---
title: "Regence BlueShield ABA coverage in Washington: the intake guide."
url: "https://carelu.com/payers/regence-blueshield-washington"
markdown_url: "https://carelu.com/payers/regence-blueshield-washington.md"
state: WA (Washington)
payer: Regence BlueShield (Washington)
kind: Commercial insurance
description: "How Regence BlueShield covers ABA in Washington: medical policies BH18 and BH33 (which cite Washington’s Mental Health Parity Act), contract-dependent preauthorization, the standardized-assessment and documentation rules, LBAT requirement, and what intake should collect."
last_reviewed: October 2026
---

# Regence BlueShield ABA coverage in Washington: the intake guide.

_Payer Guide · Regence BlueShield · Washington · Last updated October 2026 · 19 primary sources_

> Regence BH18/BH33, which name Washington’s parity act as their legal basis: PA only where the contract requires it, one standardized assessment, continuation requests 5–30 days before the end date.

Regence BlueShield is Washington’s second Blue plan, alongside Premera. Its ABA rules are two medical policies shared across its states: BH18 for treatment and BH33 for the initial assessment. Both list "Washington’s Mental Health Parity Act (RCW 48.44)" as the Washington basis for the benefit, and both define the Washington treating provider as a qualified lead behavior analysis therapist (LBAT). The version we read is effective August 1, 2025 and carries a notice that a revised BH18 takes effect November 1, 2026.

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment** _(plan-dependent)_: Only where the member’s contract requires preauthorization of the initial assessment: BH33 "only applies to member contracts that are subject to preauthorization for the initial assessment" [2]
  - Ask the plan: Regence’s preauthorization list for the member contract (via Availity): check 97151 and 97152.
- **Prior auth for treatment** _(plan-dependent)_: Where the contract requires it: BH18 "only applies to member contracts that are subject to preauthorization" for ABA; continuation documentation is due within five business days before the authorization ends and no more than 30 days before [1]
  - Ask the plan: Regence’s preauthorization list for the member contract (via Availity).
- **Autism diagnosis required?**: Yes: autism spectrum disorder diagnosed by a qualified treating health care professional "as defined by state law" (BH33 examples: pediatrician, pediatric neurologist, developmental pediatrician, psychologist) [1][2]

## At a glance

- **Covers ABA?:** Yes, for ASD, under BH18 (treatment) and BH33 (initial assessment)
- **Prior auth:** Only for contracts subject to ABA preauthorization; check the member’s contract
- **Treatment plan needs:** Objective measures and at least one standardized assessment for each targeted behavior; hours and units with clinical justification
- **Continuation:** Submit within 5 business days before the authorization ends, and no more than 30 days before
- **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 — Regence pays the rates in your provider agreement

## BH18 and BH33, applied in Washington

BH33 covers the initial ABA assessment when the member has an ASD diagnosis from a qualified treating professional, symptoms that make the member a safety risk or unable to take part in age-appropriate activities, and a recommendation or prescription for ABA from a qualified professional experienced with autism. BH18 covers starting treatment when an individualized treatment plan, prepared by a provider certified to provide ABA (in Washington, a qualified LBAT), describes each targeted behavior with "objective measurements and at least one standardized assessment," the evidence-based interventions, caregiver training, clinical justification for days per week, hours per day and supervision hours, the CPT codes and units requested for a date range, and measurable discharge goals. Initial requests also need the most recent date of service with any previous ABA provider and the reason for discharge. [1][2]

Continuation requires functional, measurable progress: data from sessions and assessments, gains maintained outside the treatment setting, the same measurement tool used for baseline and current progress, objective measures at least every six months and standardized assessments annually, and a showing that the behaviors still need this intensity. Documentation "should be submitted within five business days prior to the end of a current authorization (and no more than 30 days prior to the end of the authorization period)." ABA for educational, vocational or custodial purposes is not medically necessary. Both policies apply "only … to member contracts that are subject to preauthorization," so check the member’s contract first. [1][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. [3][4][5][6][7][8][1]

## 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). [9][10][11][12]

## 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. [13][14][16]

## Intake gates

The questions that decide whether a family can start with Regence BlueShield (Washington), and what they have to bring.

- **Diagnosis recency**: No expiry on the diagnosis is stated. The data clocks: objective measurements of treatment goals at least every six months and standardized assessments annually for continuation. [1]
- **Who may diagnose**: A qualified treating health care professional "as defined by state law"; BH33 gives as examples a pediatrician, pediatric neurologist, developmental pediatrician or psychologist. [2][1]
- **Diagnostic tools required**: No diagnostic instrument is named. For the treatment plan, each targeted behavior needs "at least one standardized assessment" (examples: SRS-2, Vineland-3, ABAS-3, SSIS, BRIEF-2, PDDBI); curriculum-based tools such as VB-MAPP, PEAK, ABLLS-R and AFLS guide planning but are not standardized. [1]
- **Referral required?**: Yes: "ABA therapy must be recommended or prescribed by a qualified treating health care professional experienced in the diagnosis and treatment of ASD," and the request needs the "Written recommendation, clinical order, or prescription for ABA services." [1][2]
- **Age limit** _(plan-dependent)_: BH18 and BH33 set 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][3]
  - Ask the plan: Availity benefits check: establish fully insured vs. self-funded and the contract’s ABA terms.
- **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. Regence publishes no Washington-specific ABA turnaround. For continuations, Regence wants documentation "within five business days prior to the end of a current authorization (and no more than 30 days prior to the end of the authorization period)." [14][18][1]
  - Ask the plan: At benefits verification ask whether the plan is fully insured in Washington or self-funded (ERISA), whether you are submitting through Regence’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, Regence 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). [17][20][21][22][23]
  - Ask the plan: Ask Regence 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.
- **Telehealth** _(ask the plan)_: BH18 and BH33 do not address telehealth. For fully insured Washington plans, RCW 48.43.735 requires same-amount reimbursement for covered, medically necessary services delivered by telemedicine that can be safely provided that way, with the home as an originating site. [1][15]
  - Ask the plan: Regence behavioral health UM via Availity: ask which ABA codes are payable by telehealth for this contract and with which POS and modifier.

## Delivery and billing rules

Coverage decides whether Regence BlueShield (Washington) 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**: BH18 sets no numeric ratio. BCaBAs work under a BCBA or BCBA-D; behavior technicians and RBTs "must be under the ongoing supervision of a BCBA, BCBA-D, or qualified supervisor," and "All supervision must be conducted in accordance with" the BACB’s ethics code and supervision standards; the plan must justify the hours per week of direct face-to-face supervision requested. In Washington, DOH’s CBT rule also applies: two face-to-face contacts a month and direct supervision of at least 5 percent of monthly hours (WAC 246-805-330). [1][10]
- **Daily limits / MUEs**: No numeric cap. Each request must give the units or hours per period with "Clinical justification for the number of days per week and hours per day," and excessive hours of supervision, assessment, social skills or parent training need extra justification; dosage "must not be based solely on diagnosis, caregiver availability, or scheduling preferences." [1]
- **Place of service**: BH18 requires justification for supervision and "observation of the child in their natural setting" and excludes ABA used for educational, vocational or custodial purposes; it sets no other setting rule. [1]
- **Concurrent billing (97153 + 97155)** _(ask the plan)_: Not addressed in the BH18 version read (effective 8/1/2025). [1]
  - Ask the plan: Regence behavioral health UM via Availity, or the revised BH18 effective 11/1/2026: ask whether 97153 and 97155 may be billed for the same time.
- **Session-note signature** _(ask the plan)_: BH18 requires the treatment plan to be documented in the medical record but sets no session-note signature rule. [1]
  - Ask the plan: Regence provider manual and participating agreement (documentation standards).
- **Bill as provider** _(ask the plan)_: BH18 defines the Washington treating provider certified to provide ABA as a qualified Lead Behavior Analysis Therapist (LBAT); it adds a BACB-certified provider as a qualifying alternative only for Idaho. It does not say whose NPI goes on the claim for technician time. [1]
  - Ask the plan: Regence provider services or your Regence agreement: ask whether CBT services are billed under the supervising LBA’s NPI.

## What intake should collect for Regence BlueShield (Washington)

- **Contract preauthorization status:** Whether the member’s Regence contract requires preauthorization for the ABA assessment and treatment.
- **Diagnosis and prescription:** ASD diagnosis from a qualified professional and a written recommendation, order or prescription for ABA.
- **Standardized assessment:** At least one standardized assessment (SRS-2, Vineland-3, ABAS-3 and similar); curriculum-based tools alone do not meet it.
- **Prior ABA history:** Most recent date of service with any previous ABA provider and the reason for discharge.
- **Plan funding type:** Fully insured Washington plan (state parity law applies) vs. self-funded ERISA.

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

## Common questions

### Does Regence BlueShield cover ABA in Washington?

Yes, under medical policies BH18 and BH33, which name Washington’s Mental Health Parity Act as the Washington basis for the benefit.

### Does Regence require prior authorization for ABA in Washington?

It depends on the member’s contract. BH18 and BH33 apply only to contracts subject to ABA preauthorization; check the member’s preauthorization requirements in Availity.

### Who can deliver ABA for Regence in Washington?

BH18 names a qualified Lead Behavior Analysis Therapist (LBAT) as the Washington treating provider, with BCaBAs and technicians under supervision. Washington also requires DOH licensure or certification.

### When should I send a Regence continuation request?

Within five business days before the current authorization ends, and no more than 30 days before, with the updated treatment plan and progress data.

## Primary sources

1. [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/)
2. [Regence Medical Policy BH33 — ABA Initial Assessment for the Treatment of Autism Spectrum Disorder (eff. 8/1/2025)](https://beonbrand.getbynder.com/m/8360cc45444cab46/)
3. [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)
4. [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)
5. [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)
6. [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)
7. [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)
8. [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)
9. [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)
10. [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)
11. [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)
12. [BACB — U.S. Licensure of Behavior Analysts (Washington: 2015, WA State Department of Health)](https://www.bacb.com/u-s-licensure-of-behavior-analysts/)
13. [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)
14. [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)
15. [RCW 48.43.735 — Reimbursement of health care services provided through telemedicine](https://app.leg.wa.gov/RCW/default.aspx?cite=48.43.735)
16. [RCW 48.43.535 — Independent review of health care disputes](https://app.leg.wa.gov/RCW/default.aspx?cite=48.43.535)
17. [WAC 284-51-205 — Coordination of benefits, order of benefit determination rules](https://app.leg.wa.gov/WAC/default.aspx?cite=284-51-205)
18. [29 CFR 2560.503-1 — ERISA claims procedure (eCFR)](https://www.ecfr.gov/current/title-29/section-2560.503-1)
19. [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)
20. [WAC 182-501-0200 — Third-party resources](https://app.leg.wa.gov/WAC/default.aspx?cite=182-501-0200)
21. [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)
22. [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)
23. [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.