---
title: "UnitedHealthcare ABA coverage in California: the intake guide."
url: "https://carelu.com/payers/unitedhealthcare-california"
markdown_url: "https://carelu.com/payers/unitedhealthcare-california.md"
state: CA (California)
payer: UnitedHealthcare in California
kind: Commercial insurance
description: "How UnitedHealthcare covers ABA for California families through Optum Behavioral Health — the CASP guidelines posted as California commercial ABA criteria, Optum’s California state-mandate entry (no IEP or Medicaid offsets, associate-level QAS professionals), phone-based treatment requests, concurrent 97153/97155 billing, and the H&S § 1374.73 mandate."
last_reviewed: October 2026
---

# UnitedHealthcare ABA coverage in California: the intake guide.

_Payer Guide · UnitedHealthcare · California · Last updated October 2026 · 15 primary sources_

> Optum BH; CASP guidelines posted as CA commercial ABA criteria; State Mandates entry bars IEP/Medicaid offsets.

UnitedHealthcare commercial behavioral health — ABA included — is managed by Optum, and in California by U.S. Behavioral Health Plan, California, doing business as OptumHealth Behavioral Solutions of California, a DMHC-licensed specialty plan. California is one of the few states where Optum publishes its own ABA criteria: Provider Express lists "California Commercial – Applied Behavior Analysis" as the Council of Autism Service Providers (CASP) ABA Practice Guidelines, and Optum’s ABA State Mandates document carries a California entry that overrides parts of the national criteria. UnitedHealthcare runs no Medi-Cal plan in 2026.

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Required — "All services require prior approval"; assessments are requested online through Optum’s ABA assessment portal, and Optum’s criteria require PA for ABA "(unless otherwise specified or mandated by contract or law)" [6][2][8]
- **Prior auth for treatment**: Required — California providers request treatment by phone with the ABA clinical team (1-866-830-0325) or through Provider Express; "most treatment reviews are required every 4-6 months depending on the account/state law," with continued-care calls no more than 30 days before the current approval expires [6][8][7]
- **Autism diagnosis required?**: Yes — "A valid diagnosis of ASD (or other applicable diagnosis as required by governing laws)," DSM-5-TR, from a state-licensed clinician with severity confirmed on at least one validated tool; California’s mandate entry covers "pervasive developmental disorder or autism" [2][3]

## At a glance

- **Covers ABA?:** Yes — for ASD/PDD, via Optum Behavioral Health
- **State mandate:** Cal. Health & Safety Code § 1374.73 (DMHC plans) / Ins. Code § 10144.51 (CDI policies)
- **Mandate age:** No age limit in the statute
- **Mandate caps:** None — no annual, lifetime, dollar or visit cap; parity with medical benefits (§ 1374.72)
- **Exempt from mandate:** Self-funded ERISA plans; Medi-Cal plan contracts; specialized plans without mental health coverage; accident-only, specified-disease, hospital-indemnity and Medicare supplement policies
- **Licensure:** None — no California behavior analyst license; QAS provider/professional/paraprofessional tiers (B&P §§ 4999.200–4999.202)
- **California criteria:** CASP ABA Practice Guidelines (3rd ed.) posted as CA commercial ABA criteria + Optum’s CA State Mandates entry
- **Requests:** Assessment: online portal · Treatment: ABA clinical team 1-866-830-0325 or Provider Express
- **Fee schedule:** None published — paid at the contracted rate on your Optum fee schedule

## Optum’s California layer

Provider Express’s "State-Specific Clinical Criteria" — criteria "used to make medical necessity determinations … when there are explicit mandates or contractual requirements outside of the Criteria above" — list "California Commercial – Applied Behavior Analysis: The Council of Autism Service Providers (CASP) Applied Behavior Analysis Practice Guidelines for the Treatment of Autism Spectrum Disorder" (3rd ed., 2024). Separately, Optum’s national ABA criteria say California Commercial’s State Mandates entry applies "along with this set of criteria," and "To the extent this criteria conflicts with applicable state-mandated criteria, the state-mandated criteria controls." Optum’s documents do not say outright which set is the working test for a given member — ask at the first review. [5][4][3][2]

The California entry in Optum’s ABA State Mandates document (BH 803ABA STM72026, effective July 2026) says a plan "shall not limit benefits or coverage for medically necessary services on the basis that those services should be or could be covered by a public entitlement program, including, but not limited to, special education or an individualized education program, Medicaid," and that BHT "is administered by a qualified autism service professional to include a psychological associate, an associate marriage and family therapist, an associate clinical social worker, or an associate professional clinical counselor." For California commercial members that overrides the national exclusion of IDEA-covered services — a school IEP alone is not a reason to deny. CASP’s guidelines add that intensity decisions "should not be based on the length of time receiving treatment and/or the age of the individual," and "Evidence of failure at a lower level of service intensity should not be required to access a higher intensity of care." [5][4][3][2]

## The California mandate: what it guarantees (and doesn’t)

California’s mandate is Health & Safety Code § 1374.73 for DMHC-regulated health care service plans (every HMO and many PPO/EPO products) and Insurance Code § 10144.51, its word-for-word twin for CDI-regulated insurance policies. Enacted by SB 946 in 2011 with a sunset, made permanent by AB 796 in 2016 and last amended by SB 402 (effective January 1, 2026), it requires every plan covering hospital, medical or surgical care to cover "behavioral health treatment for pervasive developmental disorder or autism" — defined to include "applied behavior analysis and evidence-based behavior intervention programs" — "in the same manner and … subject to the same requirements" as mental health parity under § 1374.72. The statute has no age limit and no dollar or visit cap. Treatment must be "prescribed by a physician and surgeon" or "developed by a psychologist," follow a treatment plan with measurable goals "reviewed no less than once every six months" by the qualified autism service provider, and may not be used for "respite, daycare, or educational services." Plans may still use "case management, network providers, utilization review techniques, prior authorization, copayments, or other cost sharing." [10][11][16][17][18][19]

Three newer layers matter at intake. SB 855 (§§ 1374.72, 1374.721; Ins. §§ 10144.5, 10144.52) requires medical-necessity decisions under "generally accepted standards," using the criteria of "the nonprofit professional association for the relevant clinical specialty," supplied "at no cost" — and bars limiting coverage because services "should be or could be covered by a public entitlement program, including … special education or an individualized education program, Medicaid." SB 402 (carrying AB 951) says a contract issued, amended or renewed on or after January 1, 2026 "shall not require an enrollee previously diagnosed with pervasive developmental disorder or autism to receive a rediagnosis to maintain coverage" and "shall not discontinue or delay existing treatment while waiting for a rediagnosis." And every plan must keep "an adequate network" of qualified autism service providers. Exempt: self-funded ERISA employer plans (outside state law — the California-specific Optum criteria likely do not reach them), Medi-Cal plan contracts, specialized plans that do not deliver mental health services, and — for CDI policies — accident-only, specified-disease, hospital-indemnity and Medicare supplement policies. [10][11][16][17][18][19]

## Licensure & rates in California

California has no behavior analyst license — it is absent from the BACB’s licensure table, and SB 402’s new Business & Professions Code chapter (§§ 4999.200–4999.202) is definitional only. A qualified autism service (QAS) provider is a BCBA ("certified by a national entity, such as the Behavior Analyst Certification Board") or a listed California licensee; a QAS professional (BCaBA-level behavior service providers under 17 CCR § 54342, or — since SB 805 — associate MFTs, ACSWs, APCCs and psychological associates) works under the provider’s supervision; and a QAS paraprofessional — the technician — is "an unlicensed and uncertified individual" supervised "at a level of clinical supervision that meets professionally recognized standards of practice." Optum still expects 1:1 technicians to hold an RBT, BCAT or ABAT credential (or an approved alternative) and credentials BCBAs with six months’ supervised ABA experience. Optum publishes no commercial ABA fee schedule; request yours from the Provider Service Line (1-877-614-0484). [20][21][12][6][8]

## How does UnitedHealthcare (Optum) pay for ABA, and how do you join the network?

UnitedHealthcare commercial ABA is managed by Optum Behavioral Health, which publishes no ABA rate table. Optum's ABA FAQ tells contracted providers to "bill your contracted billing codes and customary charges as outlined on your Fee Schedule after receiving appropriate authorization. You will be reimbursed based on your contracted rate." The fee schedule is the one attached to your Optum agreement; non-contracted providers get approvals through the behavioral-health number on the member's card. [6]

Joining the network: Optum lists credentialing and contracting criteria for ABA providers (BCBA with active certification, state licensure where the state licenses behavior analysts, six months of supervised ABA experience, and professional liability of $1 million per occurrence) and takes applications through the "Join Our Autism/ABA Network" section of its ABA page on Provider Express. Credentialing "can take from 45 to 120 days after submission of all materials," every new agency gets a site audit that can take up to 90 days to schedule, and a single case agreement while credentialing is "Not automatically" available, only in exception cases such as a network gap. Technicians working 1:1 must hold RBT, BCAT or ABAT certification (or an approved alternative). [6]

## Claims: what California law guarantees on filing, payment and disputes

UnitedHealthcare does not publish an ABA-specific filing limit in the documents read; the number sits in the provider agreement. For UnitedHealthcare’s DMHC-licensed products (its HMOs and any DMHC-regulated PPO/EPO), state regulation sets the floor: no claim deadline "less than 90 days for contracted providers and 180 days for non-contracted providers after the date of service"; payment of a complete claim within 30 calendar days of receipt since January 1, 2026, with 15% annual interest from day 31 (H&S § 1371 as amended by AB 3275; the regulation’s 30 and 45 working days no longer control); and at least 365 days from the plan’s action to file a provider dispute, which must be decided within 45 working days (28 CCR §§ 1300.71, 1300.71.38). CDI-regulated insurance policies are outside these DMHC rules but face the same 30-calendar-day payment clock under Ins. Code § 10123.13 since 2026; self-funded ERISA plans follow their plan documents. [1][22][23]

## Does UnitedHealthcare need a referring provider on the ABA claim?

Not for ABA. Optum, which manages UnitedHealthcare’s behavioral benefit, says in its National Network Manual (effective September 1, 2026) that a claim must carry the coding (ICD diagnosis, CPT/HCPCS and modifiers), the member ID number, customary charges, and the provider’s TIN and NPI. Paper Form 1500 claims add the member and subscriber names and dates of birth, the length of session, the type and duration of service, and the clinician’s name, credentials, Tax ID and NPI. A referring provider is not on either list. [15][24]

UnitedHealthcare’s 2026 administrative guide requires the referring provider’s name and NPI only on laboratory, DME, imaging and home health claims. For every other claim, it requires “a valid billing NPI, rendering NPI and relevant taxonomy code(s)” and says “we encourage you to submit the referring health care provider’s NPI.” In short, the referring NPI is optional on an ABA claim, and leaving it off is not a denial reason under either document. [15][24]

## Network, single case agreements, authorizations and disputes (Optum)

Single case agreements: Optum's ABA FAQ says an SCA during credentialing is granted "Not automatically. In exception cases, based on clinical need, new business implementations, or other gaps in the network, a SCA may be approved after review with the clinical team." Once an SCA provider becomes contracted, it sends its current member list to its Network Manager to have the authorizations updated. Out-of-network providers bill on the standard Form 1500. [6][15][13]

Joining the network: Optum lists its ABA contracting criteria (a BCBA with state licensure where the state licenses behavior analysts, six months of supervised ABA experience, $1 million/$1 million professional liability for an individual; $1 million/$3 million plus general or supplemental liability for a group). Credentialing "can take from 45 to 120 days after submission of all materials," and every new ABA agency needs an Optum site audit that "can take up to 90 days to schedule." None of these Optum documents says the ABA network is closed to new providers. [6][15][13]

Whose authorization it is: when an agency is credentialed, "their affiliated clinicians are not credentialed but are considered participating under the agency's Participation Agreement," but "Any claims submission for a rendering clinician who has not been added to the network is subject to denial." Approvals are issued in code clusters (assessment 97151/97152; direct care 97153/97154; multi-staff 0362T/0373T; QHP services 97155–97158) and units "can shift" within a cluster. Optum publishes no rule on moving an authorization from one agency to another; "All services require prior approval," so a new agency calls the ABA team for its own approval. [6][15][13]

Credential modifiers (commercial ABA program): HM = RBT (less than a bachelor's), HN = BCaBA (bachelor's), HO = master's-level BCBA or licensed mental health provider, HP = BCBA-D or doctoral-level licensee; one provider-level modifier per line. 0362T and 0373T are listed as codes "that do not require modifiers." [6][15][13]

Disputes: network providers follow a 2-step process — Step 1 reconsideration, Step 2 appeal — with "a total of 12 months for submission for both steps" unless state law or the Participation Agreement sets another deadline. Send "member-specific treatment plans, clinical records, payment appendices or other items that support why you believe our decision was incorrect," plus proof the claim was filed on time; mail to Optum Behavioral Health Solutions, P.O. Box 30757, Salt Lake City, UT 84123, or use Provider Express. Non-urgent clinical appeals have a 180-day window. [6][15][13]

## Intake gates

The questions that decide whether a family can start with UnitedHealthcare in California, and what they have to bring.

- **Diagnosis recency**: No expiry on the diagnosis. Optum: "Updated evaluations may target specific skill deficits and are not required to be comprehensive unless there is a question about an individual’s autism spectrum disorder diagnosis"; the request checklist asks for the diagnosing clinician and date. On fully insured California plans renewed on or after January 1, 2026, § 1374.73(c) bars requiring a rediagnosis to maintain coverage. [6][7][10]
- **Who may diagnose**: "A state licensed physician, psychologist, or other state licensed clinician qualified to make such diagnosis according to … DSM-5-TR" (Optum criteria). Psychologist diagnostic testing is billed under Optum’s general behavioral health network, not the autism contract. LCSW: Optum's test is a state-licensed clinician qualified to diagnose. California's LCSW scope statute (B&P § 4996.9) could not be fetched this run, so whether an LCSW counts as qualified to diagnose in California is not confirmed here — ask the plan before relying on an LCSW-only diagnosis. [2][6]
- **Diagnostic tools required**: Optum’s three-tier, non-exhaustive list: screening (ABC, CHAT/M-CHAT, CSBS-DP-IT, ASQ, AQ, CAST), second-level (CARS/CARS-2, RITA-T, STAT), formal diagnostic (ADI-R, ADOS/ADOS-2, DISCO), plus baseline and intensity tools (ATEC, VB-MAPP, ABLLS/ABLLS-R, AFLS, PEAK, SSIS, RBS-R, SRS, Vineland, CFQL-2). [2]
- **Referral required?**: No physician referral or order in Optum’s criteria or FAQ; coordination with the diagnosing physician or psychologist is expected. On fully insured California plans the mandate keys covered BHT to a physician prescription or a psychologist-developed plan, so collect one. [2][6][10]
- **Telehealth**: Three codes, after an attestation. Optum’s Telehealth Billing guide (updated September 2025) is explicit for commercial plans: “For ABA services, telehealth is only allowed for these 3 CPT codes: 97155, 97156 or 97157” — virtual supervision of technicians and family training — so technician-delivered 97153 is not payable by telehealth. The provider must first be “an approved Optum virtual visits provider who has attested” (the virtual-visits attestation on Provider Express) and must tell the ABA Care Advocate at authorization. Bill the in-person code with the member’s location as the place of service: POS 10 when the member is at home, POS 02 anywhere else (the older ABA CPT FAQ says POS 02; the 2025 guide requires one of the two on every behavioral-health telehealth claim, and POS 11 or a telehealth modifier alone is not paid). Optum’s criteria add that telehealth is “not intended to supplant in-person service.” The CASP guidelines Optum posts as its California commercial criteria allow in-person, telehealth or hybrid delivery. The assessment is not on that list: 97151 (initial assessment and reassessment) and 97152 are not payable by telehealth for commercial members, so plan the assessment in person. Supervision is: 97155 is billed with the in-person code and POS 02 or 10 after the attestation (Optum's ABA FAQ, Q29), and Optum publishes no minimum in-person share of supervision. [14][6][2][4]
- **Other insurance (who pays first)**: Optum’s FAQ: if the member has no ABA benefit on one plan, "Call the number on the back of the member’s insurance card to request a denial" for the secondary carrier. Its California mandate entry bars limiting coverage because services "could be covered by a public entitlement program, including … Medicaid" — so UHC pays ahead of Medi-Cal, which is payer of last resort (W&I § 14124.90). Between two parents’ plans, California’s regulators apply the birthday rule (28 CCR § 1300.67.13; 10 CCR § 2232.56). TRICARE pays after this plan (10 U.S.C. 1079(i)(1)); CHAMPVA is "the last payer" (38 CFR 17.270(b)). [6][3][28][29][30][31]
- **Age limit** _(plan-dependent)_: No age criterion in Optum’s national ABA criteria, its California mandate entry or the CASP guidelines (decisions "should not be based on … the age of the individual"). H&S § 1374.73 / Ins. § 10144.51 contain no age or dollar limit for fully insured plans; self-funded plans follow their plan document. [2][4][10]
  - Ask the plan: Benefits verification on the member ID — fully insured vs. self-funded, then the plan’s own terms.
- **Prior-auth decision time** _(plan-dependent)_: Optum publishes no ABA decision clock; continued-care requests go in "no more than 30 days prior to the current approvals on file expiring," and reviews run every 4–6 months. The regulator’s clock applies: DMHC plans (including Optum’s California entity), H&S § 1367.01(h) — "not to exceed five business days" from receipt of the information reasonably necessary, 72 hours urgent; CDI policies, Ins. § 10123.135(h), the same; self-funded ERISA plans, 29 CFR 2560.503-1 — 15 days pre-service, one 15-day extension, 72 hours urgent. [6][25][26][27]
  - Ask the plan: At benefits verification ask whether the plan is DMHC, CDI or self-funded, then confirm the turnaround with the Optum ABA clinical team (1-866-830-0325).

## Delivery and billing rules

Coverage decides whether UnitedHealthcare in California 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**: Optum’s April 2026 criteria: "Consistent with CASP standards of care, direct case supervision is required 1–2 hours for every 10 hours of direct treatment per week"; the FAQ says requests above 2:10 need a clinical rationale. Technicians "should be registered behavior technicians (RBT) or another appropriately certified behavior technician as allowable by state mandate," and BCaBAs may supervise as BCBA extenders. For California, Optum’s mandate entry lets associate-level QAS professionals administer treatment, and CASP says funders "should not restrict case supervision to the established minimum." [2][6][3][4]
- **Concurrent billing (97153 + 97155)**: Yes, with a single-provider exclusion. Optum’s commercial ABA reimbursement policy: “Can I report 97153 or 97154 with 97155 concurrently? A. Yes, as long as the criteria in the descriptors of both codes are met. A single QHP may not report 97153 or 97154 with 97155 concurrently.” So the overlap has to be two people — a technician on 97153 and an analyst on 97155 directing them with the patient present. Optum’s ABA CPT FAQ adds that 97153 and 97156 “may be billed concurrently” as separate services to different family members by different providers. 97155 and 97156 on the same date pay only if “separate, distinct, and clearly documented in the progress notes” — “A single provider can’t bill for both simultaneously.” Team meetings bill only as supervision with the member, supervisor and technician present, and “CPT codes 97153 and 97155 may not be billed for technician training.” [13][6]
- **Daily limits / MUEs**: Optum’s commercial ABA reimbursement policy (2022RP501A, updated June 2026) sets a maximum frequency per day for every code: 97151 32 units (8 hrs), 97152 16 (4 hrs), 97153 32 (8 hrs), 97154 18 (4.5 hrs), 97155 24 (6 hrs), 97156 16 (4 hrs), 97157 16 (4 hrs), 97158 16 (4 hrs), 0362T 16 (4 hrs), 0373T 32 (8 hrs) — and “If a provider bills in excess of 32 units per day, claims may be subject to non-reimbursement or recovery.” The ABA CPT FAQ confirms “For our commercial ABA program MUE’s apply.” There is no weekly hour cap: hours are authorized on documented clinical need, approved units can be shifted among codes within a cluster, and utilization below 80% of authorized hours over a two-week period is addressed at review. CASP, which Optum posts as its California commercial criteria, says intensity is “independent of the patient’s schedule of activities outside of treatment.” Two technicians on the same day combine onto one 97153 line; one copay per date of service. [13][6][4]
- **Session-note signature**: "Provider signature is required on progress notes. Parent/guardian signatures are not required." Daily notes carry place of service, start and stop time, who rendered, the service, who attended, interventions and credentials; Optum’s June 2026 documentation protocol adds "The date of signature must reflect the date the note is finalized," with late entries following late-entry rules, and 97155 notes must name the technician and any protocol modification. [6][9]
- **Place of service**: POS 12 home, 11 clinic, 99 community, 03 school, 10/02 telehealth. School-based requests need school type, hours, IEP information and goals. Nationally Optum excludes a 1:1 aide during class and IDEA-covered services, but for California commercial members its State Mandates entry bars limiting coverage because services "could be covered by … special education or an individualized education program," and "the state-mandated criteria controls." [6][7][3]
- **Bill as provider**: CMS-1500 only, EDI payer ID 87726, timely filing within 90 days of the date of service; provider-level modifiers HO (BCBA), HP (BCBA-D), HN (BCaBA) and HM (behavior technician); any credentialed supervisor under the group contract may bill. [6][8]

## What intake should collect for UnitedHealthcare in California

- **Plan funding type:** Fully insured California plan (mandate + Optum’s California criteria) vs. self-funded ERISA (national Optum criteria).
- **Updated DSM-5 diagnosis:** Optum wants a current DSM-5 ASD diagnosis — an old Asperger’s or PDD-NOS label needs updating — with the diagnosing clinician and date.
- **School and IEP details:** School type, hours and IEP information are asked on school-based requests; an IEP is not a reason to deny for California commercial members.
- **Physician or psychologist prescription:** The California mandate keys covered BHT to a physician prescription or a psychologist-developed plan.
- **Other coverage:** Birthday rule between parents; UHC pays before Medi-Cal, TRICARE and CHAMPVA.

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

## Common questions

### Does UnitedHealthcare / Optum give single case agreements for ABA?

Not automatically. Optum's ABA FAQ says an SCA may be approved "In exception cases, based on clinical need, new business implementations, or other gaps in the network" after review with the clinical team. Credentialing takes 45 to 120 days, and new agencies also need a site audit.

### Does UnitedHealthcare cover ABA therapy in California?

Yes — through Optum Behavioral Health, for autism, with prior authorization on every ABA service. Fully insured California plans also fall under the state mandate and Optum’s California-specific criteria.

### Can UHC deny ABA because the child has an IEP?

Not on that basis alone for California commercial members: Optum’s California State Mandates entry and H&S § 1374.72(h) bar limiting coverage because special education, an IEP or Medicaid could provide the service.

### Does UnitedHealthcare have a Medi-Cal plan in California?

No — no UnitedHealthcare Medi-Cal plan operates in any county in 2026. Medi-Cal ABA runs through the county Medi-Cal plan.

### How often does UnitedHealthcare (Optum) reauthorize ABA?

Optum, which manages UnitedHealthcare’s behavioral health benefits, says “At a minimum, most treatment reviews are required every 4-6 months depending on the account/state law.” Call in the continued-care request “no more than 30 days prior to the current approvals on file expiring,” with updated progress data measured the same way as baseline and updated standardized measures. There is no fixed reassessment frequency (“There is no required frequency at which an assessment must take place”) — ask for reassessment hours inside the treatment request. If more hours are needed mid-authorization, call the ABA team with a clinical rationale. On fully insured California plans the treatment plan must be “reviewed no less than once every six months” by the qualified autism service provider.

### Can the ABA assessment (97151) or BCBA supervision (97155) be done by telehealth with UnitedHealthcare in California?

Supervision yes, assessment no. For commercial plans Optum allows telehealth only on 97155, 97156 and 97157, after a virtual-visits attestation, billed with POS 02 or 10. The 97151 assessment is not on that list.

### What is UnitedHealthcare's ABA fee schedule in California?

There is no public one. Optum pays contracted providers at the rate on the fee schedule in their Optum agreement.

### Is UnitedHealthcare (Optum) accepting new ABA providers in California?

Optum takes ABA applications through the "Join Our Autism/ABA Network" section of Provider Express. Credentialing takes 45 to 120 days after a complete submission, plus a site audit for new agencies. Optum publishes no statement that its network is closed.

### Does UnitedHealthcare require a referring provider (box 17) on ABA claims?

No. Optum’s claim requirements do not include a referring provider. UnitedHealthcare makes the referring name and NPI mandatory only for lab, DME, imaging and home health claims. For other claims it encourages the referring NPI but does not require it.

## Primary sources

1. [AB 3275 (Ch. 763, Stats. 2024) — claim reimbursement within 30 calendar days from 1/1/2026 (H&S § 1371, Ins. Code § 10123.13, W&I § 14093.08)](https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202320240AB3275)
2. [Optum — ABA Supplemental Clinical Criteria (BH803ABASCC, interim review 4/21/2026)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/autismABA/abaSCC.pdf)
3. [Optum — ABA State Mandates (BH 803ABA STM72026, eff. July 2026)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/guidelines/scc/ABA_SCC_SM.pdf)
4. [CASP ABA Practice Guidelines for the Treatment of ASD, 3rd ed. (posted by Optum as California Commercial ABA criteria)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/ourNetworkMain/welcomeNtwk/CA/ca_hpc_aba_guidelines.pdf)
5. [Optum Provider Express — Guidelines/Policies (State-Specific Clinical Criteria)](https://www.providerexpress.com/content/ope-provexpr/us/en/clinical-resources/guidelines-policies.html)
6. [Optum — FAQ: Autism/ABA Using CPT Codes (BH00083-24-FAQ, 01/2024)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/autismABA/abaCPT-FAQs.pdf)
7. [Optum — ABA Request for Services Checklist QRG (BH00853-25, 5/2025)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/autismABA/BH00853-25-QRG_ABAQRG.pdf)
8. [Optum — Autism Network Commercial Solo/Agency Provider QRG (BH3865)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/autismABA/abaQRG.pdf)
9. [Optum — Medical Records Documentation for Reviews of ABA Services (6/1/2026)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/autismABA/OBHS_ABA_Services_Documentation_Protocols.pdf)
10. [Health & Safety Code § 1374.73 (as amended by SB 402, eff. 1/1/2026)](https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=HSC&sectionNum=1374.73)
11. [Insurance Code § 10144.51 (as amended by SB 402, eff. 1/1/2026)](https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=INS&sectionNum=10144.51)
12. [BACB — U.S. Licensure of Behavior Analysts](https://www.bacb.com/u-s-licensure-of-behavior-analysts/)
13. [Optum — ABA Reimbursement Policy, Commercial (2022RP501A, updated 06/2026)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/guidelines/reimbPolicies/abaReimburs2020s.pdf)
14. [Optum — Telehealth Billing Quick Reference Guide (BH01511, updated September 2025)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/home/Telehealth_Billing_Guide_Updates.pdf)
15. [Optum Behavioral Health National Network Manual (BH02330, published July 1, 2026, effective Sept. 1, 2026): network status of group clinicians; Provider Reconsideration and Appeal Process](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/adminResourcesMain/netwmanual/NNManual.pdf)
16. [Health & Safety Code § 1374.72 — mental health parity (SB 855)](https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=HSC&sectionNum=1374.72)
17. [Health & Safety Code § 1374.721 — nonprofit-association UM criteria (SB 855)](https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=HSC&sectionNum=1374.721)
18. [AB 796 (2016) — deletes the mandate sunset](https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201520160AB796)
19. [SB 402 (Stats. 2025, ch. 413) — chaptered text](https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202520260SB402)
20. [Business & Professions Code § 4999.200 — Qualified autism service provider (SB 402, eff. 1/1/2026)](https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=BPC&sectionNum=4999.200)
21. [Business & Professions Code § 4999.202 — Qualified autism service paraprofessional (SB 402, eff. 1/1/2026)](https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=BPC&sectionNum=4999.202)
22. [28 CCR § 1300.71 — Claims settlement practices (DMHC plans)](https://www.law.cornell.edu/regulations/california/28-CCR-1300.71)
23. [28 CCR § 1300.71.38 — Provider dispute resolution mechanism (DMHC plans)](https://www.law.cornell.edu/regulations/california/28-CCR-1300.71.38)
24. [2026 UnitedHealthcare Care Provider Administrative Guide (Commercial), Chapter 10: complete claim and NPI requirements](https://www.uhcprovider.com/content/dam/provider/docs/public/admin-guides/2026-UHC-Administrative-Guide.pdf)
25. [Health & Safety Code § 1367.01 — utilization review timelines](https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=HSC&sectionNum=1367.01)
26. [Insurance Code § 10123.135 — utilization review timelines (CDI)](https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=INS&sectionNum=10123.135)
27. [29 CFR 2560.503-1 — ERISA claims procedure](https://www.ecfr.gov/current/title-29/section-2560.503-1)
28. [28 CCR § 1300.67.13 — Coordination of benefits (DMHC plans)](https://www.law.cornell.edu/regulations/california/28-CCR-1300.67.13)
29. [Welfare & Institutions Code § 14124.90 — Medi-Cal payer of last resort](https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=WIC&sectionNum=14124.90)
30. [10 U.S.C. 1079 — TRICARE pays after other coverage except Medicaid](https://www.law.cornell.edu/uscode/text/10/1079)
31. [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.