For an intake team in Arkansas, a UnitedHealthcare card means three layers: Optum Behavioral Health’s national ABA criteria, Arkansas’s autism mandate and prior-authorization law, and the plan’s funding type. Optum’s ABA State Mandates supplement (July 2026) does not list Arkansas, so no Arkansas-specific Optum criteria apply. UnitedHealthcare is not an Arkansas PASSE.
UnitedHealthcare administers ABA through Optum Behavioral Health under the ABA Supplemental Clinical Criteria (BH803ABASCC; interim review April 2026), which require prior authorization “unless otherwise specified or mandated by contract or law,” direct case supervision of 1–2 hours per 10 hours of treatment, and an explanation when use falls below 80% of authorized hours. Optum’s State Mandates supplement lists Arizona, California, Connecticut, Florida, Massachusetts, New Jersey and others, not Arkansas. Arkansas’s Act 575 gold-card exemption can still remove prior authorization for a provider on a fully insured plan.[1][2][8]
Arkansas’s autism mandate is Ark. Code § 23-99-418, created by Act 196 of 2011 (HB 1315) for health benefit plans delivered, issued or renewed on or after October 1, 2011. As enacted, it reaches group and blanket plans, HMOs and hospital and medical service corporations, and the state and public school employee plans, but not individual major medical plans. Mandated “treatment” is care “prescribed, provided, or ordered for a specfic individual diagnosed with an autism spectrum disorder by a licensed physician or a licensed psychologist who determines the care to be medically necessary and evidence-based,” including “Applied behavior analysis when provided by or supervised by a Board Certified Behavior Analyst,” plus pharmacy, psychiatric, psychological and speech, occupational and physical therapy care. The enacted text says ABA services “shall: (1) Have an annual limitation of fifty thousand dollars ($50,000); and (2) Be limited to children under eighteen (18) years of age.” Coverage may not carry visit limits or less favorable dollar limits, deductibles or coinsurance than physical illness, “shall not be denied on the basis that the treatment is habilitative in nature,” and an insurer may not review the medical necessity of ongoing autism treatment “to a greater extent than it does for other illnesses.” It does not displace IEP or IFSP obligations, and from 2014 exchange plans are excused from benefits beyond the essential health benefits. Those age and dollar terms have since moved in practice: Arkansas Blue Cross’s current ABA policy applies the $50,000 cap only to “Grandfathered” plans and quotes the Arkansas Insurance Department that it “will not allow age limits for any service for the treatment of autism.” We could not open the current codified text of § 23-99-418, so confirm the plan’s own terms. Self-funded ERISA plans sit outside the statute.[6][11]
Arkansas regulates behavior analysts by registration, not licensure, and only since 2025. Act 432 of 2025 (the Arkansas Behavior Analyst Registration Act, Ark. Code § 17-97-601 et seq.) has the Arkansas Psychology Board register a “registered behavior analyst” on proof of BCBA or BCBA-D certification and a criminal background check, for two years at a time. The Act protects the title: unless registered, a person may not hold themselves out as a registered behavior analyst. It does not make practice itself unlawful without registration. It also offers temporary registration to a behavior analyst licensed elsewhere, or BACB-certified, who practices in Arkansas “on a short-term basis,” and reciprocity for analysts licensed in comparable states. The BACB’s licensure table lists Arkansas (2025, AR Psychology Board). Payers credential on BACB certification: the mandate itself keys ABA to a Board Certified Behavior Analyst. Commercial ABA rates are negotiated and unpublished; the public benchmark is the Arkansas Medicaid fee schedule (97151 $20.00, 97153 $15.00, 97155 $22.50, 97156 $20.00 per 15-minute unit).[9][10][6][12]
UnitedHealthcare publishes no ABA rate table; Optum pays from the contract. Its National Network Manual (effective Sept. 1, 2026) defines the “Fee Maximum” as the most a participating provider may be paid for a service and says “Reimbursement to clinicians is based upon licensure rather than degree.” Optum’s commercial ABA Reimbursement Policy (2022RP501A, updated June 2026) puts a credential modifier on every line: HM for an RBT, HN for a BCaBA, HO for a master’s-level BCBA, HP for a doctoral-level provider; indirect work is bundled into direct codes. For a public benchmark, Arkansas Medicaid pays 97153 at $15.00 per 15 minutes.[5][4][12]
Billing details from Optum’s own documents. Codes: the commercial ABA reimbursement policy (2022RP501A) covers ABA billed "with CPT codes 97151-97158" plus 0362T and 0373T, each line with its credential modifier; it lists no HCPCS H-code. Telehealth: claims "must include either POS 02 or POS 10" (10 when the member is at home), and "Optum will not reimburse for services billed with only telehealth modifiers"; modifiers 93, 95, FQ, GT and GQ are optional, and commercial ABA telehealth covers only 97155, 97156 and 97157. Filing: claims are due "no more than 90 calendar days from the date of service, or as allowed by state or federal law or the member’s specific benefit plan," and "Any corrections or additions to a claim should be made within 90 days of initial claim receipt." Payment: clean claims with any required authorization are generally paid within 45 calendar days of receipt or as state and federal law requires, which may exclude claims needing a coordination-of-benefits determination. Reauthorization (Supplemental Clinical Criteria): each continued-service review needs progress for every target "including the same modes of measurement that were utilized for baseline," with "rate and percentage of mastered programs, rates of mastered targets, change scores for any outcome measures, updated standardized adaptive measures"; inadequate progress over a 6-month period requires an analysis and modified interventions. Graphs are not named. Supervision: "direct case supervision is required 1–2 hours for every 10 hours of direct treatment per week," with no published cap on technicians per BCBA.[4][3][5][1]
The questions that decide whether a family can start with UnitedHealthcare / Optum in Arkansas, and what they have to bring. Each maps onto something intake should ask on the first call.
No expiry on the diagnosis; it must be confirmed with severity level using validated tools, and use below 80% of authorized hours triggers review.[1]
A state-licensed physician, psychologist or other state-licensed clinician qualified to diagnose under DSM-5-TR.[1]
At least one validated tool from a non-exhaustive list: screens (M-CHAT, CARS/CARS-2, RITA-T, STAT) and formal diagnostic tools (ADI-R, ADOS/ADOS-2, DISCO).[1]
No separate physician referral; the criteria require prior authorization. Optum publishes no ABA order form or validity period. On the claim, Optum’s National Network Manual (effective Sept. 1, 2026) lists the Form 1500 fields it needs (member and subscriber, diagnosis, dates and length of session, and the clinician who actually provided the service with credentials, Tax ID and NPI) and does not ask for a referring provider in box 17. For a fully insured Arkansas plan, § 23-99-418 (as enacted) defines mandated treatment as care “prescribed, provided, or ordered” by a licensed physician or licensed psychologist who finds it medically necessary and evidence-based, so keep that prescription on file.[1][6][5]
Optum’s Telehealth Billing guide (updated September 2025) says for commercial plans: “For ABA services, telehealth is only allowed for these 3 CPT codes: 97155, 97156 or 97157.” Claims must use POS 02 or POS 10; telehealth modifiers alone are not paid. The criteria add that telehealth is “not intended to supplant” in-person service. Optum’s guide makes modifiers 93, 95, FQ, GT and GQ optional; the POS is what marks the claim as telehealth, and the authorization does not need a telehealth flag in any Optum document read.[3][1]
The criteria carry no age limit; the member’s benefit plan governs. For fully insured Arkansas plans, § 23-99-418 as enacted in 2011 limited mandated ABA to children under 18 with a $50,000 annual cap; Arkansas Blue Cross’s current policy says the Arkansas Insurance Department “will not allow age limits for any service for the treatment of autism” and applies the $50,000 cap only to grandfathered plans. Self-funded ERISA plans are outside the statute.[1][6][11]
Ask the plan: Provider Express benefits check or the behavioral health number on the card: establish fully insured vs. self-funded first.
Fully insured Arkansas plans, plus risk-based provider organizations and nonfederal self-funded governmental plans (Act 575 of 2023), fall under the Prior Authorization Transparency Act. As enacted in Act 1106 of 2015, a nonurgent prior-authorization decision is due “within two (2) business days of obtaining all necessary information,” and an urgent one “no later than one (1) business day after receiving all information needed.” Act 575 adds that an adverse determination must be made by a physician with an unrestricted Arkansas license, that the provider may discuss the denial with that physician within one business day (urgent) or two business days (nonurgent) of receiving it, and that an insurer that approved at least 90% of a provider’s requests for a service in a six-month evaluation period may not require prior authorization of that provider for that service. Self-funded ERISA plans follow 29 CFR 2560.503-1 instead: pre-service decisions “not later than 15 days after receipt of the claim,” one 15-day extension, urgent care within 72 hours. Optum publishes no Arkansas-specific ABA turnaround.[7][8][13]
Ask the plan: At benefits verification ask whether the plan is fully insured (Arkansas-regulated) or self-funded ERISA, and what reauthorization lead time Optum expects.
Optum publishes no Arkansas-specific ABA coordination rule. If the child also has Arkansas Medicaid (fee-for-service or a PASSE), this plan pays first: Medicaid pays only the difference up to its maximum and “will not make any payment if the amount received from the third party insurance is equal to or greater than the Medicaid allowable rate” (Section I § 131.000; 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). We did not verify Arkansas’s rule for ordering two parents’ group plans, so get the order from the plan.[14][15][16][17]
Ask the plan: Ask UnitedHealthcare/Optum at benefits verification for the member’s coordination-of-benefits order and record every other coverage the child has.
Coverage decides whether UnitedHealthcare / Optum in Arkansas 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.
Consistent with CASP standards, “direct case supervision is required 1–2 hours for every 10 hours of direct treatment per week.” Technicians should be RBTs or otherwise appropriately certified; Optum does not recommend parents serving as their own child’s RBT. Optum’s criteria publish no cap on the number of technicians per BCBA.[1]
Yes, with limits: 97153 or 97154 may be reported with 97155 concurrently “as long as the criteria in the descriptors of both codes are met,” but “A single QHP may not report 97153 or 97154 with 97155 concurrently.” Optum’s ABA documents do not address ABA at the same time as speech, occupational or physical therapy; its ABA FAQ expects the ABA provider to know "the other therapies in which the child is involved, how often those therapies occur" and their goals, and to document that coordination.[4][18]
Optum’s commercial ABA reimbursement policy (2022RP501A, updated June 2026) sets a maximum per day for each code: 97151 32 units (8 hours), 97152 16, 97153 32 (8 hours), 97154 18, 97155 24 (6 hours), 97156 16, 97157 16, 97158 16, 0362T 16 and 0373T 32; "If a provider bills in excess of 32 units per day, claims may be subject to non-reimbursement or recovery," and commercial claims are subject to CMS medically unlikely edits. There is no weekly unit cap: requested hours must be justified at the least restrictive appropriate level, and use below 80% of authorized hours must be explained at continued-service review.[1][4]
ABA is provided at the least restrictive, most clinically appropriate level. Not covered: services that are not ABA, “such as 1:1 aid delivered simultaneously during classroom instruction,” or services covered under IDEA; school coordination is allowed.[1]
Every line carries the rendering credential: HM (RBT), HN (BCaBA), HO (master’s-level BCBA or licensed clinician), HP (doctoral level). The policy notes that state regulatory requirements “may supplement, modify or supersede” it.[4]
Not addressed. The criteria set what must be documented for coverage, not who signs a session note or when.[1]
Ask the plan: Optum National Network Manual (documentation standards) and the participating-provider agreement.
No. Optum’s commercial ABA policy uses CPT 97151–97158, 0362T and 0373T with credential modifiers.
The criteria ask for progress measured the same way as baseline, mastery rates, change scores and updated standardized adaptive measures; graphs are not named.
Optum: 90 calendar days from the date of service unless state law or the plan allows longer, with corrections within 90 days of the first claim’s receipt.
Yes, under Optum’s national ABA criteria for ASD, with Arkansas’s § 23-99-418 mandate for fully insured group plans.
No. Optum’s July 2026 ABA State Mandates supplement does not list Arkansas.
Only 97155, 97156 and 97157 on commercial plans, billed POS 02 or 10. The 97151 assessment and 97153 are not on Optum’s list.
The HM modifier’s approved rendering provider is a Registered Behavior Technician, and the criteria expect technicians to be RBTs or otherwise appropriately certified.
Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed October 2026; it is general information, not billing, legal, or clinical advice. Always verify current requirements against the payer's live policy and a benefits check for the specific member.
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