---
title: "UnitedHealthcare / Optum ABA coverage in Connecticut: the intake guide."
url: "https://carelu.com/payers/unitedhealthcare-connecticut"
markdown_url: "https://carelu.com/payers/unitedhealthcare-connecticut.md"
state: CT (Connecticut)
payer: UnitedHealthcare / Optum in Connecticut
kind: Commercial insurance
description: "How UnitedHealthcare / Optum covers ABA for Connecticut families: Optum’s ABA criteria and its Connecticut state-mandate entry, the 3-code telehealth rule, credential modifiers, Connecticut’s § 38a-514b mandate, the behavior analyst license, and what intake should verify."
last_reviewed: October 2026
---

# UnitedHealthcare / Optum ABA coverage in Connecticut: the intake guide.

_Payer Guide · UnitedHealthcare · Connecticut · Last updated October 2026 · 20 primary sources_

> Optum ABA criteria + Optum’s Connecticut state-mandate entry (1 hr face-to-face per 10) + § 38a-514b; telehealth limited to 3 codes.

For an intake team in Connecticut, a UnitedHealthcare card means three layers: Optum Behavioral Health’s national ABA criteria, Optum’s own Connecticut state-mandate entry, and Connecticut’s autism statute for fully insured plans. UnitedHealthcare is not a HUSKY Health plan, because Connecticut Medicaid has no managed care plans. A UHC card here is commercial or Medicare.

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Required: Optum’s ABA Supplemental Clinical Criteria say “Prior authorization is required for ABA *(unless otherwise specified or mandated by contract or law)” [1]
- **Prior auth for treatment** _(plan-dependent)_: Required; the review interval is set per authorization, and use below 80% of authorized hours over two weeks is examined at continued-service review [1]
  - Ask the plan: Optum Provider Express or the behavioral health number on the card: ask what review interval applies to this member’s ABA authorization.
- **Autism diagnosis required?**: Yes: DSM-5-TR ASD diagnosis and severity level confirmed by the diagnosing clinician with at least one clinically validated tool [1]

## At a glance

- **Covers ABA?:** Yes, for ASD, per Optum’s ABA Supplemental Clinical Criteria (interim review 4/2026)
- **Optum CT entry:** Optum’s State Mandates document applies Connecticut’s 1-hour-per-10 face-to-face supervision definition
- **State mandate:** Conn. Gen. Stat. § 38a-514b (group) and § 38a-488b (individual)
- **Mandate age:** Behavioral therapy for children under 21; under 26 from January 1, 2027 (Nov. Sp. Sess. P.A. 25-3)
- **Mandate caps:** No dollar cap and no visit limits except for medical necessity (the old coverage limit was deleted in 2015)
- **Exempt from mandate:** Self-funded ERISA employer plans (outside state insurance law)
- **Licensure:** Required: DPH license for behavior analysts (§ 20-185j); a current BCBA qualifies (§ 20-185k)
- **Fee schedule:** Not public. Optum pays up to the “Fee Maximum” in your agreement, by credential level (HM/HN/HO/HP)

## The national policy, applied in Connecticut

UnitedHealthcare administers ABA through Optum Behavioral Health under the ABA Supplemental Clinical Criteria (BH803ABASCC; interim review April 2026). These require prior authorization, a DSM-5-TR diagnosis confirmed with a validated tool, and continued-service review that looks closely at use below 80% of authorized hours. The criteria list “Connecticut Commercial” among the states whose mandated criteria apply on top, and say that where they conflict, “the state-mandated criteria controls.” Optum’s ABA State Mandates document (effective July 2026) has this Connecticut entry: “Behavioral therapy is ‘supervised by’ such licensed behavior analyst, licensed physician or licensed psychologist when such supervision entails at least one hour of face-to-face supervision of the autism spectrum disorder services provider … for each ten hours of behavioral therapy provided by the supervised provider.” That is the statute’s own definition. [1][2]

## The Connecticut mandate: what it guarantees

Connecticut’s autism mandate is two parallel statutes: § 38a-514b for group policies and § 38a-488b for individual policies. Each requires coverage “for the diagnosis and treatment of autism spectrum disorder,” which the law treats as an illness. Covered treatments must be medically necessary and “identified and ordered by a licensed physician, licensed psychologist or licensed clinical social worker,” following a treatment plan written by a licensed behavior analyst, physician, psychologist or licensed clinical social worker after a comprehensive evaluation or reevaluation. “Behavioral therapy,” which expressly includes applied behavior analysis, is covered when it is “Provided to children less than twenty-one years of age” and “provided or supervised by (i) a licensed behavior analyst, (ii) a licensed physician, or (iii) a licensed psychologist.” Supervision is defined as “at least one hour of face-to-face supervision” for every ten hours of behavioral therapy. From January 1, 2027, the age limit rises: Public Act 25-3 of the November 2025 special session changes the text to individuals “under twenty-six years of age.” The statute bans visit limits “on any basis other than a lack of medical necessity” and cost-sharing heavier than for other medical conditions. The 2015 amendment (June Sp. Sess. P.A. 15-5) deleted the old coverage limit, so no dollar cap remains. Two utilization-review protections help intake: outside inpatient care, the carrier may review the treatment plan “not more than once every six months” unless the treating clinician agrees or changes the plan, and “the results of a diagnosis shall be valid for a period of not less than twelve months.” Coverage can still carry the policy’s ordinary terms (coordination of benefits, network rules, limits on services by family or household members). Nothing in the statute requires a plan to pay for special education under an IEP. The mandate binds fully insured policies issued in Connecticut. Self-funded employer plans fall under ERISA instead. [6][7]

## Does a BCBA need a Connecticut license? (out-of-state and telehealth)

Yes. Connecticut licenses behavior analysts, and the license is required to practice. Conn. Gen. Stat. § 20-185j(a) says: “No person may practice behavior analysis unless licensed pursuant to section 20-185k or 20-185l.” Licensure began July 1, 2018 and is run by the Department of Public Health. The route is simple for a current BCBA. Under § 20-185k, DPH “shall grant a license as a behavior analyst to any applicant who furnishes evidence satisfactory to the commissioner that such applicant is certified as a behavior analyst by the Behavior Analyst Certification Board.” The application is online only and costs $350. DPH verifies the BCBA online and requires verification of every other state license you hold or have held. The license renews every year for $180, with current BACB certification and a one-time two hours of training on PTSD, suicide-risk, depression and grief screening and suicide prevention, then repeated every six years. Section 20-185l adds licensure by endorsement for people licensed in a state with substantially similar or higher requirements. Several people do not need the license (§ 20-185j(c)): a BCaBA “working under the supervision of a behavior analyst” under BACB standards; anyone who “implements an intervention based on behavior analysis under the supervision of a behavior analyst” (RBTs and technicians); students in an accredited program under direct supervision; course instructors; family members carrying out a plan; and other licensees acting within their own scope who do not call themselves behavior analysts. The license matters for payment too. The commercial mandate covers behavioral therapy only when it is provided or supervised by a licensed behavior analyst, physician or psychologist, so a BCBA without a Connecticut license cannot be the supervising clinician on a fully insured Connecticut plan. [11][12][13][14][6]

Telehealth from another state does not get around the license. Under § 19a-906(a)(12)(A), a “telehealth provider” means a provider “licensed pursuant to title 20,” the title that contains the behavior analyst chapter. A separate route let behavior analysts licensed in another state treat Connecticut patients by telehealth after registering with DPH and applying for a Connecticut license. In the 2026 Supplement that route applies only “on or before June 30, 2025.” Section 19a-906(j) lets a telehealth provider serve a patient “from any location to a patient in any location,” but only “subject to compliance with … state licensing standards.” A Connecticut agency that contracts with an out-of-state telehealth provider who has no DPH license must check that provider’s DPH registration (§ 19a-906(k)). Our reading, as of the 2026 Supplement: a BCBA must hold a Connecticut license to treat a member located in Connecticut, in person or by telehealth. We did not review 2026-session public acts. Confirm with DPH (dph.counselorsteam@ct.gov) before relying on any exception. [11][12][13][14][6]

## What is UnitedHealthcare’s fee schedule for ABA?

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 maximum amount a participating provider may be paid for a specific health care service provided to a member,” and adds that “Reimbursement to clinicians is based upon licensure rather than degree.” Optum’s commercial ABA Reimbursement Policy (2022RP501A, updated June 2026) requires a credential modifier on every line: HM for an RBT, HN for a BCaBA, HO for a master’s-level BCBA or licensed clinician, HP for a doctoral-level provider. Only one modifier is allowed per line. Connecticut’s prompt-pay rule is in its unfair claim settlement statute, § 38a-816(15). An insurer must pay a claim within 60 days of receipt if filed on paper and within 20 days if filed electronically. If information is missing, it must list every deficiency within 30 days (paper) or 10 days (electronic), then pay within 30 or 10 days of receiving what it asked for. A late claim carries interest “at the rate of fifteen per cent per annum.” The statute defines “health care provider” to include anyone licensed under chapters 375 to 383c, a range that takes in licensed behavior analysts (chapter 382a). It applies to insured policies. Self-funded ERISA plans follow federal claim rules instead. For a public benchmark, Connecticut Medicaid’s ASD fee schedule (rates effective January 1, 2026) pays 97153 at $14.00 per 15 minutes. Commercial contracts are negotiated separately. [5][4][10][20]

## Claim filing, telehealth billing and reauthorization

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]

## Intake gates

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

- **Diagnosis recency**: No expiry on the diagnosis, which must be confirmed with severity level using a validated tool. Insured Connecticut plans must treat a diagnosis as valid for at least 12 months. [1][6]
- **Who may diagnose**: “a state licensed physician, psychologist, or other state licensed clinician qualified to make such diagnosis” under DSM-5-TR. [1]
- **Diagnostic tools required**: At least one clinically validated tool, from a list that is not exhaustive: first-level screens (M-CHAT and others), second-level screens (CARS/CARS-2, RITA-T, STAT), and formal tools (ADI-R, ADOS/ADOS-2, DISCO). [1]
- **Referral required?**: No separate physician referral in Optum’s criteria, which require prior authorization. For a fully insured Connecticut plan, §§ 38a-514b(c) and 38a-488b(c) cover ABA only when it is “identified and ordered by a licensed physician, licensed psychologist or licensed clinical social worker” and follows a treatment plan by a licensed behavior analyst, physician, psychologist or LCSW. Get that order before the first request. Self-funded ERISA plans are outside the statute. [1][6]
- **Telehealth**: Optum’s commercial telehealth guide (September 2025): “For ABA services, telehealth is only allowed for these 3 CPT codes: 97155, 97156 or 97157.” The 97151 assessment and technician 97153 are not on the list. Claims must carry POS 02 or 10. Optum’s criteria add that telehealth is meant to “supplement,” not “supplant,” in-person service. For a fully insured Connecticut plan, § 38a-526a (group; § 38a-499a for individual policies) requires coverage of care “provided through telehealth, to the extent coverage is provided for such advice, diagnosis, care or treatment when provided through in-person consultation between the insured and a health care provider licensed in the state.” A plan may not exclude a service “solely because such service is provided only through telehealth … provided telehealth is appropriate for the provision of such service,” and any utilization review must use the same criteria as for in-person care. The section’s own list of “telehealth provider” professions does not name behavior analysts (chapter 382a), so ask the carrier how it treats ABA under it. Self-funded employer plans are outside the statute. Ask Optum how it applies the three-code list to a fully insured Connecticut plan. 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][8]
- **Age limit** _(plan-dependent)_: The criteria carry no age limit; the member’s benefit plan governs. For fully insured Connecticut plans, the mandate covers behavioral therapy for children under 21 today and for individuals under 26 from January 1, 2027 (Nov. Sp. Sess. P.A. 25-3). It has no dollar cap. Self-funded ERISA plans are outside the statute, so the plan’s funding type decides whether this applies. [1][6][7]
  - Ask the plan: Provider Express benefits check or the behavioral health number on the card: fully insured vs. self-funded first.
- **Prior-auth decision time** _(plan-dependent)_: Depends on how the plan is funded. Fully insured Connecticut plans fall under § 38a-591d. For a non-urgent prospective or concurrent request, the carrier must decide “not later than seven calendar days after the date the health carrier receives such request.” It may extend once by up to five calendar days for circumstances beyond its control, or by up to fifteen if the clinician says the service will not start for at least three months. Retrospective requests get 30 days. Urgent requests are decided within 24 hours. A concurrent urgent request to extend a course of treatment counts only if made at least 24 hours before the current authorization ends. After a medical-necessity denial, the carrier must offer your clinician a conference with a clinical peer, who has authority to reverse the denial. Self-funded employer (ERISA) plans follow 29 CFR 2560.503-1 instead: pre-service decisions “not later than 15 days after receipt of the claim,” one 15-day extension, urgent care within 72 hours. UnitedHealthcare/Optum publishes no Connecticut-specific ABA turnaround. [9][15]
  - Ask the plan: At benefits verification ask whether the plan is fully insured (Connecticut-regulated) or self-funded (ERISA), and what reauthorization lead time UnitedHealthcare/Optum expects.
- **Other insurance (who pays first)** _(plan-dependent)_: UnitedHealthcare/Optum is primary to Connecticut Medicaid. HUSKY Health is “the payer of last resort,” and if a member has third-party coverage “the benefits of these policies must be fully exhausted prior to claim submission” to Medicaid (42 CFR 433.139). So be in the commercial network and get its authorization as well as the Carelon BH CT authorization. TRICARE pays after this plan (10 U.S.C. 1079(i)(1)). CHAMPVA is “the last payer” (38 CFR 17.270). Connecticut’s autism statutes let insured coverage carry the policy’s ordinary coordination-of-benefits terms (§ 38a-514b(f)). We did not read Connecticut’s coordination-of-benefits regulation, so get the order between two parents’ plans from the carriers. [16][17][18][19][6]
  - Ask the plan: Ask UnitedHealthcare/Optum at benefits verification for the member’s coordination-of-benefits order between both parents’ plans, and record every other coverage the child has (HUSKY, TRICARE, CHAMPVA).

## Delivery and billing rules

Coverage decides whether UnitedHealthcare / Optum in Connecticut 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**: “Consistent with CASP standards of care, direct case supervision is required 1–2 hours for every 10 hours of direct treatment per week.” Technicians work under a BCBA or licensed behavioral health clinician and “should be registered behavior technicians (RBT) or another appropriately certified behavior technician.” For Connecticut, Optum’s state-mandate entry applies at least one hour of face-to-face supervision per ten hours by a licensed behavior analyst, physician or psychologist. Optum’s criteria publish no cap on the number of technicians per BCBA. [1][2]
- **Concurrent billing (97153 + 97155)**: Optum’s commercial reimbursement policy allows 97153 or 97154 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.” 97155 and 97156 on the same day must be separate, distinct and at different times. [4]
- **Daily limits / MUEs**: Commercial ABA follows CMS MUEs, and “Optum allows 32 units per day for CPT code 97153.” Billing more risks non-payment or recovery. Requested hours must be justified at the least restrictive appropriate level. [4][1]
- **Place of service**: ABA is provided at the least restrictive, most clinically appropriate level. It is not covered for “1:1 aid delivered simultaneously during classroom instruction, or services covered under” IDEA. School coordination (teacher training, meetings, observations) is covered. [1]
- **Bill as provider**: Each line carries the rendering provider’s credential modifier: HM for an RBT (“State regulatory requirements may supplement, modify or supersede this policy”), HN for a BCaBA, HO for a master’s-level BCBA or licensed clinician, HP for a doctoral-level provider. Indirect work has no separate code and is bundled into the direct codes. [4]
- **Session-note signature** _(ask the plan)_: Not addressed in the ABA criteria or reimbursement policy, which set what must be documented, not who signs a session note or when. [1][4]
  - Ask the plan: Optum National Network Manual (treatment record documentation section) and your participation agreement.

## What intake should collect for UnitedHealthcare / Optum in Connecticut

- **Plan funding type:** Fully insured (§ 38a-514b applies) or self-funded ERISA (plan document governs).
- **Member ID + card photo:** Enough to run a live benefits verification on Provider Express.
- **Diagnosis with a validated tool:** DSM-5-TR ASD and severity level, confirmed with a validated tool (ADI-R, ADOS-2, CARS-2 and others).
- **Order from a licensed clinician:** The mandate covers ABA ordered by a licensed physician, psychologist or LCSW.
- **Credential of each rendering staff member:** Every claim line needs the right HM/HN/HO/HP modifier.

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

## Common questions

### Does UnitedHealthcare accept H0031 or H2019 for ABA?

No. Optum’s commercial ABA policy uses CPT 97151–97158, 0362T and 0373T with credential modifiers.

### Does Optum require graphs for an ABA reauthorization?

The criteria ask for progress measured the same way as baseline, mastery rates, change scores and updated standardized adaptive measures; graphs are not named.

### What is UnitedHealthcare’s timely filing limit for ABA claims?

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.

### Does UnitedHealthcare cover ABA therapy in Connecticut?

Yes, under Optum’s ABA criteria for ASD, with Connecticut’s mandate added for fully insured plans. Optum’s State Mandates document has a Connecticut entry.

### Is UnitedHealthcare a HUSKY (Connecticut Medicaid) plan?

No. Connecticut Medicaid has no managed care plans. HUSKY ABA is authorized by Carelon BH CT and paid fee-for-service.

### Can ABA be delivered by telehealth with UnitedHealthcare in Connecticut?

Optum’s commercial guide allows only 97155, 97156 and 97157 by telehealth, billed POS 02 or 10. Fully insured Connecticut plans also fall under § 38a-526a, which bars excluding a service solely because it is delivered by telehealth when telehealth is appropriate, so ask Optum how it applies the list.

### What does UnitedHealthcare pay for ABA in Connecticut?

Optum publishes no rates. You are paid up to the Fee Maximum in your agreement, with a credential modifier on each line (HM RBT, HN BCaBA, HO BCBA, HP doctoral). Connecticut Medicaid’s 97153 rate ($14.00 per 15 minutes) is the only public benchmark.

### Do Connecticut licensure laws stop a BCBA without a Connecticut license from practicing there, including by telehealth?

Yes. Conn. Gen. Stat. § 20-185j says “No person may practice behavior analysis unless licensed.” A current BCBA gets the license from DPH by showing BACB certification ($350, renewed yearly), and § 20-185l offers licensure by endorsement. RBTs, technicians and BCaBAs working under a licensed behavior analyst’s supervision do not need their own license. Telehealth into Connecticut also requires the Connecticut license: the telehealth statute (§ 19a-906) defines a telehealth provider as someone licensed under title 20, and its temporary route for out-of-state behavior analysts applied only on or before June 30, 2025 (2026 Supplement text). On a fully insured plan, the autism mandate covers behavioral therapy only when it is provided or supervised by a licensed behavior analyst, physician or psychologist.

## Primary sources

1. [Optum ABA Supplemental Clinical Criteria (BH803ABASCC; annual review 8/2025, interim review 4/2026)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/autismABA/abaSCC.pdf)
2. [Optum — ABA State Mandates (BH 803ABA STM72026, eff. July 2026; Connecticut entry)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/guidelines/scc/ABA_SCC_SM.pdf)
3. [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)
4. [Optum — ABA Reimbursement Policy, Commercial (2022RP501A, updated June 2026)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/guidelines/reimbPolicies/abaReimburs2020s.pdf)
5. [Optum National Network Manual (BH02330, effective Sept. 1, 2026)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/adminResourcesMain/netwmanual/NNManual.pdf)
6. [Conn. Gen. Stat. § 38a-514b — Coverage for autism spectrum disorder, group policies (2026 Supplement, incl. the Jan. 1, 2027 amendment)](https://www.cga.ct.gov/2026/sup/chap_700c.htm#sec_38a-514b)
7. [Conn. Gen. Stat. § 38a-488b — Coverage for autism spectrum disorder therapies, individual policies (2026 Supplement)](https://www.cga.ct.gov/2026/sup/chap_700c.htm#sec_38a-488b)
8. [Conn. Gen. Stat. § 38a-526a — Coverage for telehealth services, group policies (§ 38a-499a for individual policies)](https://www.cga.ct.gov/current/pub/chap_700c.htm#sec_38a-526a)
9. [Conn. Gen. Stat. § 38a-591d — Utilization review and benefit determinations (timeframes)](https://www.cga.ct.gov/current/pub/chap_700c.htm#sec_38a-591d)
10. [Conn. Gen. Stat. § 38a-816(15) — Unfair claim settlement practices: health claim payment deadlines and 15% interest](https://www.cga.ct.gov/current/pub/chap_704.htm#sec_38a-816)
11. [Conn. Gen. Stat. ch. 382a, §§ 20-185i to 20-185m — Behavior Analysts (licensure, exceptions, endorsement)](https://www.cga.ct.gov/current/pub/chap_382a.htm)
12. [CT Department of Public Health — Behavior Analyst Licensing Requirements](https://portal.ct.gov/DPH/Practitioner-Licensing--Investigations/Behavioral-Analyst/Licensing-Requirements)
13. [BACB — U.S. Licensure of Behavior Analysts (Connecticut: 2017, CT State Department of Public Health)](https://www.bacb.com/u-s-licensure-of-behavior-analysts/)
14. [Conn. Gen. Stat. § 19a-906 — Telehealth services (2026 Supplement)](https://www.cga.ct.gov/2026/sup/chap_368ll.htm#sec_19a-906)
15. [29 CFR 2560.503-1 — ERISA claims procedure (eCFR)](https://www.ecfr.gov/current/title-29/section-2560.503-1)
16. [HUSKY Health Behavioral Health Provider Handbook, CT BHP / Carelon BH CT (revised 6/2026)](https://s18637.pcdn.co/wp-content/uploads/sites/76/Provider-Handbook-2026-final.pdf)
17. [42 CFR 433.139 — Medicaid third-party liability (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-433/subpart-D/section-433.139)
18. [10 U.S.C. 1079(i)(1) — TRICARE pays after other coverage except Medicaid](https://www.govinfo.gov/content/pkg/USCODE-2023-title10/html/USCODE-2023-title10-subtitleA-partII-chap55-sec1079.htm)
19. [38 CFR 17.270 — CHAMPVA is the last payer](https://www.ecfr.gov/current/title-38/section-17.270)
20. [CMAP Autism Spectrum Disorder fee schedule (CSV, "Autism Spectrum Disorder 1/1/2026")](https://www.ctdssmap.com/CTPortal/Information/Get-Download-File?Filename=refw242_feesched_asd_82.csv&URI=fee_schedules/refw242_feesched_asd_82.csv)

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.