Select Health is Utah’s home-grown insurer, part of Intermountain Health, and its commercial plans — large and small employer groups, self-funded employer plans and individual plans — run ABA through Select Health’s own medical policy, its own ABA Preauthorization Form and its own utilization-management intake. This guide covers those commercial members only. A family whose card says Select Health Community Care is on Utah Medicaid, and Utah carves ABA out of its Medicaid plans to fee-for-service; see our Select Health (Utah) guide for that split and our Utah Medicaid guide for the state rules.
For a Utah intake team a Select Health commercial card means three layers: Policy #630 (the clinical criteria), the preauthorization mechanics on the ABA form, and the Utah autism mandate, which binds individual and large-group plans but not small-group or self-funded ones. Ask which market segment the member is in before quoting what the mandate guarantees.
Select Health’s commercial (and CHIP) criteria live in Medical Policy #630, Applied Behavior Analysis — implemented 3/14/2019, last revised 1/1/2026. To qualify the member needs a DSM-5 ASD diagnosis (ICD-10 F84.0; F84.3–F84.9) from a provider licensed to make it under state law; for Utah the policy repeats the statute: a licensed physician board certified in neurology, psychiatry or pediatrics with experience diagnosing ASD, or a licensed psychologist with that experience. ABA “must be recommended or prescribed by a qualified treating healthcare professional experienced in the diagnosis and treatment of ASD, as defined by state law.”[1]
The essential elements: identifiable target behaviors that keep the member from participating in developmentally appropriate activities such as school, or a significant risk of harm to self or others; treatment that is not custodial; and an individualized treatment plan that is member-centric, names parent/caregiver goals, documents collaboration with family, pediatric providers, school psychologists and behavior analysts, identifies every staff member who will work with the member and the start date, sets baselines by objective measures with quantifiable progress and mastery criteria, and includes reinforcers, generalization strategies, fading and discharge criteria. Policy #630 says either focused or comprehensive ABA is allowed and access to either “should not be restricted by age, cognitive level, diagnosis, or co-occurring conditions,” unless a state mandate says otherwise.[1]
Intensity is set by a severity guide rather than a cap. Policy #630’s table assigns hours per week by how far below the norm the member scores in each of three domains — maladaptive behavior, social communication and self-care — at 0 hours (less than 1 SD below), 1–4 (mild, more than 1 SD), 4–7 (moderate, more than 1.5 SD) and 7–10 (severe, more than 2 SD), and “The chart hours are intended to be additive.” QHP protocol modification may be authorized at 1 to 2 hours per 10 hours of treatment by protocol, and caregiver training in a “Clinically Approved Dosage” based on clinical recommendations. Select Health considers ABA experimental/investigational for every indication other than ASD.[1]
Select Health’s ABA Preauthorization Form (form 3868050, revised 04/26) is the request. Mark it initial or concurrent: “For initial requests submit the diagnostic evaluation report”; “For concurrent request submit the updated individualized treatment plan with progress from previous authorization and/or assessment.” Commercial plans (“Large/Small Employer, Self-Funded, Ind.”) go to commercialUMintake@imail.org or fax 801-442-0825 — a different inbox from Community Care (Medicaid/CHIP) and Medicare. The form also asks for the member’s weekly ABA schedule by day, time span and location (office, home or other), the school and other-therapy schedule, the school program (public, private, home), whether an IEP, ISP, 504 or ARD is in place, other PT/OT/speech services and whether care is coordinated. Select Health points providers to its online Preauth & Care Plan Tool to cut turnaround, where “Some requests even qualify for auto-approval.”[2][3][1][4]
The clock: “Once Select Health receives this form, we have the following decision time frames ... For Commercial Plans: 14 days (Utah)” unless an expedited review is requested. The provider manual asks for at least 14 days’ notice before services where reasonably possible, says preauthorization “is not a guarantee of payment,” and warns that where a member uses a non-panel facility, failure to preauthorize can cut standard benefits by up to 50 percent of eligible charges. Policy #630 reviews continued authorization “up to every 6 consecutive months,” adjusting hours up or down on intensity and severity, and expects the plan of care to be updated with validated scales such as the Vineland-3, ABAS, VB-MAPP or ABLLS.[2][3][1][4]
Utah Code § 31A-22-642 requires a health benefit plan “offered in the individual market or the large group market and entered into or renewed on or after January 1, 2020” to cover the diagnosis and treatment of autism spectrum disorder, and for those plans behavioral health treatment “may not have a limit on the number of hours covered”; the 600-hours-a-year floor and the ages-2-to-under-10 window belong to legacy plans entered or renewed from 2016 to 2019. Small-group plans are not named, and self-funded employer plans fall outside state insurance law — Select Health’s ABA form routes “Large/Small Employer, Self-Funded, Ind.” through one inbox, so the form does not tell you which rules bind. The statute also sets operating rules: the provider submits a treatment plan within 14 business days of starting treatment, the insurer may request a review “not more than once every three months,” and the plan network must include both board certified behavior analysts and qualified mental health providers. From the 2026 amendment, every health benefit plan must report to the Insurance Department before July 1, 2027, and each July after, its average wait for an autism assessment, whether it has prior-authorization requirements for autism assessment or treatment, and ABA hours and cost.[5][2]
Select Health publishes no commercial ABA fee schedule; the rate is in your participating provider agreement, and the provider manual sends “fee schedule issues” to your Provider Relations representative rather than the provider appeal process. Rates change by contract, not by a published schedule, so ask Provider Relations what your agreement says about fee-schedule updates. For a public benchmark, Utah Medicaid pays 97153 at $19.67 and 97151, 97155 and 97156 at $37.51 per 15-minute unit from July 1, 2026.[3][6]
Claims go on the CMS-1500 (“HCFA 1500”) “within 12 months of the date of service”; later claims are denied unless the provider shows notice was given as soon as reasonably possible, and the manual notes that filing periods can vary by contract. When Select Health is secondary, the supporting information must arrive within 12 months after the primary plan processed the claim, and a claim filed to the wrong primary insurer can be re-filed to the right one within 24 months of the date of service. Member appeals on commercial plans are due within 180 days of the denial notice. Provider appeals (coding issues such as modifiers) go through the Provider Benefit Tool or the Provider Appeal form within 180 days of the date the claim was processed, and Select Health answers in writing within 60 days.[3][6]
The questions that decide whether a family can start with Select Health (commercial, Utah), and what they have to bring. Each maps onto something intake should ask on the first call.
None in Select Health’s policy: access to comprehensive and focused ABA “should not be restricted by age, cognitive level, diagnosis, or co-occurring conditions” unless a state mandate says otherwise. Utah’s mandate sets no age limit for individual and large-group plans entered or renewed since 1/1/2020 (the 2-to-under-10 window applies only to 2016–2019 plans); small-group and self-funded plans follow the plan document.[1][5]
No recency window is published. The initial request must include the diagnostic evaluation report, and Policy #630 requires a DSM-5 ASD diagnosis, but neither says how old the evaluation may be.[2][1]
For Utah, Policy #630 repeats the statute: the diagnosis must be “Performed by a licensed physician who is board certified in neurology, psychiatry, or pediatrics and has experience diagnosing autism spectrum disorder, or a licensed psychologist with experience diagnosing autism spectrum disorder” (Utah Code § 31A-22-642).[1][5]
No diagnostic instrument is mandated. Policy #630 requires baselines “established through objective measures” and, for continued authorization, a plan of care “updated utilizing validated scales (e.g. Vineland Adaptive Behavior Scales 3 (VABS-3), the Adaptive Behavior Assessment Scale (ABAS), VB-MAPP, or ABLLS)”; its intensity guide is keyed to standard-deviation scores below the norm.[1]
A recommendation or prescription is required: ABA “must be recommended or prescribed by a qualified treating healthcare professional experienced in the diagnosis and treatment of ASD, as defined by state law” (Policy #630). Under the Utah mandate, covered treatment is care “prescribed or ordered” by the qualifying physician or licensed psychologist. Neither sets a validity period for the order.[1][5]
“Once Select Health receives this form, we have the following decision time frames to make a benefit determination (unless an expedited review is requested): For Commercial Plans: 14 days (Utah)” (ABA Preauthorization Form, 04/26). The provider manual asks for at least 14 days’ notice before services where reasonably possible; continued authorization is reviewed up to every 6 months (Policy #630).[2][3]
The provider manual follows the standard order: the plan covering the person other than as a dependent pays first; for a child of parents who are not separated or divorced, “The benefits of the plan of the parent whose birthday falls earlier in the calendar year are determined before those of the plan of the parent whose birthday falls later in the year” (month and day only). Because of the government’s role, CHAMPUS/TRICARE and Medicaid “are always considered secondary,” so Select Health commercial pays before a child’s Medicaid or TRICARE. When Select Health is secondary, the information must reach it within 12 months after the primary plan processed the claim.[3]
Not addressed for ABA. Policy #630, the ABA Preauthorization Form (whose setting choices are office, home or other) and the provider manual state no ABA telehealth rule, so whether 97151 or 97155 may be delivered remotely is a question for Select Health.[1][2]
Ask the plan: Select Health UM intake or Provider Relations: ask which ABA codes are payable by telehealth and with what POS/modifier. Checked this run: Policy #630, the ABA form and the provider manual.
Coverage decides whether Select Health (commercial, Utah) 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.
Policy #630: ABA must be provided directly or supervised by licensed behavior analysts (in states that license them), board-certified behavior analysts, or licensed psychologists whose scope covers behavior analysis, with unlicensed or non-certified staff supervised “in line with practice standards,” unless state mandates, plan documents or contracts say otherwise. “Services should be supervised at a minimum of 5% of direct service hours and should be supervised at least monthly.” QHP protocol modification may additionally be authorized at 1 to 2 hours per 10 hours of treatment by protocol.[1]
No per-day unit ceiling is published. Policy #630 sets hours by a severity guide — 0, 1–4, 4–7 or 7–10 hours per week in each of three domains (maladaptive behavior, social communication, self-care), “intended to be additive” — and an assessment-unit guide (functional analysis 8–16 units, focused 16–24, comprehensive 32). For individual and large-group plans entered or renewed since 1/1/2020, Utah Code § 31A-22-642 bars any limit on the number of covered behavioral-health hours.[1][5]
Select Health has a general medical-record rule, not an ABA-specific one. Its Provider Office Medical Record Standards say “All entries in the medical record should contain author identification,” which “may be handwritten, stamped, or electronic” (signing office notes is optional in a solo practice), and “Each entry should have a date indicating the date of the visit.” Policy #630 sets no session-note or amendment rule of its own.[3]
Office, home and other settings. The ABA Preauthorization Form records the servicing location (office, home or other) and asks for each day’s schedule by setting, and Policy #630 wants community-based treatment optimized, for example school engagement. Neither document publishes a list of payable POS codes or a school-setting rule, so confirm school delivery with Select Health.[2][1]
Not addressed. Policy #630 lists 97151–97158, 0362T, 0373T and 96202/96203 as covered when criteria are met and allows 1–2 hours of QHP protocol modification per 10 hours of technician treatment, but says nothing about billing 97155 and 97153 for the same clock time.[1]
Ask the plan: Select Health Provider Relations or your participating provider agreement: ask whether 97155 and 97153 may be billed for the same minutes. Checked this run: Policy #630 and the provider manual — neither addresses it.
Not published. The ABA form collects a requesting and a servicing provider (each with NPI) and a tax ID, and Policy #630 says who may provide or supervise, but neither says whether technician time is billed under the technician or the supervising analyst.[2]
Ask the plan: Select Health Provider Relations / credentialing: ask whose NPI goes in the rendering field for 97153 delivered by an RBT. Checked this run: Policy #630, the ABA form and the provider manual.
Yes, for autism spectrum disorder under Medical Policy #630, when the essential elements are met and the plan covers it. Select Health treats ABA for any other indication as experimental/investigational. Individual and large-group plans also answer to Utah Code § 31A-22-642.
Send the ABA Preauthorization Form with clinical notes to commercialUMintake@imail.org (fax 801-442-0825), or use the Preauth & Care Plan Tool. Include the diagnostic evaluation report on an initial request and the updated treatment plan with progress on a concurrent request.
Fourteen days for Utah commercial plans unless you ask for expedited review, per the ABA Preauthorization Form.
Not settled from public documents. The form has an initial-request path and Policy #630 gives an assessment-unit guide, but the code-level commercial preauthorization list is behind Select Health’s login. Ask UM intake before scheduling the assessment.
At least 5% of direct service hours, and at least monthly (Policy #630). QHP protocol modification can be authorized at 1–2 hours per 10 hours of technician treatment.
Select Health publishes no commercial ABA rates; they are in your participating provider agreement, and fee-schedule questions go to your Provider Relations representative. Utah Medicaid’s published rates (97153 $19.67 per 15 minutes from 7/1/2026) are the public benchmark.
Twelve months from the date of service on the CMS-1500, unless your contract says otherwise. Secondary claims need the primary plan’s information within 12 months of the primary’s processing.
No. It covers individual and large-group plans. Small-group and self-funded employer plans are outside it, even though Select Health’s ABA form sends all commercial requests to the same inbox.
Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed October 2026; it is general information, not billing, legal, or clinical advice. Always verify current requirements against the payer's live policy and a benefits check for the specific member.
Carelu collects all of this automatically.
Every ID, document, and detail this payer requires — gathered conversationally the moment a family reaches out, with insurance verified before your team touches the file.
Get a Demo