the direct treatment services … are covered services" (3.01.510); both the LBA and the technician write separate chart notes. Otherwise, more than one clinician giving direct ABA to the same member at once is not medically necessary, and group sessions are covered for one clinician only. [1][2]
- **Daily limits / MUEs**: Policy 3.01.510 sets no numeric hour cap; it points to CASP guidance on treatment intensity. Prep time, charting and provider travel are not separately covered. [1]
- **Session-note signature**: Premera says that during supervision of direct treatment "both the LBA and the RBT need to create separate chart notes," and for supervision outside direct treatment only the LBA’s note is needed. It sets no signature timing rule. [2]
- **Place of service**: Home or clinic most often, community settings as needed, in person or by real-time video. School: some direct treatment may occur there when autism-related difficulties are evident, but only bona-fide ABA; classroom aide, 1:1 teacher, tutoring and IEP services are not covered, and some plans exclude school settings. Camps and specialized schools are not covered. [1][2]
- **Bill as provider**: Program development, plan development, supervision and coordination are covered "only for program managers/lead behavioral therapists." LABAs are not credentialed separately: "Their services are billed under the credentialed, supervising licensed behavior analyst’s (LBA’s) name." In-network providers must use the codes listed in the policy (CPT 97151–97158, 0362T, 0373T, or the listed HCPCS codes) to be reimbursed. [1][2]

## What intake should collect for Premera Blue Cross

- **Plan type:** Individual plan (separate PA site, per the ID card) vs. group; fully insured vs. self-funded (Microsoft and Amazon, for example, are large employer groups).
- **Diagnosis report:** ASD diagnosis from a professional licensed to diagnose psychiatric or neurodevelopmental disorders.
- **History, physical and medical necessity:** Premera’s code list asks for these with the PA request.
- **Treatment plan:** Updated every six months; kept on file.
- **Other providers:** Speech, OT and school services, so sessions are not scheduled at the same time as ABA.

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

## Common questions

### Does Premera Blue Cross cover ABA therapy?

Yes, for autism spectrum disorder under medical policy 3.01.510, subject to prior authorization. Fully insured Washington plans are also bound by the state’s mental health parity law.

### Does Premera require prior authorization for the ABA assessment?

Yes. Premera’s October 2026 code lists put ABA among services needing prior authorization, and the individual-plan list marks 97151 (and 0362T) as PA required.

### Do LABAs need to be credentialed with Premera?

No. LABA services are billed under the credentialed, supervising LBA’s name.

### Can ABA be done at school with Premera?

Some direct treatment may take place at school when autism-related difficulties are evident there, but it must be entirely ABA treatment; acting as a classroom aide or providing IEP services is not covered, and some plans exclude school settings.

### Can a BCBA licensed in another state treat a Premera member in Washington?

Only with Washington authorization: a DOH license, reciprocity, or a 180-day temporary license for nonresidents licensed elsewhere. Premera’s own policy requires state licensure where the state licenses behavior analysts.

### How do I handle an out-of-state Blue member for ABA with Premera?

Through BlueCard. Check eligibility and file through Availity under "Other Blue Plans Premera BlueExchange," look up the home plan's medical policy and pre-authorization rules with Premera's out-of-area tool, and expect payment on your Premera contract terms. BlueCard claims line: 888-261-9562.

## Primary sources

1. [Premera Blue Cross Medical Policy 3.01.510 — Applied Behavior Analysis (ABA) (effective May 1, 2026; last revised Apr. 27, 2026)](https://www.premera.com/medicalpolicies/3.01.510.pdf)
2. [Premera — Applied Behavior Analysis (ABA) Resources for providers](https://www.premera.com/wa/provider/applied-behavior-analysis-resources/)
3. [Premera — Code List, Individual Plans Only (050237, 10-01-2026)](https://www.premera.com/documents/050237.pdf)
4. [Premera — Code List, Non-Individual Plans Only (027236, 10-01-2026)](https://www.premera.com/documents/027236.pdf)
5. [Premera — About prior authorization (submission sites by plan type)](https://www.premera.com/wa/provider/utilization-review/about-prior-authorization/)
6. [RCW 48.44.341 — Mental health services, health care service contractors (effective until January 1, 2027)](https://app.leg.wa.gov/RCW/default.aspx?cite=48.44.341)
7. [RCW 48.46.291 — Mental health services, HMOs (effective until January 1, 2027)](https://app.leg.wa.gov/RCW/default.aspx?cite=48.46.291)
8. [RCW 48.21.241 — Mental health services, group disability plans (effective until January 1, 2027)](https://app.leg.wa.gov/RCW/default.aspx?cite=48.21.241)
9. [WAC 284-43-5642 — Essential health benefit categories (mental health incl. "behavioral treatment for a DSM category diagnosis"; eff. 1/19/2026)](https://app.leg.wa.gov/WAC/default.aspx?cite=284-43-5642)
10. [E2SHB 1432, Chapter 227, Laws of 2025 — updates Washington’s mental health parity law; repeals RCW 48.20.580, 48.21.241, 48.44.341, 48.46.291 from January 1, 2027](https://lawfilesext.leg.wa.gov/biennium/2025-26/Pdf/Bills/Session%20Laws/House/1432-S2.SL.pdf)
11. [RCW 48.43.766 — Mental health and substance use disorder services, coverage and utilization review (effective January 1, 2027)](https://app.leg.wa.gov/RCW/default.aspx?cite=48.43.766)
12. [Chapter 18.380 RCW — Applied behavior analysis (licensure of behavior analysts, assistant behavior analysts and certified behavior technicians)](https://app.leg.wa.gov/RCW/default.aspx?cite=18.380&full=true)
13. [Chapter 246-805 WAC — Applied behavior analysis (DOH rules: supervision, reciprocity, temporary license)](https://app.leg.wa.gov/WAC/default.aspx?cite=246-805&full=true)
14. [Chapter 18.134 RCW — Uniform Telehealth Act (out-of-state practitioners, RCW 18.134.050)](https://app.leg.wa.gov/RCW/default.aspx?cite=18.134&full=true)
15. [BACB — U.S. Licensure of Behavior Analysts (Washington: 2015, WA State Department of Health)](https://www.bacb.com/u-s-licensure-of-behavior-analysts/)
16. [WAC 284-170-431 — Provider contracts, terms and conditions of payment (prompt pay)](https://app.leg.wa.gov/WAC/default.aspx?cite=284-170-431)
17. [RCW 48.43.830 — Prior authorization standards and decision timeframes (effective until January 1, 2027)](https://app.leg.wa.gov/RCW/default.aspx?cite=48.43.830)
18. [RCW 48.43.735 — Reimbursement of health care services provided through telemedicine](https://app.leg.wa.gov/RCW/default.aspx?cite=48.43.735)
19. [RCW 48.43.535 — Independent review of health care disputes](https://app.leg.wa.gov/RCW/default.aspx?cite=48.43.535)
20. [WAC 284-51-205 — Coordination of benefits, order of benefit determination rules](https://app.leg.wa.gov/WAC/default.aspx?cite=284-51-205)
21. [29 CFR 2560.503-1 — ERISA claims procedure (eCFR)](https://www.ecfr.gov/current/title-29/section-2560.503-1)
22. [HCA — ABA Treatment Fee Schedule (effective July 1, 2026; last updated July 29, 2026)](https://www.hca.wa.gov/assets/billers-and-providers/aba-20260701.xlsx)
23. [Premera — BlueCard Resources (prefix list, out-of-area medical policy and pre-service review)](https://www.premera.com/wa/provider/bluecard-resources/)
24. [Premera — Medical Reference Manual: BlueCard and Shared Administration chapter](https://www.premera.com/wa/provider/reference/medical-manuals/bluecard/)
25. [Premera — Provider News (WA provider news site)](https://providernews.premera.com/)
26. [Regence Medical Policy BH18 — Applied Behavior Analysis for the Treatment of Autism Spectrum Disorder (version effective 8/1/2025, carrying a notice that a revision takes effect 11/1/2026)](https://beonbrand.getbynder.com/m/e4646f415eb7f4eb/)
27. [WAC 182-501-0200 — Third-party resources](https://app.leg.wa.gov/WAC/default.aspx?cite=182-501-0200)
28. [42 CFR 433.139 — Medicaid third-party liability (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-433/subpart-D/section-433.139)
29. [10 U.S.C. 1079(i)(1) — TRICARE pays after other coverage except Medicaid](https://www.govinfo.gov/content/pkg/USCODE-2023-title10/html/USCODE-2023-title10-subtitleA-partII-chap55-sec1079.htm)
30. [38 CFR 17.270 — CHAMPVA is the last payer](https://www.ecfr.gov/current/title-38/section-17.270)

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.