---
title: "UnitedHealthcare / Optum ABA coverage in Mississippi: the intake guide."
url: "https://carelu.com/payers/unitedhealthcare-mississippi"
markdown_url: "https://carelu.com/payers/unitedhealthcare-mississippi.md"
state: MS (Mississippi)
payer: UnitedHealthcare / Optum in Mississippi
kind: Commercial insurance
description: "How UnitedHealthcare / Optum covers ABA for Mississippi families: Optum’s ABA criteria and prior authorization, Mississippi’s § 83-9-26 autism mandate, telehealth limits, the Prior Authorization Reform Act, LBA licensure, and UHC’s exit from MississippiCAN."
last_reviewed: October 2026
---

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

_Payer Guide · UnitedHealthcare · Mississippi · Last updated October 2026 · 22 primary sources_

> Optum criteria (BH803ABASCC) + Mississippi’s § 83-9-26 mandate; no Mississippi state supplement; UHC left MississippiCAN 6/30/2025.

For a Mississippi intake team a UnitedHealthcare card means Optum Behavioral Health’s national ABA criteria, Mississippi’s autism mandate in § 83-9-26, and the plan’s funding type. Since July 1, 2025 UnitedHealthcare Community Plan is no longer a MississippiCAN or CHIP plan, so a UHC card on a Mississippi child is commercial (or Medicare); a family still holding a UHC Community Plan Medicaid card needs to check which CCO they were moved to.

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Required: Optum’s ABA Supplemental Clinical Criteria require prior authorization for ABA "unless otherwise specified or mandated by contract or law" [1]
- **Prior auth for treatment** _(plan-dependent)_: Required: treatment is authorized after the assessment; the review interval is set per authorization [1]
  - Ask the plan: Optum Provider Express support: ask what review interval will be set on this member’s ABA authorization.
- **Autism diagnosis required?**: Yes: DSM-5-TR ASD confirmed by the diagnosing clinician with at least one validated tool [1]

## At a glance

- **Covers ABA?:** Yes, for ASD, per Optum’s ABA Supplemental Clinical Criteria
- **State mandate:** Miss. Code Ann. § 83-9-26 (HB 885, 2015; policies issued or renewed from 1/1/2016)
- **Mandate age:** ABA not required beyond age 8, unless medical necessity for an extension is shown
- **Mandate caps:** 25 hours/week of ABA, no more than 10 hours/week of licensed behavior analyst time; extendable on medical necessity; no less favorable dollar limits than medical
- **Exempt from mandate:** Self-funded ERISA plans; non-grandfathered individual and small-group ACA plans; small employers (≤100) must only offer it
- **Licensure:** Mississippi Autism Board license (LBA/LABA); RBTs registered under the supervisor
- **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 Mississippi

UnitedHealthcare administers ABA through Optum Behavioral Health under the ABA Supplemental Clinical Criteria (BH803ABASCC; interim review April 2026): "Prior authorization is required for ABA *(unless otherwise specified or mandated by contract or law)," and continued-service reviews look hard at use below 80% of authorized hours. Optum’s ABA State Mandates supplement (annual review July 2026) lists Arizona, California, Connecticut, Florida, Massachusetts, New Jersey, New York, Ohio and Pennsylvania; Mississippi is not there, so no Mississippi-specific criteria modify the commercial policy. UnitedHealthcare Community Plan stopped covering MississippiCAN and CHIP after June 30, 2025. [1][2][6]

## The Mississippi mandate: what it guarantees

Mississippi’s autism mandate is Miss. Code Ann. § 83-9-26, enacted as HB 885 in 2015. A health insurance policy "shall provide coverage for the screening, diagnosis, and treatment of autism spectrum disorder" for policies delivered, issued or renewed in the state (or outside it if insuring Mississippi residents) on or after January 1, 2016. Treatment means evidence-based care "prescribed or ordered" by a licensed physician or licensed psychologist who finds it medically necessary, and it includes "behavioral health treatment" (behavior modification and counseling programs "including applied behavior analysis"), pharmacy, psychiatric, psychological and therapeutic care. Behavioral health treatment must be "provided or supervised by a licensed behavior mental health professional," and a diagnosis of ASD means assessments "performed by a licensed psychologist or licensed physician." The limits sit in subsection (5): ABA coverage "shall be limited to twenty-five (25) hours per week, and shall not be required beyond the age of eight (8) years," and "no more than ten (10) hours per week shall be for the services of a licensed behavior analyst," with all services "under the supervision or direction of a licensed behavior analyst or licensed psychologist." Those limits can be exceeded under an ongoing treatment plan "if medical necessity for the extension is determined to exist," and otherwise the policy’s appeal rights govern. Dollar limits, deductibles and coinsurance may not be less favorable than for medical and surgical benefits. Except for inpatient care, the insurer may review the treatment plan every six months, at its own cost. Schools’ IEP, IFSP and IDEA obligations are not shifted to insurers. Subsection (8) exempts non-grandfathered individual and small-group plans that carry ACA essential health benefits, and subsection (9) requires small employers with 100 or fewer eligible employees only to offer the coverage (they may charge for it). Self-funded ERISA plans are outside state law. The Insurance Department’s autism page lists Blue Cross & Blue Shield of Mississippi, UnitedHealthcare and Ambetter of Magnolia as having "voluntarily removed all age restrictions" for ABA, and tells families to confirm with their plan. [7][8]

## Licensure, telehealth and out-of-state BCBAs

Mississippi licenses behavior analysts. The BACB’s licensure table lists Mississippi (2015) with the Mississippi Autism Board, which licenses Licensed Behavior Analysts and Licensed Assistant Behavior Analysts under Miss. Code Ann. § 73-75. To be licensed as a behavior analyst a person needs at least a master’s degree, "current and active certification" as a BCBA or BCBA-D, a fingerprint-based state and FBI background check, and the Board’s other requirements, which include an oral examination the Board gives at least quarterly (Rule 3.2); licenses run three years but never past the BACB certification. Assistant behavior analysts need a bachelor’s degree, BCaBA certification and proof of supervision by a licensed behavior analyst. Technicians are not licensed: the supervising licensee registers each Registered Behavior Technician with the Board, the technician "works solely under the license of the behavior analyst," and supervision follows the BACB’s policy (Rule 9). For a BCBA licensed in another state, the statute’s exemption list (§ 73-75-5: licensed psychologists, other licensed professionals within scope, supervised technicians, family members, trainees, school employees) does not include behavior analysts licensed elsewhere, and the Board’s rules contain no telehealth provision, so plan on a Mississippi license before treating a Mississippi patient in person or by telehealth. The route is licensure by reciprocity (Rule 3.4), which still requires meeting the Rule 3.1 and 3.2 requirements; a temporary license exists only for applicants awaiting exam scores or the next oral exam, restricts practice to Mississippi and requires supervision. The autism mandate ties into this: a "licensed behavior analyst" in § 83-9-26 is one licensed under § 73-75-13. [9][10][11][12][13][14]

For state-regulated plans, Miss. Code Ann. § 83-9-351 says "All health insurance and employee benefit plans in this state must provide coverage for telemedicine services to the same extent that the services would be covered if they were provided through in-person consultation," with cost sharing no higher than in person. Telemedicine other than remote monitoring and store-and-forward "must be 'real-time' audio visual capable," and the claim carries the procedure code "with the appropriate modifier indicating interactive communication was used." The section was set to lapse on July 1, 2025; SB 2415 (2025), as sent to the Governor, moves the repeal date to July 1, 2028. Self-funded employer plans are covered only to the extent federal law permits. [9][10][11][12][13][14]

## What is UnitedHealthcare’s fee schedule for ABA, and how fast must it pay?

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 and says "Reimbursement to clinicians is based upon licensure rather than degree." The commercial ABA Reimbursement Policy (2022RP501A, updated 06/2026) puts the credential 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, and "There is no CPT code for reporting indirect services separately." Mississippi’s prompt-pay law, Miss. Code Ann. § 83-9-5(1)(h), requires clean claims to be paid within 25 days of receipt of due written proof for electronic claims and 35 days for paper, with interest of 3% a month after that; a clean claim "requires no further information, adjustment or alteration by the provider." The public benchmark is Mississippi Medicaid’s fee schedule (July 2026 Mississippi Medicaid ASD fee schedule, per 15-minute unit: 97151 $34.18 (no PA), 97152 $41.74, 97153 $15.08, 97154 $9.42, 97155 and 97156 $24.35, 97157 and 97158 $12.17, 0362T $56.64, 0373T $41.49, ages 0–20). [4][5][16][22]

Optum’s National Network Manual: claims must be received "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." Complete, authorized claims "will be paid within 45 calendar days after Optum receives the claim, or as required by state and federal laws," which may exclude claims that need coordination-of-benefits decisions; the manual sets no separate secondary-claim deadline and publishes no check-run schedule. [4][5][16][22]

## What a reauthorization must show

Optum’s ABA Supplemental Clinical Criteria (review 04/2026) set what each continued-service review needs: progress "assessed and documented for each targeted symptom and behavior … including the same modes of measurement that were utilized for baseline measurement"; progress that includes "rate and percentage of mastered programs, rates of mastered targets, change scores for any outcome measures, updated standardized adaptive measures, and change scores for skills-based assessments"; an assessment of the reasons and modified interventions when there is inadequate progress "within a 6-month period"; and an explanation when use of authorized hours falls below 80% over a two-week period. Treatment plans "are usually reviewed/updated twice annually." The criteria do not require graphs. [1]

## Intake gates

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

- **Diagnosis recency**: No expiry on the diagnosis; it must be confirmed with severity using validated tools, and progress is reassessed over 6-month periods. [1]
- **Who may diagnose**: A state-licensed physician, psychologist or other state-licensed clinician qualified to diagnose under DSM-5-TR. For fully insured Mississippi plans, § 83-9-26 defines diagnosis as performed by a licensed psychologist or licensed physician. [1][7]
- **Diagnostic tools required**: At least one clinically validated tool from Optum’s non-exhaustive list (screens such as M-CHAT, CARS-2, STAT; diagnostic tools such as ADI-R, ADOS-2, DISCO); baseline measures such as VB-MAPP, ABLLS-R, Vineland or SRS. [1]
- **Referral required?**: No separate physician referral in Optum’s criteria; prior authorization is required. 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. Under § 83-9-26 the mandated treatment is care "prescribed or ordered" by a licensed physician or licensed psychologist, so keep that order on file for a fully insured Mississippi plan; the insurer may review the treatment plan every six months. [1][7][4]
- **Telehealth**: Optum’s telehealth billing guide (updated September 2025): "For ABA services, telehealth is only allowed for these 3 CPT codes: 97155, 97156 or 97157," billed POS 02 or POS 10 (POS 11 is not a telehealth POS). The 97151 assessment and 97153 are not on the list, and the criteria say telehealth is "not intended to supplant in" person care. For state-regulated plans, Miss. Code Ann. § 83-9-351 says "All health insurance and employee benefit plans in this state must provide coverage for telemedicine services to the same extent that the services would be covered if they were provided through in-person consultation," with cost sharing no higher than in person. Telemedicine other than remote monitoring and store-and-forward "must be 'real-time' audio visual capable," and the claim carries the procedure code "with the appropriate modifier indicating interactive communication was used." The section was set to lapse on July 1, 2025; SB 2415 (2025), as sent to the Governor, moves the repeal date to July 1, 2028. Self-funded employer plans are covered only to the extent federal law permits. Ask Optum how it applies the three-code list to a fully insured Mississippi plan. [3][1][13][14]
- **Age limit** _(plan-dependent)_: Optum’s criteria carry no age criterion; the benefit plan governs. For fully insured Mississippi plans, § 83-9-26(5) lets ABA coverage stop at age 8 and 25 hours a week unless medical necessity for an extension is shown under an ongoing treatment plan; non-grandfathered individual and small-group plans and self-funded ERISA plans are outside the mandate. [1][7]
  - Ask the plan: Provider Express benefits check: establish fully insured vs. self-funded and the market segment, then the plan’s ABA age terms. The Insurance Department lists UHC as having voluntarily removed ABA age limits; confirm on this plan.
- **Prior-auth decision time** _(plan-dependent)_: Fully insured plans fall under the Mississippi Prior Authorization Reform Act (SB 2140, effective July 1, 2024). It applies to health insurance issuers, health benefit plans and private review agents, "with the exception of employee or employer self-insured health benefit plans" under ERISA. A non-urgent decision is due "no later than seven (7) calendar days after obtaining all necessary information," an urgent one "no later than forty-eight (48) hours after receiving all information needed." A missed deadline means the services are "automatically deemed authorized." An approval stays valid for the lesser of six months, the length of treatment set by the clinician, or the plan’s renewal (12 months for chronic-condition treatment). 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, and at least 180 days to appeal a denial. UnitedHealthcare/Optum publishes no Mississippi-specific ABA turnaround. [15][18]
  - Ask the plan: At verification ask whether the plan is fully insured (Mississippi-regulated) or self-funded (ERISA).
- **Other insurance (who pays first)** _(plan-dependent)_: Mississippi’s coordination-of-benefits regulation (19 Miss. Admin. Code Pt. 3, R. 7.01) lets insurers file coordination provisions but sets no order-of-benefits rule of its own, so the order for a child on two parents’ plans comes from the plan documents (ask about the birthday rule at verification). The same regulation says "other health plans" for coordination "shall not include … Medicaid," and Medicaid is payer of last resort (42 CFR 433.139), so this plan pays before Mississippi Medicaid or a MississippiCAN plan. TRICARE pays after this plan (10 U.S.C. 1079(i)(1)); CHAMPVA is the last payer (38 CFR 17.270). [17][19][20][21]
  - Ask the plan: Ask UnitedHealthcare/Optum at verification for the member’s coordination-of-benefits order and record every other coverage the child has.

## Delivery and billing rules

Coverage decides whether UnitedHealthcare / Optum in Mississippi 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 criteria require direct case supervision of 1–2 hours for every 10 hours of direct treatment, by a BCBA or licensed behavioral health clinician; technicians should be RBTs or otherwise certified "as allowable by state mandate," and parents should not serve as their own child’s RBT. In Mississippi the supervisor must be licensed by the Autism Board and RBTs registered under them. [1][12]
- **Concurrent billing (97153 + 97155)**: Yes, with a single-provider exclusion. Optum’s commercial ABA reimbursement policy (2022RP501A, updated June 2026): "Can I report 97153 or 97154 with 97155 concurrently? 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 the analyst on 97155. 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." 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. [1][5][23]
- **Daily limits / MUEs**: 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, and use below 80% of authorized hours must be explained at review. For fully insured Mississippi plans the mandate permits a 25-hour weekly ABA limit, extendable on medical necessity. [1][7][5]
- **Place of service**: 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 covered. § 83-9-26(7) leaves IEP services with the schools. [1][7]
- **Bill as provider**: Every line carries the rendering credential modifier: HM (RBT), HN (BCaBA), HO (master’s-level BCBA or licensed clinician), HP (doctoral level); the RBT definition notes that "State regulatory requirements may supplement, modify or supersede this policy." [5]
- **Session-note signature** _(ask the plan)_: Not addressed in Optum’s ABA criteria, which set what must be documented for coverage, not who signs session notes. [1]
  - Ask the plan: Optum National Network Manual (documentation standards) and your participating-provider agreement.

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

- **Plan funding and market:** Fully insured large group (mandate applies), small group or individual ACA plan (exempt), or self-funded ERISA (plan document governs).
- **Medicaid or commercial?:** UHC Community Plan left MississippiCAN on 6/30/2025; a Medicaid child now belongs to Magnolia, Molina or TrueCare.
- **Diagnosis with a validated tool:** DSM-5-TR ASD with severity, confirmed with a validated tool (ADI-R, ADOS-2 and others).
- **Physician or psychologist order:** The mandate covers treatment prescribed or ordered by a licensed physician or psychologist.

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

## Common questions

### Does UnitedHealthcare (Optum) require graphs for ABA continued-service reviews?

No. Optum’s criteria ask for progress on every target using the baseline measurement method, mastery rates and change scores, updated standardized adaptive measures, and an explanation of low hour use, but they do not require graphs.

### What are UnitedHealthcare (Optum)’s claim filing deadlines for Mississippi ABA claims?

90 calendar days from the date of service (or longer where state law or the plan allows), corrections within 90 days of the original claim’s receipt, and payment of complete claims within 45 days or the state’s shorter clock. No check-run schedule is published.

### Does UnitedHealthcare cover ABA therapy in Mississippi?

Yes, under Optum’s national ABA criteria for ASD, with Mississippi’s § 83-9-26 mandate layered on fully insured large-group and grandfathered plans.

### Is UnitedHealthcare still a Mississippi Medicaid plan?

No. UnitedHealthcare Community Plan stopped covering MississippiCAN and CHIP after June 30, 2025; the Medicaid plans are Magnolia, Molina and TrueCare.

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

Optum’s commercial guide allows telehealth only for 97155, 97156 and 97157 (POS 02 or 10). Mississippi’s § 83-9-351 requires state-regulated plans to cover telemedicine to the same extent as in person, so ask Optum how it applies the list on a fully insured plan.

### Does Optum have Mississippi-specific ABA criteria?

No. Optum’s ABA State Mandates supplement does not list Mississippi.

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

Optum pays up to the Fee Maximum in your agreement with a credential modifier on each line (HM RBT, HN BCaBA, HO BCBA, HP doctoral). Mississippi Medicaid’s 97153 rate ($15.08 per 15 minutes) is the only public benchmark.

## 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 supplemental criteria (annual review 7/2026; Mississippi not listed)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/guidelines/scc/ABA_SCC_SM.pdf)
3. [Optum — Telehealth Billing Quick Reference Guide (updated September 2025)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/home/Telehealth_Billing_Guide_Updates.pdf)
4. [Optum National Network Manual (effective Sept. 1, 2026)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/adminResourcesMain/netwmanual/NNManual.pdf)
5. [Optum — ABA Reimbursement Policy, Commercial (2022RP501A, updated 06/2026)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/guidelines/reimbPolicies/abaReimburs2020s.pdf)
6. [Mississippi Division of Medicaid — Special enrollment period (UnitedHealthcare Community Plan exits MSCAN/CHIP after 6/30/2025; TrueCare joins 7/1/2025)](https://medicaid.ms.gov/special-enrollment-period-underway-for-managed-care-members/)
7. [Miss. Code Ann. § 83-9-26 — Screening, Diagnosis, and Treatment of Autism Spectrum Disorder (Mississippi Insurance Department copy)](https://www.mid.ms.gov/wp-content/uploads/2023/04/MissCodeAnn83-9-26.pdf)
8. [Mississippi Insurance Department — Autism (FAQ on the § 83-9-26 mandate; carriers that voluntarily removed ABA age limits)](https://www.mid.ms.gov/mississippi-insurance-department/healthcare/autism/)
9. [BACB — U.S. Licensure of Behavior Analysts (Mississippi: 2015, MS Autism Board)](https://www.bacb.com/u-s-licensure-of-behavior-analysts/)
10. [Miss. Code Ann. § 73-75-13 — eligibility for licensure as a behavior analyst or assistant behavior analyst (FindLaw)](https://codes.findlaw.com/ms/title-73-professions-and-vocations/ms-code-sect-73-75-13/)
11. [Miss. Code Ann. § 73-75-5 — exemptions from the behavior analyst licensure chapter (FindLaw)](https://codes.findlaw.com/ms/title-73-professions-and-vocations/ms-code-sect-73-75-5/)
12. [Mississippi Autism Board — Title 30 Part 3301, Licensure of Behavior Analysts and Assistant Behavior Analysts (rules final 3/13/2024)](https://www.msautismboard.ms.gov/sites/autism/files/UploadedDocuments/2024/MAB%20R&R%20(Final)%203.13.2024.pdf)
13. [Miss. Code Ann. § 83-9-351 — Telemedicine coverage (FindLaw, current as of Jan. 1, 2025)](https://codes.findlaw.com/ms/title-83-insurance/ms-code-sect-83-9-351/)
14. [Mississippi SB 2415 (2025) — extends the § 83-9-351 telemedicine repealer to July 1, 2028 (as sent to the Governor)](https://billstatus.ls.state.ms.us/documents/2025/dt/SB/2400-2499/SB2415SG.pdf)
15. [Mississippi SB 2140 (2024), "Mississippi Prior Authorization Reform Act" — as sent to the Governor (eff. July 1, 2024)](https://billstatus.ls.state.ms.us/documents/2024/pdf/SB/2100-2199/SB2140SG.pdf)
16. [Miss. Code Ann. § 83-9-5(1)(h) — payment of clean claims (FindLaw, current as of Jan. 1, 2025)](https://codes.findlaw.com/ms/title-83-insurance/ms-code-sect-83-9-5/)
17. [19 Miss. Admin. Code Pt. 3, R. 7.01 — (88-102) Coordinating or Integrating Accident and Health Insurance Benefits (Cornell LII)](https://www.law.cornell.edu/regulations/mississippi/19-Miss-Code-R-SS-3-7-1)
18. [29 CFR 2560.503-1 — ERISA claims procedure (eCFR)](https://www.ecfr.gov/current/title-29/section-2560.503-1)
19. [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)
20. [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)
21. [38 CFR 17.270 — CHAMPVA is the last payer](https://www.ecfr.gov/current/title-38/section-17.270)
22. [Mississippi Division of Medicaid — Autism Spectrum Disorder Services Fee Schedule, July 2026 (.xlsx)](https://medicaid.ms.gov/wp-content/uploads/2026/07/ASD-FEE_SHEDULE-JULY-2026-fnl.xlsx)
23. [Optum — Autism/ABA CPT code FAQs (BH00083-24-FAQ, 01/2024)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/autismABA/abaCPT-FAQs.pdf)

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.