---
title: "Select Health ABA coverage in Utah: Medicaid ACO vs. commercial."
url: "https://carelu.com/payers/select-health-utah"
markdown_url: "https://carelu.com/payers/select-health-utah.md"
state: UT (Utah)
payer: Select Health (Utah)
kind: Medicaid managed care plan (MCO)
parent_program: Utah Medicaid
description: "Select Health in Utah is two different products for ABA purposes: SelectHealth Community Care (the Medicaid ACO) rides Utah Medicaid's FFS carve-out, while Select Health commercial plans run their own ABA policy (#630) with a dedicated preauthorization form. What intake needs to ask."
last_reviewed: October 2026
vob_data_updated: 2026-10-15
---

# Select Health ABA coverage in Utah: Medicaid ACO vs. commercial.

_Payer Guide · Select Health · Last updated October 2026 · 13 primary sources_

> Two different products under one name: Community Care (Medicaid) rides UT FFS; commercial runs its own Policy #630.

A family saying "we have Select Health" in Utah could mean two structurally different things, and getting it right changes where the ABA request goes. SelectHealth Community Care is one of Utah Medicaid's four ACOs (alongside Health Choice Utah, Healthy U, and Molina) — and Utah Medicaid carves ABA out of every ACO to state fee-for-service, so a Community Care member's ABA request never touches Select Health at all; it goes straight to Utah Medicaid, exactly as our Utah Medicaid guide describes. Select Health also separately sells commercial insurance — employer group and individual/marketplace plans, branded simply "Select Health" — and for those members, Select Health runs its own ABA clinical policy, its own prior-authorization form, and its own utilization-management team. Select Health (the parent brand) is a wholly owned subsidiary of Intermountain Health. This guide covers both paths.

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

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Community Care (Medicaid) members: none — routes to Utah Medicaid FFS, not Select Health (Section I of the Utah Medicaid manual lists ASD services among the carve-outs "not covered by any of the MCEs"). Commercial members: required — ABA Preauthorization Form, initial request [9][10][5]
- **Prior auth for treatment**: Community Care (Medicaid) members: routes to Utah Medicaid FFS. Commercial members: required — concurrent ABA Preauthorization Form; 14-day decision (Utah) [9][10][5]
- **Autism diagnosis required?**: Yes — ASD on both sides. Medicaid members follow Utah Medicaid's diagnostic-tool requirement (no specific instrument mandated). Commercial members follow Select Health Medical Policy #630 (Applied Behavior Analysis): a DSM-5 diagnosis of ASD (ICD-10/F84.0; F84.3–F84.9) obtained by an appropriate provider per the requirements of the state the provider practices in — in Utah, a physician board-certified in neurology, psychiatry or pediatrics with ASD-diagnosing experience, or an experienced licensed psychologist, with the diagnosis resting on medically necessary assessments, evaluations or tests. Select Health considers ABA experimental/investigational for any indication other than ASD. [9][4]

## At a glance

- **Two products, one name:** SelectHealth Community Care (Medicaid ACO) vs. Select Health commercial (employer/individual)
- **Community Care + ABA:** Carved out to Utah Medicaid FFS — Select Health does not administer it
- **Commercial + ABA:** Select Health's own Policy #630 "Applied Behavior Analysis" (revised eff. 1/1/2026)
- **Commercial prior auth:** Required — ABA Preauthorization Form; 14-day decision in Utah
- **Commercial submission:** commercialUMintake@imail.org · fax 801-442-0825
- **Parent company:** Intermountain Health (Select Health is a wholly owned subsidiary)
- **Utah mandate:** Utah Code § 31A-22-642 — governs individual/large-group commercial plans, not small-group or Medicaid

## First question: which Select Health?

Select Health's own Medicaid Provider Summary describes SelectHealth Community Care as one of three government/managed products it runs alongside Select Health Medicare and Select Health Share, "available to eligible members living in all Utah counties." Its Provider Reference Manual separately defines a "Fee-For-Service Medicaid member" as anyone whose needed service is covered by Medicaid rather than the ACO plan — the same carve-out mechanism our Utah Medicaid guide documents for all four ACOs — and its Appendix B for Community Care states plainly that "Select Health Community Care policies typically align with State of Utah Medicaid policy." Select Health's own published carved-out-services list names mental-health medications, emergency transportation, long-term care, apnea monitors, and dental — it doesn't explicitly name ABA/autism services, so treat the FFS routing as inherited from Utah Medicaid's own carve-out policy (already verified in our Utah Medicaid guide) rather than a Select Health-authored statement. Either way, the operational answer for intake is the same: for a Community Care member, don't call Select Health for ABA — go straight to Utah Medicaid. [1][2][3]

## Commercial members: Select Health's own ABA policy

For employer-group, self-funded, and individual/marketplace members, Select Health runs its own numbered medical policy — Policy #630, "Applied Behavior Analysis (ABA)" — last revised 1/1/2026 (implementation date 3/14/19; prior revisions 1/15/21, 5/7/21, 2/27/24, 11/13/24, 7/1/25). The policy's own medical-necessity criteria, now directly confirmed: target behaviors must impact the member's participation in developmentally-appropriate activities or pose a safety risk, treatment cannot be custodial, and the treatment plan needs identified target behaviors with baseline measures, parent/caregiver goals, discharge criteria, and documented collaboration with existing providers or the school district. ABA must be provided directly or supervised by a licensed behavior analyst, BCBA, or licensed psychologist practicing within scope — unless state mandates, plan documents, or contracts say otherwise — with any unlicensed/non-certified staff supervised in line with practice standards. Either focused or comprehensive ABA is allowed, and access "should not be restricted by age, cognitive level, diagnosis, or co-occurring conditions" unless a state mandate says otherwise. Select Health considers ABA experimental/investigational for anything other than ASD. What is independently confirmed from Select Health's own live 2026 ABA Preauthorization Form: it distinguishes an initial request (diagnostic evaluation report required) from a concurrent/continuation request (updated treatment plan with progress data required), and Utah decisions on commercial plans are due within 14 days absent expedited review. The form also collects a detailed weekly ABA schedule (day, time, setting — office/home/other), school and other-therapy schedules, and IEP/ISP/504/ARD status — build that into your intake packet before submitting. [4][5]

## Submission mechanics by line of business

Select Health's ABA Preauthorization Form routes requests by email, split cleanly by line of business: commercial (large/small employer, self-funded, individual) goes to commercialUMintake@imail.org (fax 801-442-0825); Select Health Community Care (Medicaid/CHIP) goes to medicaidUMintake@imail.org (fax 801-442-0625) — relevant only for the non-ABA services Community Care still administers, since ABA itself routes to Utah Medicaid, not this address; Select Health Medicare goes to medicareUMintake@imail.org (fax 801-442-0302), with a 14-day decision window across all states. Select Health also runs an online "Preauth & Care Plan Tool," where some requests qualify for auto-approval, and a general 24/7 preauthorization help desk at 800-442-4566. General provider support for commercial plans runs through 800-222-6358. [5][6]

## The Utah mandate and commercial market segment

Utah Code § 31A-22-642 requires ASD diagnosis-and-treatment coverage in the individual and large-group markets — small-group plans are not named by the statute. Select Health's own ABA Preauthorization Form lists "Commercial Plans (Large/Small Employer, Self-Funded, Ind.)" as a single routing category, meaning Select Health's ABA intake process is unified across market segments even though the mandate's protections (no age limit, no hour cap for plans entered or renewed since 1/1/2020) legally apply only to individual and large-group business — small-group and self-funded ERISA plans sit outside the mandate. We found no Select Health page that discusses mandate compliance or breaks out market segment explicitly, so confirm a given member's market segment (individual, small-group, large-group, or self-funded) as part of benefits verification rather than assuming mandate protections apply. Also worth knowing: starting before July 1, 2027, Utah requires every health benefit plan — Select Health included — to publicly report autism-assessment wait times, PA practices, and average ABA hours/cost to the Insurance Department annually. [7][5]

## Rates

No Select Health-specific ABA fee schedule (commercial or Community Care) was found published. For Community Care members, ABA rides Utah Medicaid FFS entirely, so the relevant benchmark is Utah Medicaid's own published PRISM rates ($19.67 per 15-minute unit on 97153; $37.51 on 97151/97155/97156, effective 7/1/2026) — not a Select Health rate at all. For commercial members, rates are contract-negotiated and live in your participating-provider agreement. [8]

## What are Select Health’s claim filing and appeal deadlines?

Select Health’s provider reference manual: claims "must be submitted to Select Health on UB-92/04 or HCFA 1500 claim forms within 12 months of the date of service," and later claims are denied unless the provider shows notice was given as soon as reasonably possible. For Select Health Community Care (Medicaid) "Appeals must be filed within 60 days of the Adverse Benefit Determination," and a provider appeal gets a written response within 60 days of receipt. [2][10]

Utah Medicaid’s Section I adds the state step: after the plan’s appeal is finished, a hearing request goes to the Office of Administrative Hearings within 120 calendar days of the MCE’s written notice. [2][10]

## Intake gates

The questions that decide whether a family can start with Select Health (Utah), and what they have to bring.

- **Diagnosis recency**: No recency window is published on either side. Utah Medicaid states none (see our Utah Medicaid guide), and Select Health's commercial ABA Preauthorization Form distinguishes an initial request, which requires the diagnostic evaluation report, from a concurrent request, which requires an updated treatment plan with progress data — without dating the diagnosis. Policy #630 confirms this directly: it requires the DSM-5/ICD-10 diagnosis "obtained by an appropriate... licensed provider" but states no maximum age for that diagnosis. [5][9][4]
- **Who may diagnose**: For SelectHealth Community Care (Medicaid) members this is not a Select Health question: ABA is carved out of every Utah Medicaid ACO to state fee-for-service, so the Utah Medicaid rule governs — the diagnosis may be rendered by any clinician authorized under the scope of their licensure and trained in the use and interpretation of the selected assessment tool. For commercial members the Utah mandate's definition is narrower and stricter: a board-certified neurologist, psychiatrist or pediatrician with ASD experience, or an experienced licensed psychologist. [9][12][7][10]
- **Diagnostic tools required**: For SelectHealth Community Care (Medicaid) members this is not a Select Health question: ABA is carved out of every Utah Medicaid ACO to state fee-for-service, so the Utah Medicaid rule governs — no specific instrument is mandated, but the DSM-5 determination must rest on evidence-based standardized measures and the completed tool accompanies the initial PA. For commercial members, Select Health's ABA Preauthorization Form requires the diagnostic evaluation report on an initial request, and Policy #630's Utah-specific rule likewise names no required instrument — just "medically necessary assessments, evaluations, or tests" behind the diagnosis. The policy's background section separately lists the M-CHAT-R/F as an example general ASD screening tool and reproduces the full DSM-5 criteria A–E, but does not make any one instrument mandatory for ABA authorization; continuation reviews instead look for progress measured on "validated scales (e.g. Vineland Adaptive Behavior Scales 3 (VABS-3), the Adaptive Behavior Assessment Scale (ABAS), VB-MAPP, or ABLLS)." [9][5][10][4]
- **Referral required?**: For SelectHealth Community Care (Medicaid) members this is not a Select Health question: ABA is carved out of every Utah Medicaid ACO to state fee-for-service, so the Utah Medicaid rule governs — an order or prescription for ABA from a licensed clinician authorized to prescribe it is required in the initial packet and renewed annually. For commercial members, Select Health requires preauthorization on its own ABA Preauthorization Form (commercialUMintake@imail.org, fax 801-442-0825), with Utah decisions due within 14 days absent expedited review; Policy #630 — now directly confirmed — publishes no separate physician-referral requirement beyond the diagnosing-provider rule itself. [9][5][10][4]
- **Telehealth**: For SelectHealth Community Care (Medicaid) members this is not a Select Health question: ABA is carved out of every Utah Medicaid ACO to state fee-for-service, so the Utah Medicaid rule governs — the January 2026 ASD manual lets behavior identification assessments (97151) and supervision of a technician or assistant analyst (97155) occur by remote access technology when clinically appropriate, plus parent training, but not technician-delivered 97153/97154 or QHP-delivered group 97158; synchronous two-way video only, POS 02 (Section I also accepts POS 10). For commercial members the Preauthorization Form collects a weekly ABA schedule by setting (office, home, other), and Policy #630 — now directly confirmed — states no telehealth-specific modality rule of its own for ABA. [9][12][5][10][4]
- **Prior-auth decision time**: Commercial members: Select Health's own 2026 ABA Preauthorization Form sets the clock — "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)." Expedited review is available only if the standard time frame could seriously jeopardize life, health or the ability to regain maximum function, or leave severe pain unmanaged. Utah requires fully insured plans' adverse-determination procedures to comply with 29 CFR 2560.503-1, which caps an urgent pre-service decision at 72 hours after receipt. From January 1, 2027 Utah Code 31A-22-650 (SB 319, 2026) tightens insurers to "no later than seven calendar days after the day on which the insurer receives all necessary information," and 72 hours for urgent care. Select Health separately distinguishes an initial request (diagnostic evaluation report) from a concurrent request (updated treatment plan with progress data). Community Care (Medicaid) members: the plan's manual gives 14 calendar days standard and 72 hours urgent for its own preauthorizations, but this guide records ABA as routing to Utah Medicaid fee-for-service, where the state's clock applies instead. [5][2][14][15][16]
  - Ask the plan: Select Health Health Services, 800-442-5305: the reauthorization lead time for ABA concurrent requests, which neither the form nor the manual states.
- **Other insurance (who pays first)**: Commercial members follow the standard order in Select Health's manual, which tracks Utah's COB rule. For a child on both parents' plans, "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; same birthday goes to the plan that covered the parent longer). Divorced or separated parents: a court decree naming the responsible parent controls; joint custody without one uses the birthday rule. "Because of the government's role in subsidizing care for members enrolled in CHAMPUS/TRICARE and MEDICAID, these policies are always considered secondary to another plan" — so Select Health commercial pays before a child's Medicaid or TRICARE. When Select Health is secondary, the COB information must reach it "within 12 months after the claim was processed by the primary plan." Community Care (Medicaid) members: Medicaid is payer of last resort; for ABA routed to fee-for-service, Utah Medicaid's own TPL rules apply (other coverage exhausted first, 6-month transition to an in-network provider). [2][17][9]
- **Age limit** _(plan-dependent)_: For SelectHealth Community Care (Medicaid) members this is not a Select Health question: ABA is carved out of every Utah Medicaid ACO to state fee-for-service, so the Utah Medicaid rule governs — no upper age limit, PRISM showing ages 1 and older including adult plans. For Select Health commercial members, the Utah mandate sets the floor where it applies: Utah Code § 31A-22-642 imposes no age limit on individual and large-group plans entered or renewed since 1/1/2020, but small-group plans are not named by the statute and self-funded ERISA plans are exempt. Select Health's own Policy #630 independently backs this up for the plans it does bind: access to both comprehensive and focused ABA "should not be restricted by age, cognitive level, diagnosis, or co-occurring conditions," unless a state mandate says otherwise. [8][11][7][10][4]
  - Ask the plan: A live benefits verification of the member's market segment (individual, small-group, large-group or self-funded) — the mandate's protections do not reach small-group or self-funded business.

## Delivery and billing rules

Coverage decides whether Select Health (Utah) 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**: For SelectHealth Community Care (Medicaid) members this is not a Select Health question: ABA is carved out of every Utah Medicaid ACO to state fee-for-service, so the Utah Medicaid rule governs — the QHP must supervise at least 10% of technician or assistant-analyst direct-service time, at least half of it direct supervision. For commercial members, Select Health Policy #630 sets its own floor: "Services should be supervised at a minimum of 5% of direct service hours and should be supervised at least monthly," with services delivered directly by or under the supervision of a licensed behavior analyst, BCBA, or licensed psychologist. The policy also authorizes additional billable QHP protocol-modification/direction time — 1 to 2 hours per 10 hours of treatment by protocol — based on functional-impairment severity. [9][12][10][4]
- **Daily limits / MUEs**: For SelectHealth Community Care (Medicaid) members this is not a Select Health question: ABA is carved out of every Utah Medicaid ACO to state fee-for-service, so the Utah Medicaid rule governs — limits are set per 26-week authorization period, not per day (97153 up to 780 hours; 97155 plus H0032 capped at 84 combined hours). On the commercial side the Utah mandate removed hour caps for individual and large-group plans entered or renewed since 1/1/2020 — the 600-hours-a-year floor survives only on legacy pre-2020 plans — but small-group and self-funded plans sit outside the statute. Select Health Policy #630 itself sets no hard unit cap but ties authorized hours to severity: a guide table bands weekly hours by how far maladaptive behavior, social communication, and self-care skills fall below the population mean — "None" (<1 SD) gets 0 hrs/week, "Mild" (>1 SD) 1–4 hrs/week, "Moderate" (>1.5 SD) 4–7 hrs/week, "Severe" (>2 SD) 7–10 hrs/week — plus a separate assessment-units guide (functional analysis 8–16 units, focused treatment 16–24 units, comprehensive treatment 32 units; 1 unit = 15 minutes). Authorization is reviewed for adjustment up or down at least every 6 consecutive months. [9][7][10][4]
- **Bill as provider**: For SelectHealth Community Care (Medicaid) members this is not a Select Health question: ABA is carved out of every Utah Medicaid ACO to state fee-for-service, so the Utah Medicaid rule governs — technicians and assistant analysts work under a QHP who is responsible for all work performed, with credential modifiers (HP, HO, HN) on supervision codes and group-size modifiers on group codes; enrolment runs through state PRISM, not Select Health. For commercial members, Policy #630 requires that "ABA services must be provided directly or supervised by licensed behavior analysts (in states with Behavior analyst licensure laws), board-certified behavior analysts, or licensed psychologists ... unless state mandates, plan documents or contracts require otherwise"; where an unlicensed or non-BACB-certified provider delivers the service under an allowed exception, that work must still carry direction and supervision "in line with practice standards." No separate claim-attribution/NPI rule beyond that is published. [9][12][10][4]
- **Place of service** _(plan-dependent)_: For SelectHealth Community Care (Medicaid) members this is not a Select Health question: ABA is carved out of every Utah Medicaid ACO to state fee-for-service, so the Utah Medicaid rule governs — home, community and clinic settings are payable across the same day, while school ASD services route to the School-Based Skills Development benefit and the January 2026 manual says Medicaid "shall not reimburse fee-for-service ABA services in school-based settings" beyond the analyst's part in the school care-plan meeting. For commercial members, Select Health's ABA Preauthorization Form collects a full weekly schedule by setting (office, home, other) plus school and other-therapy schedules and IEP/ISP/504/ARD status, which is how setting is actually adjudicated; Policy #630 adds only that "community-based treatments are optimized" with documented collaboration among stakeholders including school psychologists, without naming allowed POS codes. [9][5][10][4]
  - Ask the plan: Select Health UM (commercialUMintake@imail.org, 800-442-4566) — Policy #630 does not publish specific POS codes, so confirm with the plan directly.
- **Concurrent billing (97153 + 97155)** _(ask the plan)_: For SelectHealth Community Care (Medicaid) members this is not a Select Health question: ABA is carved out of every Utah Medicaid ACO to state fee-for-service, so the Utah Medicaid rule governs — 97155 contemplates the QHP simultaneously directing a technician with the member present, while a behavior analyst personally delivering 97153/97154 may not also bill analyst-level services. Select Health Policy #630 lists the full CPT set it covers (0362T, 0373T, 96202-96203, 97151-97158) and its own code descriptions mirror AMA language — "97155 ... may include simultaneous direction of technician" — but the policy states no explicit rule on billing 97153 and 97155 for overlapping clock time; this is now confirmed as a genuine gap in the retrieved policy, not a missing document. [9][12][10][4]
  - Ask the plan: Select Health UM (commercialUMintake@imail.org, 800-442-4566) — Policy #630 does not state a concurrent-billing rule, so this is plan-level claims-adjudication guidance, not a document gap.
- **Session-note signature** _(ask the plan)_: For SelectHealth Community Care (Medicaid) members this is not a Select Health question: ABA is carved out of every Utah Medicaid ACO to state fee-for-service, so the Utah Medicaid rule governs — the treatment plan must carry the name and signature of the QHP who conducted the assessment and developed it, with an attestation of medical necessity. Select Health Policy #630 requires the treatment plan to "identify all staff that will work with the member" and date services are scheduled to start, but — now directly confirmed — publishes no specific signature or co-signer rule of its own for commercial members. [9][12][10][4]
  - Ask the plan: Select Health UM (commercialUMintake@imail.org, 800-442-4566) — Policy #630 does not publish a signature standard, so confirm documentation requirements with the plan directly.

## What intake should collect for Select Health (Utah)

- **Community Care vs. commercial:** The single most important question — ask which product the family is on, or check whether the card says "Community Care" (Medicaid) vs. a standard employer/individual plan.
- **For Community Care members: route to Utah Medicaid:** ABA never touches Select Health for these members — collect the same documents our Utah Medicaid guide describes and submit through PRISM.
- **For commercial members: market segment:** Individual/large-group (mandate applies, no hour cap since 2020) vs. small-group/self-funded (mandate doesn't apply) — ask for the employer and check the card.
- **Diagnostic evaluation report (initial) or updated treatment plan (continuation):** Select Health's commercial ABA Preauthorization Form requires one or the other depending on request type.
- **Weekly ABA schedule + IEP/504 status:** The commercial preauth form asks for a full weekly schedule by setting and school-plan status — gather this before submitting.

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

## Verification of benefits (VOB) data

How Select Health (Utah) ABA benefits route and read on an eligibility check. Data last updated 2026-10-15.

### EDI routing

- **Payer ID (Availity):** SX107 (Availity Advanced) / HT006873-001 (Availity Basic, via UHIN) — SX107/HT006873-001 come from a WebSearch summary of Select Health's own Payer ID List PDF, corroborated by a second independent source (thepracticebridge.com), but neither was read directly from readable primary-document text this pass — treat as inferred, not verified. IMPORTANT: for a Community Care (Medicaid) member, do NOT use this ID for an ABA eligibility check — route to utah-medicaid's own entry (pVerify 01324) instead, since ABA is carved out to state FFS entirely and Select Health never adjudicates it for these members.
- **Supports 270/271 eligibility:** Yes
- **Behavioral health administrator:** For Community Care (Medicaid) members: none via Select Health — ABA is carved out entirely to Utah Medicaid FFS, identical to Utah's other three ACOs (see utah-medicaid above); Select Health does not administer or adjudicate ABA for these members at all. For commercial members: Select Health administers ABA in-house under its own Policy #630 — no third-party BH vendor named.
- **BH administrator payer ID:** N/A (Community Care) / unverified (commercial)
- **ABA rides on:** medical benefit
- **Two-hop verification required:** No

### How the 271 reports ABA benefits

- **ABA benefit bucket (service type code):** 30 — Utah Medicaid's own 270/271 companion guide (UT_PRISM_COMPANION_GUIDE, already cited in this guide's edi.medicaid271Notes) states plainly that Utah Medicaid "does not return eligibility at the procedure code level" and defaults to the generic STC "30" (Health Benefit Plan Coverage) bucket — ABA-specific cost-share detail is NOT surfaced on the wire; the FFS carve-out is applied from policy knowledge, not read off the 271.
- **271 response quality for ABA:** low — Seeded 'low': the companion guide's own default-to-STC-30, no-procedure-level-detail statement means a real 271 for an ABA member returns only generic plan-active/inactive information, not service-level financial detail.

### Code-level coverage

| Code | Covered | Prior auth | Unit cap | Place of service | Telehealth | Modifiers |
| --- | --- | --- | --- | --- | --- | --- |
| 96202 | Yes — commercial members only, under Select Health's own Policy #630 ("Applied Behavior Analysis (ABA)," last revised 1/1/2026). NOT applicable to Community Care (Medicaid) members — see utah-medicaid's codeGrid instead; ABA never touches Select Health for those members. | Required — Select Health's own ABA Preauthorization Form: an initial request needs a diagnostic evaluation report; a concurrent/continuation request needs an updated treatment plan with progress data. Decisions on Utah commercial plans are due within 14 days absent expedited review. | No hard unit cap — Policy #630 instead bands authorized hours by severity (SD below population mean): None <1SD = 0 hrs/wk, Mild >1SD = 1-4 hrs/wk, Moderate >1.5SD = 4-7 hrs/wk, Severe >2SD = 7-10 hrs/wk, plus 1-2 add'l QHP protocol-direction hours per 10 hrs of treatment. Separate assessment-units guide: functional analysis 8-16 units, focused 16-24 units, comprehensive 32 units (1 unit = 15 min). per Continuation/reauthorization reviewed at least every 6 consecutive months per Policy #630. | office, home, other (per the Preauthorization Form's weekly-schedule field — Policy #630 names no CMS POS numbers) | — | — |
| 96203 | Yes — commercial members only, under Select Health's own Policy #630 ("Applied Behavior Analysis (ABA)," last revised 1/1/2026). NOT applicable to Community Care (Medicaid) members — see utah-medicaid's codeGrid instead; ABA never touches Select Health for those members. | Required — Select Health's own ABA Preauthorization Form: an initial request needs a diagnostic evaluation report; a concurrent/continuation request needs an updated treatment plan with progress data. Decisions on Utah commercial plans are due within 14 days absent expedited review. | No hard unit cap — Policy #630 instead bands authorized hours by severity (SD below population mean): None <1SD = 0 hrs/wk, Mild >1SD = 1-4 hrs/wk, Moderate >1.5SD = 4-7 hrs/wk, Severe >2SD = 7-10 hrs/wk, plus 1-2 add'l QHP protocol-direction hours per 10 hrs of treatment. Separate assessment-units guide: functional analysis 8-16 units, focused 16-24 units, comprehensive 32 units (1 unit = 15 min). per Continuation/reauthorization reviewed at least every 6 consecutive months per Policy #630. | office, home, other (per the Preauthorization Form's weekly-schedule field — Policy #630 names no CMS POS numbers) | — | — |
| 97151 | Yes — commercial members only, under Select Health's own Policy #630 ("Applied Behavior Analysis (ABA)," last revised 1/1/2026). NOT applicable to Community Care (Medicaid) members — see utah-medicaid's codeGrid instead; ABA never touches Select Health for those members. | Required — Select Health's own ABA Preauthorization Form: an initial request needs a diagnostic evaluation report; a concurrent/continuation request needs an updated treatment plan with progress data. Decisions on Utah commercial plans are due within 14 days absent expedited review. | No hard unit cap — Policy #630 instead bands authorized hours by severity (SD below population mean): None <1SD = 0 hrs/wk, Mild >1SD = 1-4 hrs/wk, Moderate >1.5SD = 4-7 hrs/wk, Severe >2SD = 7-10 hrs/wk, plus 1-2 add'l QHP protocol-direction hours per 10 hrs of treatment. Separate assessment-units guide: functional analysis 8-16 units, focused 16-24 units, comprehensive 32 units (1 unit = 15 min). per Continuation/reauthorization reviewed at least every 6 consecutive months per Policy #630. | office, home, other (per the Preauthorization Form's weekly-schedule field — Policy #630 names no CMS POS numbers) | — | — |
| 97152 | Yes — commercial members only, under Select Health's own Policy #630 ("Applied Behavior Analysis (ABA)," last revised 1/1/2026). NOT applicable to Community Care (Medicaid) members — see utah-medicaid's codeGrid instead; ABA never touches Select Health for those members. | Required — Select Health's own ABA Preauthorization Form: an initial request needs a diagnostic evaluation report; a concurrent/continuation request needs an updated treatment plan with progress data. Decisions on Utah commercial plans are due within 14 days absent expedited review. | No hard unit cap — Policy #630 instead bands authorized hours by severity (SD below population mean): None <1SD = 0 hrs/wk, Mild >1SD = 1-4 hrs/wk, Moderate >1.5SD = 4-7 hrs/wk, Severe >2SD = 7-10 hrs/wk, plus 1-2 add'l QHP protocol-direction hours per 10 hrs of treatment. Separate assessment-units guide: functional analysis 8-16 units, focused 16-24 units, comprehensive 32 units (1 unit = 15 min). per Continuation/reauthorization reviewed at least every 6 consecutive months per Policy #630. | office, home, other (per the Preauthorization Form's weekly-schedule field — Policy #630 names no CMS POS numbers) | — | — |
| 97153 | Yes — commercial members only, under Select Health's own Policy #630 ("Applied Behavior Analysis (ABA)," last revised 1/1/2026). NOT applicable to Community Care (Medicaid) members — see utah-medicaid's codeGrid instead; ABA never touches Select Health for those members. | Required — Select Health's own ABA Preauthorization Form: an initial request needs a diagnostic evaluation report; a concurrent/continuation request needs an updated treatment plan with progress data. Decisions on Utah commercial plans are due within 14 days absent expedited review. | No hard unit cap — Policy #630 instead bands authorized hours by severity (SD below population mean): None <1SD = 0 hrs/wk, Mild >1SD = 1-4 hrs/wk, Moderate >1.5SD = 4-7 hrs/wk, Severe >2SD = 7-10 hrs/wk, plus 1-2 add'l QHP protocol-direction hours per 10 hrs of treatment. Separate assessment-units guide: functional analysis 8-16 units, focused 16-24 units, comprehensive 32 units (1 unit = 15 min). per Continuation/reauthorization reviewed at least every 6 consecutive months per Policy #630. | office, home, other (per the Preauthorization Form's weekly-schedule field — Policy #630 names no CMS POS numbers) | — | — |
| 97154 | Yes — commercial members only, under Select Health's own Policy #630 ("Applied Behavior Analysis (ABA)," last revised 1/1/2026). NOT applicable to Community Care (Medicaid) members — see utah-medicaid's codeGrid instead; ABA never touches Select Health for those members. | Required — Select Health's own ABA Preauthorization Form: an initial request needs a diagnostic evaluation report; a concurrent/continuation request needs an updated treatment plan with progress data. Decisions on Utah commercial plans are due within 14 days absent expedited review. | No hard unit cap — Policy #630 instead bands authorized hours by severity (SD below population mean): None <1SD = 0 hrs/wk, Mild >1SD = 1-4 hrs/wk, Moderate >1.5SD = 4-7 hrs/wk, Severe >2SD = 7-10 hrs/wk, plus 1-2 add'l QHP protocol-direction hours per 10 hrs of treatment. Separate assessment-units guide: functional analysis 8-16 units, focused 16-24 units, comprehensive 32 units (1 unit = 15 min). per Continuation/reauthorization reviewed at least every 6 consecutive months per Policy #630. | office, home, other (per the Preauthorization Form's weekly-schedule field — Policy #630 names no CMS POS numbers) | — | — |
| 97155 | Yes — commercial members only, under Select Health's own Policy #630 ("Applied Behavior Analysis (ABA)," last revised 1/1/2026). NOT applicable to Community Care (Medicaid) members — see utah-medicaid's codeGrid instead; ABA never touches Select Health for those members. | Required — Select Health's own ABA Preauthorization Form: an initial request needs a diagnostic evaluation report; a concurrent/continuation request needs an updated treatment plan with progress data. Decisions on Utah commercial plans are due within 14 days absent expedited review. | No hard unit cap — Policy #630 instead bands authorized hours by severity (SD below population mean): None <1SD = 0 hrs/wk, Mild >1SD = 1-4 hrs/wk, Moderate >1.5SD = 4-7 hrs/wk, Severe >2SD = 7-10 hrs/wk, plus 1-2 add'l QHP protocol-direction hours per 10 hrs of treatment. Separate assessment-units guide: functional analysis 8-16 units, focused 16-24 units, comprehensive 32 units (1 unit = 15 min). per Continuation/reauthorization reviewed at least every 6 consecutive months per Policy #630. | office, home, other (per the Preauthorization Form's weekly-schedule field — Policy #630 names no CMS POS numbers) | — | — |
| 97156 | Yes — commercial members only, under Select Health's own Policy #630 ("Applied Behavior Analysis (ABA)," last revised 1/1/2026). NOT applicable to Community Care (Medicaid) members — see utah-medicaid's codeGrid instead; ABA never touches Select Health for those members. | Required — Select Health's own ABA Preauthorization Form: an initial request needs a diagnostic evaluation report; a concurrent/continuation request needs an updated treatment plan with progress data. Decisions on Utah commercial plans are due within 14 days absent expedited review. | No hard unit cap — Policy #630 instead bands authorized hours by severity (SD below population mean): None <1SD = 0 hrs/wk, Mild >1SD = 1-4 hrs/wk, Moderate >1.5SD = 4-7 hrs/wk, Severe >2SD = 7-10 hrs/wk, plus 1-2 add'l QHP protocol-direction hours per 10 hrs of treatment. Separate assessment-units guide: functional analysis 8-16 units, focused 16-24 units, comprehensive 32 units (1 unit = 15 min). per Continuation/reauthorization reviewed at least every 6 consecutive months per Policy #630. | office, home, other (per the Preauthorization Form's weekly-schedule field — Policy #630 names no CMS POS numbers) | — | — |
| 97157 | Yes — commercial members only, under Select Health's own Policy #630 ("Applied Behavior Analysis (ABA)," last revised 1/1/2026). NOT applicable to Community Care (Medicaid) members — see utah-medicaid's codeGrid instead; ABA never touches Select Health for those members. | Required — Select Health's own ABA Preauthorization Form: an initial request needs a diagnostic evaluation report; a concurrent/continuation request needs an updated treatment plan with progress data. Decisions on Utah commercial plans are due within 14 days absent expedited review. | No hard unit cap — Policy #630 instead bands authorized hours by severity (SD below population mean): None <1SD = 0 hrs/wk, Mild >1SD = 1-4 hrs/wk, Moderate >1.5SD = 4-7 hrs/wk, Severe >2SD = 7-10 hrs/wk, plus 1-2 add'l QHP protocol-direction hours per 10 hrs of treatment. Separate assessment-units guide: functional analysis 8-16 units, focused 16-24 units, comprehensive 32 units (1 unit = 15 min). per Continuation/reauthorization reviewed at least every 6 consecutive months per Policy #630. | office, home, other (per the Preauthorization Form's weekly-schedule field — Policy #630 names no CMS POS numbers) | — | — |
| 97158 | Yes — commercial members only, under Select Health's own Policy #630 ("Applied Behavior Analysis (ABA)," last revised 1/1/2026). NOT applicable to Community Care (Medicaid) members — see utah-medicaid's codeGrid instead; ABA never touches Select Health for those members. | Required — Select Health's own ABA Preauthorization Form: an initial request needs a diagnostic evaluation report; a concurrent/continuation request needs an updated treatment plan with progress data. Decisions on Utah commercial plans are due within 14 days absent expedited review. | No hard unit cap — Policy #630 instead bands authorized hours by severity (SD below population mean): None <1SD = 0 hrs/wk, Mild >1SD = 1-4 hrs/wk, Moderate >1.5SD = 4-7 hrs/wk, Severe >2SD = 7-10 hrs/wk, plus 1-2 add'l QHP protocol-direction hours per 10 hrs of treatment. Separate assessment-units guide: functional analysis 8-16 units, focused 16-24 units, comprehensive 32 units (1 unit = 15 min). per Continuation/reauthorization reviewed at least every 6 consecutive months per Policy #630. | office, home, other (per the Preauthorization Form's weekly-schedule field — Policy #630 names no CMS POS numbers) | — | — |
| 0362T | Yes — commercial members only, under Select Health's own Policy #630 ("Applied Behavior Analysis (ABA)," last revised 1/1/2026). NOT applicable to Community Care (Medicaid) members — see utah-medicaid's codeGrid instead; ABA never touches Select Health for those members. | Required — Select Health's own ABA Preauthorization Form: an initial request needs a diagnostic evaluation report; a concurrent/continuation request needs an updated treatment plan with progress data. Decisions on Utah commercial plans are due within 14 days absent expedited review. | No hard unit cap — Policy #630 instead bands authorized hours by severity (SD below population mean): None <1SD = 0 hrs/wk, Mild >1SD = 1-4 hrs/wk, Moderate >1.5SD = 4-7 hrs/wk, Severe >2SD = 7-10 hrs/wk, plus 1-2 add'l QHP protocol-direction hours per 10 hrs of treatment. Separate assessment-units guide: functional analysis 8-16 units, focused 16-24 units, comprehensive 32 units (1 unit = 15 min). per Continuation/reauthorization reviewed at least every 6 consecutive months per Policy #630. | office, home, other (per the Preauthorization Form's weekly-schedule field — Policy #630 names no CMS POS numbers) | — | — |
| 0373T | Yes — commercial members only, under Select Health's own Policy #630 ("Applied Behavior Analysis (ABA)," last revised 1/1/2026). NOT applicable to Community Care (Medicaid) members — see utah-medicaid's codeGrid instead; ABA never touches Select Health for those members. | Required — Select Health's own ABA Preauthorization Form: an initial request needs a diagnostic evaluation report; a concurrent/continuation request needs an updated treatment plan with progress data. Decisions on Utah commercial plans are due within 14 days absent expedited review. | No hard unit cap — Policy #630 instead bands authorized hours by severity (SD below population mean): None <1SD = 0 hrs/wk, Mild >1SD = 1-4 hrs/wk, Moderate >1.5SD = 4-7 hrs/wk, Severe >2SD = 7-10 hrs/wk, plus 1-2 add'l QHP protocol-direction hours per 10 hrs of treatment. Separate assessment-units guide: functional analysis 8-16 units, focused 16-24 units, comprehensive 32 units (1 unit = 15 min). per Continuation/reauthorization reviewed at least every 6 consecutive months per Policy #630. | office, home, other (per the Preauthorization Form's weekly-schedule field — Policy #630 names no CMS POS numbers) | — | — |

Code notes:

- **96202, 96203, 97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, 0362T, 0373T:** Policy #630 (read directly, accessed 10/1/2026): ABA must be delivered directly by or supervised by a licensed behavior analyst, BCBA, or licensed psychologist (min. 5% of direct service hours, at least monthly) unless state mandates/plan/contract differ; ASD dx per Utah's own statutory definition (board-certified neurologist/psychiatrist/pediatrician with ASD experience, or an experienced licensed psychologist); ABA for non-ASD diagnoses is experimental/investigational. Verify via: Select Health commercial UM intake (commercialUMintake@imail.org, fax 801-442-0825) for POS codes, modifiers, and telehealth, none of which the policy itself specifies. The Utah Code 31A-22-642 mandate layer (individual + large group only — NOT small group) governs limits for qualifying plans, not coding mechanics.

### Contacts

- **Benefits by phone:** Yes
- **Provider services phone:** 800-222-6358 (general commercial provider support) / 800-442-4566 (24/7 preauthorization help desk)
- **Portal:** [Select Health Preauth & Care Plan Tool](https://selecthealth.org/providers/preauthorization/forms-reports)
- **Fax:** 801-442-0825 (commercial UM intake); Community Care (non-ABA services) 801-442-0625

Questions to ask on a verification call:

- Confirm which product this family is on — SelectHealth Community Care (Medicaid, routes ABA to Utah Medicaid FFS entirely) vs. Select Health commercial (Policy #630, its own PA process) — since the two have completely different ABA workflows.
- For commercial members: what POS codes and billing modifiers apply — Policy #630 (now read directly) gives severity-based hour bands and a 6-month review cycle but names no CMS POS numbers or modifier table.
- For commercial members: what market segment is this plan (individual/large-group vs. small-group/self-funded), since only the first two are protected by the Utah Code 31A-22-642 mandate?
- Is telehealth allowed for any ABA codes under the commercial Policy #630? The policy itself states no telehealth-specific rule — confirm directly with UM.
- What EDI payer ID should be used for a commercial member's 270/271 eligibility check — SX107 or HT006873-001 — neither was independently confirmed against readable primary-source text this pass?

### VOB data sources

- https://selecthealth.org/content/dam/selecthealth/Provider/PDFs/programs/government/medicaid-provider-summary.pdf (accessed 2026-07-23)
- https://selecthealth.org/content/dam/selecthealth/Provider/PDFs/Reference%20Manuals/prm-comm-govt.pdf (accessed 2026-07-23)
- https://www.selecthealth.org/content/dam/selecthealth/Provider/PDFs/claims/payer-id-list.pdf (accessed 2026-07-23; source document older than 18 months)
- 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.caqh.org/sites/default/files/CAQH%20CORE%20Eligibility%20Benefits%20(270_271)%20Data%20Content%20Rule%20vEB2.0.pdf (accessed 2026-07-23)
- https://medicaid-documents.dhhs.utah.gov/Documents/pdfs/EE-Health%20Care%20Eligibility%20Benefit%20Inquiry%20and%20Response%20Companion%20(270,%20271)%20SFY25.pdf (accessed 2026-07-23)
- https://selecthealth.org/content/dam/selecthealth/Archive%20PDFs/medical-policies/beh-policies.pdf (accessed 2026-07-23)
- https://selecthealth.org/content/dam/selecthealth/Provider/PDFs/forms/sh-aba-pre-auth-form.pdf (accessed 2026-07-23)
- https://le.utah.gov/xcode/Title31A/Chapter22/C31A-22-S642_2026050620260506.html (accessed 2026-07-23)
- https://selecthealth.org/providers/preauthorization/forms-reports (accessed 2026-07-23)
- https://selecthealth.org/providers/join-our-networks/new-provider-resources (accessed 2026-10-14)

## Common questions

### Does Select Health cover ABA therapy in Utah?

Depends which Select Health. SelectHealth Community Care (the Medicaid ACO) never administers ABA — it rides Utah Medicaid's fee-for-service carve-out. Select Health commercial (employer/individual) plans cover ABA under the plan's own Policy #630, with prior authorization required.

### My client has "Select Health Community Care" — where does the ABA request go?

To Utah Medicaid directly, not to Select Health. ABA is carved out of all four Utah Medicaid ACOs (including SelectHealth Community Care) to state fee-for-service — see our Utah Medicaid guide.

### How do I submit an ABA prior authorization to Select Health commercial?

Select Health's ABA Preauthorization Form, emailed to commercialUMintake@imail.org (fax 801-442-0825 as backup). Decisions on Utah commercial plans are due within 14 days.

### Does Select Health require RBT certification for ABA technicians?

Depends on the product. Community Care (Medicaid) ABA follows Utah Medicaid, which requires technicians to be fully certified (RBT, QABA or BICC) before serving any member. For commercial members, Policy #630 requires ABA to be delivered or supervised by a licensed behavior analyst, BCBA or licensed psychologist and, where unlicensed or non-certified staff are allowed, supervision in line with practice standards (at least 5% of direct hours, monthly); it names no RBT requirement.

### What does Select Health pay for ABA?

No published fee schedule exists for either product. Community Care members' ABA is paid at Utah Medicaid's own PRISM rates (not a Select Health rate); commercial rates are negotiated in your participating-provider agreement.

### What is Select Health’s timely filing limit?

Twelve months from the date of service (Select Health provider reference manual).

## Primary sources

1. [Select Health — Medicaid Provider Summary](https://selecthealth.org/content/dam/selecthealth/Provider/PDFs/programs/government/medicaid-provider-summary.pdf)
2. [Select Health — Provider Reference Manual (Commercial & Government)](https://selecthealth.org/content/dam/selecthealth/Provider/PDFs/Reference%20Manuals/prm-comm-govt.pdf)
3. [Select Health — Medicaid Member Handbook](https://selecthealth.org/content/dam/selecthealth/Medicaid/PDFs/medicaid-handbook.pdf)
4. [Select Health Medical Policy #630 — Applied Behavior Analysis (rev. 1/1/26; accessed 10/1/2026)](https://selecthealth.org/content/dam/selecthealth/Archive%20PDFs/medical-policies/beh-policies.pdf)
5. [Select Health — ABA Preauthorization Form (2026)](https://selecthealth.org/content/dam/selecthealth/Provider/PDFs/forms/sh-aba-pre-auth-form.pdf)
6. [Select Health — Preauthorization Forms & Reports](https://selecthealth.org/providers/preauthorization/forms-reports)
7. [Utah Code § 31A-22-642 (current, eff. 5/6/2026)](https://le.utah.gov/xcode/Title31A/Chapter22/C31A-22-S642_2026050620260506.html)
8. [PRISM Coverage and Reimbursement Lookup (rates & PA flags)](https://health.utah.gov/stplan/lookup/CoverageLookup.php)
9. [Utah Medicaid Provider Manual — Autism Spectrum Disorder Services (updated January 2026)](https://medicaid-documents.dhhs.utah.gov/Documents/manuals/pdfs/Medicaid%20Provider%20Manuals/Autism%20Spectrum%20Disorder%20Services/AutismSpectrumDisorder.pdf)
10. [Utah Medicaid Provider Manual — Section I: General Information, ch. 2-6 MCE Carve-Out Services (updated September 2026)](https://medicaid-documents.dhhs.utah.gov/Documents/manuals/pdfs/Medicaid+Provider+Manuals/All+Providers+General+Information+Section+I/AllProvidersGeneralInfo_Section_1.pdf)
11. [ASD Related Services program page](https://medicaid.utah.gov/ltc-2/asd/)
12. [Utah Medicaid Provider Manual — ASD Services (July 2023 edition, archived)](https://web.archive.org/web/20240821082018/https://medicaid.utah.gov/Documents/manuals/pdfs/Medicaid%20Provider%20Manuals/Autism%20Spectrum%20Disorder%20Services/AutismSpectrumDisorder7-23.pdf)
13. [Select Health — Provider News Digest (index of provider news)](https://selecthealth.org/providers/publication-resources/provider-news-digest)
14. [Utah Admin. Code R590-261-4 — Adverse Benefit Determination Procedure Compliance (Cornell LII mirror; rules.utah.gov blocked)](https://www.law.cornell.edu/regulations/utah/Utah-Admin-Code-R590-261-4)
15. [29 CFR 2560.503-1(f)(2) — Group health plan claim decision timeframes (eCFR)](https://www.ecfr.gov/current/title-29/section-2560.503-1)
16. [Utah Code 31A-22-650 — Health care preauthorization requirements (version effective 1/1/2027)](https://le.utah.gov/xcode/Title31A/Chapter22/C31A-22-S650_2026050620270101.html)
17. [Utah Admin. Code R590-131-6 — Determining Order of Benefits (Cornell LII mirror)](https://www.law.cornell.edu/regulations/utah/Utah-Admin-Code-R590-131-6)

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.