---
title: "UnitedHealthcare / Optum ABA coverage in Nebraska: the intake guide."
url: "https://carelu.com/payers/unitedhealthcare-nebraska"
markdown_url: "https://carelu.com/payers/unitedhealthcare-nebraska.md"
state: NE (Nebraska)
payer: UnitedHealthcare / Optum in Nebraska
kind: Commercial insurance
description: "How UnitedHealthcare / Optum covers ABA for Nebraska families — the national clinical policy, prior authorization, the Neb. Rev. Stat. § 44-7,106 mandate (under 21, the 25-hour weekly cap, exemptions), Nebraska behavior-analyst licensure, and what intake should verify."
last_reviewed: October 2026
vob_data_updated: 2026-10-15
---

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

_Payer Guide · UnitedHealthcare · Nebraska · Last updated October 2026 · 12 primary sources_

> Optum Supplemental Clinical Criteria (BH803ABASCC) + the Neb. Rev. Stat. § 44-7,106 mandate layer.

For an intake team in Nebraska, a UnitedHealthcare card means three layers at once: the carrier's national clinical policy, Nebraska's autism insurance mandate (Neb. Rev. Stat. § 44-7,106), and the plan's funding type deciding which of the two actually binds. This guide stacks them in order.

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Required — step 1 of Optum's two-step authorization (assessment auth via Provider Express) [2]
- **Prior auth for treatment**: Required — a separate treatment authorization after the assessment. “At a minimum, most treatment reviews are required every 4-6 months depending on the account/state law,” and continued-care requests go in “no more than 30 days prior to the current approvals on file expiring” (Optum ABA CPT FAQ) [9][2]
- **Autism diagnosis required?**: Yes — DSM-5-TR ASD confirmed with a validated tool (ADI-R, ADOS-2, etc.) [2]

## At a glance

- **Covers ABA?:** Yes — for ASD, per the national UnitedHealthcare policy
- **State mandate:** Neb. Rev. Stat. § 44-7,106 (LB 254, eff. 1/1/2015)
- **Mandate age:** Under 21 (screening, diagnosis, and treatment of ASD)
- **Mandate caps:** 25 hrs/week maximum benefit for behavioral health treatment incl. ABA
- **Exempt from mandate:** Non-grandfathered individual/small-group ACA plans; self-funded ERISA (preempted)
- **Licensure:** NE Licensed Behavior Analyst (DHHS Licensure Unit, 172 NAC 86)

## The national policy, applied in Nebraska

UnitedHealthcare administers ABA through Optum Behavioral Health as a two-step authorization on the Provider Express portal — assessment authorized first, then treatment — under Optum's Supplemental Clinical Criteria, with continued-service reviews every 4–6 months and an operational flag when utilization falls below 80% of authorized hours. That clinical policy is national — what changes in Nebraska is the legal floor underneath it: the state mandate below governs what state-regulated plans must cover, while self-funded employer plans answer to ERISA and federal parity instead. Plan funding type is therefore the first fact to establish on every benefits check. Notably, Optum's ABA State Mandates supplemental criteria document (BH 803ABA, January 2026) contains no Nebraska entry — so Nebraska commercial members get the standard Optum criteria, with the state mandate operating at the benefits layer rather than through carrier-modified clinical criteria. The full national policy breakdown lives in our UnitedHealthcare / Optum guide; this page covers what changes in Nebraska. [2][3]

## The Nebraska mandate: what it guarantees (and doesn't)

Nebraska's mandate (LB 254 of 2014, effective for policies delivered or renewed on or after January 1, 2015) requires coverage of screening, diagnosis, and treatment of ASD for individuals under 21 — with behavioral health treatment including ABA capped at a maximum benefit of 25 hours per week until age 21. No visit limits or less-favorable dollar limits or cost-sharing are otherwise permitted, non-BHT payments (OT/ST/PT, pharmacy, psychiatric care) cannot be applied against the cap, and the insurer may review treatment at most once every 6 months, at its own cost. ABA must be provided or supervised by a nationally certified behavior analyst or licensed psychologist, in person or by telehealth. The reach is narrower than it reads: the statute exempts non-grandfathered individual and small-group ACA plans required to include essential health benefits, so the mandate's practical territory is large-group and grandfathered plans — and while the statute's text reaches self-funded plans "to the extent not preempted," ERISA preemption still takes self-funded employer plans off the table. The 25-hour cap is also a quantitative limit whose enforceability against group plans is in tension with federal parity (MHPAEA) — treat that as an argument to raise, not a settled fact. [4]

## UnitedHealthcare Medicaid in Nebraska

A family saying "we have UnitedHealthcare" in Nebraska may actually be on the carrier's Medicaid plan — UnitedHealthcare Community Plan of Nebraska (Heritage Health), whose ABA network Optum has managed since 2017 — which follows the state Medicaid rules and the Optum Medicaid workflow, not this commercial policy. Verify which line of business the card belongs to, and use the dedicated guide for the Medicaid plan. [8]

## Licensure & rates in Nebraska

Nebraska licenses behavior analysts under the Behavior Analyst Practice Act (Neb. Rev. Stat. § 38-4401 et seq., regulations at 172 NAC 86): the Licensed Behavior Analyst (LBA) credential for BCBAs and LaBA for BCaBAs, administered by the DHHS Licensure Unit with a Board of Behavior Analysts — and since January 1, 2025 the state's Medicaid program requires the license of every practicing BCBA, which has made LBA licensure the de facto floor for the market. On rates: UnitedHealthcare does not publish commercial ABA fee schedules for Nebraska (none of the national carriers do) — rates are contract-negotiated and live in your participating-provider agreement. When benchmarking, note that Nebraska's Medicaid fee schedule sits unusually low after the August 2025 cuts (97153 at $18.70 per 15 minutes), so commercial contracts here carry more of the margin than in most states. [5][7]

## How fast must UnitedHealthcare pay a clean ABA claim in Nebraska?

Nebraska’s Health Care Prompt Payment Act requires an insurer to pay, deny or settle a clean claim "within thirty calendar days after receipt by the insurer if submitted electronically and within forty-five calendar days after receipt if submitted in a form other than electronically" (§ 44-8004). The clock tolls while requested information is outstanding. The Act covers insurers and HMOs but not the Medicaid program or a self-insured employer plan (§ 44-8002). [6][1][13][14][12]

UnitedHealthcare’s 2026 administrative guide publishes no single timely-filing number ("Timely filing limits vary based on state requirements and contracts"; check your agreement). It requires "a valid billing NPI, rendering NPI and relevant taxonomy code(s) on all claims," and encourages, but does not require, the referring provider’s NPI. Most claims are adjudicated within 15 days, up to 45. Claim reconsiderations and appeals are due within 12 months of the original EOB or PRA. [6][1][13][14][12]

UnitedHealthcare’s ABA claims run through Optum Behavioral Health, whose National Network Manual (effective September 1, 2026) sets the deadlines. "All information necessary to process claims must be received by Optum 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." The member may not be billed for a late claim. Payment: claims with all required information and any required authorization "will be paid within 45 calendar days after Optum receives the claim, or as required by state and federal laws," which may exclude claims needing a coordination-of-benefits determination; when Optum is secondary it pays up to the Optum contracted rate. UnitedHealthcare’s 2026 administrative guide adds that a corrected claim (frequency code 7, with the original claim number) must arrive within the same timely-filing limit as the original. No weekly payment cycle or submission cutoff is published. [6][1][13][14][12]

Which codes: Optum’s commercial ABA reimbursement policy (2022RP501A, updated June 2026) lists the reimbursable codes for the commercial ABA program as 97151–97158, 0362T and 0373T, each in 15-minute units with a credential modifier (HM, HN, HO or HP); no HCPCS H-code (H0031, H0032, H2014, H2019) is on that list. [6][1][13][14][12]

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

Neither UnitedHealthcare's 2026 commercial administrative guide nor Optum's commercial ABA reimbursement policy sets a referring-provider requirement for ABA claims. On plans that do require PCP referrals, the administrative guide lists "Mental health/substance use disorder services with network behavioral health clinicians" among the services members can get without one, and Optum manages the ABA benefit through its own two-step authorization. [12][6]

So box 17 is not a published condition of a UnitedHealthcare ABA claim in Nebraska; the authorization is. Enter a referring provider only when one exists. [12][6]

## Can ABA overlap with speech, OT or PT under UnitedHealthcare (Optum)?

Optum's criteria publish no clock-time rule for ABA against speech, OT or PT, but they do rule out duplication. The Supplemental Clinical Criteria state that "ABA services do not duplicate the services provided to or available to the individual by other medical or behavioral services." They require coordination with "speech/occupational therapists and others," and they size intensity on "The individual's ability to participate in ABA, given participation in other therapies and engagements." [2][6]

In practice, list the child's other therapies, with their schedule, in the treatment plan, and show the ABA hours fit around them. Optum's own same-time rules cover ABA codes only: 97153 or 97154 with 97155 concurrently, but never by a single QHP. [2][6]

## What must a UnitedHealthcare ABA reauthorization request contain, and are graphs required?

Optum’s ABA Supplemental Clinical Criteria (interim review April 2026) say that "With each clinical review for continued ABA treatment, the provider must submit updated documentation" showing progress "for each targeted symptom and behavior, including progress toward defined goals, including the same modes of measurement that were utilized for baseline measurement." Progress "should include 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," with movement from baseline shown on validated, norm-referenced assessments and, where applicable, the caregiver’s own progress. Inadequate progress over six months calls for an analysis of the reasons and modified interventions, and the review looks at use below 80 percent of authorized hours over two weeks. The criteria do not require graphs as such. [2]

## Intake gates

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

- **Who may diagnose**: A licensure test with a diagnostic-competence qualifier: "A valid diagnosis of ASD (or other applicable diagnosis as required by governing laws) must be issued by a state licensed physician, psychologist, or other state licensed clinician qualified to make such diagnosis according to the diagnostic criteria based on the DSM-5-TR." The diagnosing clinician must also confirm and document the severity level. Once the diagnosis is confirmed, the ABA provider identified for the member must be a master's- or doctoral-level BCBA, a licensed behavioral health clinician who has attested to sufficient expertise and been credentialed for ABA, or a BCaBA or non-licensed individual working under direct supervision. [2]
- **Diagnostic tools required**: Optum publishes the most explicit instrument list of any national carrier, and splits it three ways. The DSM-5 diagnosis and severity level must be confirmed "using at least one clinically validated tool (not an all-inclusive list)": first-level screeners (ABC, CHAT/M-CHAT, CSBS-DP-IT-Checklist, ASQ, AQ, CAST), second-level screeners (CARS/CARS-2, RITA-T, STAT), and formal diagnostic tools used as part of a comprehensive diagnostic evaluation — the Autism Diagnostic Interview-Revised (ADI), the Autism Diagnostic Observation Schedule (ADOS/ADOS-2), and the Diagnostic Interview for Social and Communication Disorders (DISCO). Separately, treatment intensity must be chosen against baseline measurement using at least one of ATEC, VB-MAPP, ABLLS/ABLLS-R, AFLS, PEAK, SSIS, RBS-R, SRS, VABS or CFQL-2, individualized to the client rather than applied uniformly. [2]
- **Referral required?**: No UnitedHealthcare referral, but the state mandate wants an order. UnitedHealthcare's 2026 administrative guide lists "Mental health/substance use disorder services with network behavioral health clinicians" among the services a member on a referral-required plan may get without a PCP referral. Optum gates ABA on prior authorization, assessment first and treatment second. Nebraska's mandate defines covered treatment as care "prescribed or ordered for an individual diagnosed with an autism spectrum disorder by a licensed physician or a licensed psychologist" (Neb. Rev. Stat. § 44-7,106(1)(i)). Keep that physician's or psychologist's order on file for any plan the statute reaches. The statute exempts non-grandfathered ACA individual and small-group plans, and self-funded ERISA plans only to the extent federal law preempts it. Neither UnitedHealthcare nor Optum publishes an order form or a validity period for one. [12][2][4]
- **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, and neither is the 97151 assessment or the technician-assisted 97152: plan the assessment in person. 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.” Nebraska’s statute also contemplates remote delivery: § 44-7,106 requires that ABA be “provided or supervised by a nationally certified behavior analyst or licensed psychologist” and says so expressly of care delivered “in person or by telehealth.” [10][9][2][4]
- **Other insurance (who pays first)**: UnitedHealthcare: "COB is administered according to the member's benefit plan and in accordance with law. We accept secondary claims electronically," and "If COB caused a delay, you have 90 days from the date of the primary carrier Explanation of Benefits to submit." For ABA through Optum: "bill the primary insurance carrier first, then notify Optum of your findings"; Optum processes "using industry-wide coordination of benefits (COB) standards and in accordance with benefit contracts and applicable state laws." Nebraska's COB regulation (210 NAC 39) governs fully insured plans: for a child whose parents are married or living together, "The plan of the parent whose birthday falls earlier in the calendar year is the primary plan" (same birthday: the plan that has covered the parent longest); for divorced or separated parents a court decree naming the responsible parent controls. Self-funded plans follow their plan document. If another payer needs a UHC denial to pay, Optum's FAQ says to "Call the number on the back of the member's insurance card to request a denial." If the child also has Medicaid, this plan pays first: Medicaid is payer of last resort (42 CFR 433.139) — bill here, then send the EOB or denial to Medicaid, and get Medicaid's own prior auth too if the state requires it. TRICARE is secondary to this plan ("TRICARE shall be last pay," 32 CFR 199.8), and "CHAMPVA is the last payer to OHI" (38 CFR 17.276(d)). [12][1][15][18][19][20][21]
- **Age limit** _(plan-dependent)_: Optum's Supplemental Clinical Criteria set no age limit for ABA — coverage turns on a valid ASD diagnosis, a credentialed provider and demonstrated medical necessity, with age entering only through norm-referenced instruments that compare functioning "to age-matched neurotypical peers." The binding age question is the legal layer underneath: Nebraska's mandate (Neb. Rev. Stat. § 44-7,106) reaches individuals under 21 on state-regulated plans and caps behavioral health treatment including ABA at 25 hours per week to age 21; non-grandfathered individual and small-group ACA plans are exempt, and a self-funded ERISA plan answers to its own plan document. Optum's ABA State Mandates supplement carries no Nebraska entry, so nothing carrier-side modifies the age question here. [2][3][4]
  - Ask the plan: The member's benefit document and Optum via Provider Express — funding type decides whether the state mandate or the plan document sets the age boundary.
- **Prior-auth decision time** _(plan-dependent)_: UnitedHealthcare publishes its own commercial clock: "Standard requests: up to 15 calendar days"; "Expedited requests: 72 hours"; "We may extend this time if we need additional information." Submit "at least 15 calendar days in advance, if possible, but … at least 5 business days before the planned service date." ABA requests route to Optum (Provider Express, AutismABA), where "All services require prior approval"; Optum's ABA FAQ says to request a continuation "no more than 30 days prior to the current approvals on file expiring" (that FAQ dates from October 2021). Nebraska fully insured plans are bound by LB 77 (operative January 1, 2026): a decision "within seventy-two hours after obtaining all necessary information" for urgent care and "within seven days after obtaining all necessary information" for nonurgent care (urgent tightens to 48 hours from January 1, 2028); "Health care services are deemed authorized if a utilization review agent fails to comply with the deadlines," the approval notice must state the authorization's duration or expiry date, and "prior authorization shall be valid for at least one year from the date the utilization review agent approves the prior authorization request." Self-funded ERISA plans are outside state law and follow 29 CFR 2560.503-1: a pre-service decision "not later than 15 days after receipt of the claim" (one 15-day extension), 72 hours for urgent care, and an urgent request to extend an approved course of treatment decided within 24 hours if made "at least 24 hours prior to the expiration." Where state law is stricter than UHC's 15 days, the law wins for fully insured members. [12][15][16][17]
  - Ask the plan: Optum Behavioral Health (number on the member ID card): confirm whether the plan is fully insured or self-funded, which sets whether state law or UHC's 15-day ceiling governs.
- **Diagnosis recency** _(ask the plan)_: Not published. Optum's ABA criteria require a valid DSM-5-TR diagnosis confirmed with at least one clinically validated tool but set no maximum age for the diagnostic evaluation. The recency Optum does police is progress rather than diagnosis: continued coverage looks for demonstrable progress within a 6-month window and for updated standardized adaptive measures with change scores. [2]
  - Ask the plan: Optum via Provider Express, or the Care Advocate handling the authorization — ask whether the plan applies a diagnostic-evaluation recency window at intake.

## Delivery and billing rules

Coverage decides whether UnitedHealthcare / Optum in Nebraska 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 commercial reimbursement policy publishes no supervision percentage or caseload cap — it refers providers to the ABA Coding Coalition for supervision requirements. What it does police is the boundary: "CPT codes 97153 and 97155 may not be billed for technician training," including training a technician new to the organization on a client's programming or on reassessment-driven goal changes. And 97155 "should be reported only for services where the QHP is either engaged directly with the patient or is directing a technician in implementing a modified protocol with the patient" — treatment planning is an indirect service and not separately reimbursable. [6]
- **Concurrent billing (97153 + 97155)**: Yes, with a single-provider exclusion. "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 concurrency has to be two people — technician on 97153, analyst on 97155 directing them with the patient present. Separately, 97155 and 97156 may both pay on the same date of service only if the services are separate, distinct and clearly documented; "a single provider can't bill for both simultaneously (e.g., in the same 15-minute block)." [6]
- **Daily limits / MUEs**: Optum publishes its own per-day table on top of CMS MUEs — maximum frequency per day: 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). MUEs otherwise apply per CMS guidance, and billing above 32 units/day of 97153 "may be subject to non-reimbursement or recovery." Time is counted on the CMS 15-minute rule (1 unit at ≥ 8 minutes, 2 at ≥ 23, and so on). [6]
- **Session-note signature**: “Provider signature is required on progress notes. Parent/guardian signatures are not required on progress notes” (Optum ABA CPT FAQ). Each daily session note records place of service, start and stop time, who rendered the service, the specific service, who attended and the interventions. Optum’s ABA documentation protocol (June 1, 2026) requires the “signature of the rendering provider” and “Legible identity of the rendering provider with credentials,” and “The date of signature must reflect the date the note is finalized” — a note signed after the date of service must follow late-entry rules and show the date it was signed. Same-date services must be “separate, distinct, and clearly documented in the progress notes,” or the claim may be denied. [9][11][6]
- **Bill as provider**: One provider-level modifier per line, matching whoever actually rendered the service: HM = Registered Behavior Technician (less than bachelor's level), HN = BCaBA (bachelor's level), HO = BCBA or master's-level licensed clinician, HP = BCBA-D or doctoral-level licensed clinician. A billable ABA-supervisor service is billed with the applicable CPT code plus HO. Stacking level modifiers is a denial risk: "Billing multiple provider-level modifiers (HN, HM, HO, HP) on the same service line same service and same DOS is not appropriate and may result in claim denial." Indirect work has no code of its own — it is bundled into the direct-service code. [6]
- **Place of service** _(ask the plan)_: The commercial ABA reimbursement policy sets no place-of-service rule, and Optum's published ABA State Mandates document carries no Nebraska entry at all — so there is no carrier document answering where Nebraska commercial ABA is payable. Daily progress notes must record the place of service regardless. In Nebraska the layer underneath is § 44-7,106 for state-regulated plans, and the plan document for a self-funded one — note that the state's own Medicaid rule sends school-based ABA to the Medicaid school-based services program (471 NAC 25) rather than to independent providers, which is a Medicaid rule and not a commercial one. [6][3]
  - Ask the plan: UnitedHealthcare provider services and the member's benefit document.

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

- **Plan funding type:** Large-group/grandfathered state-regulated (mandate applies) vs. small-group/individual ACA or self-funded ERISA (exempt) — it decides which rulebook governs.
- **Line of business:** Commercial vs. UnitedHealthcare Community Plan of Nebraska (Heritage Health Medicaid) — different rules, different guide.
- **Member ID + card photo:** Enough to run a live benefits verification — the only reliable answer on limits and cost-sharing.
- **Diagnosis report:** DSM-5-TR ASD diagnosis confirmed with a validated tool (ADI-R, ADOS-2, etc.) — Optum's criteria require it.
- **Requested weekly hours vs. the 25-hour cap:** Where the mandate governs, BHT including ABA caps at 25 hrs/week — plan intensity and any parity argument accordingly.

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

## Verification of benefits (VOB) data

How UnitedHealthcare / Optum in Nebraska ABA benefits route and read on an eligibility check. Data last updated 2026-10-15.

### EDI routing

- **Payer ID (pVerify):** 00192
- **Supports 270/271 eligibility:** Yes
- **Behavioral health administrator:** Optum Behavioral Health

### How the 271 reports ABA benefits

- **ABA benefit bucket (service type code):** MH — UHC's own EDI feed (87726) formally supports MH/A4-A8 with financial detail, but whether members whose ABA benefit is carved to Optum Behavioral Health actually receive populated MH-flavor detail through this SAME feed — versus a referral/vendor-lookup stub via the guide's own documented EB*U 'vendor' segment mechanism — is not resolved by any source found this pass. Confirm via Provider Express / UHC provider services for the specific plan.
- **Deductible applies to ABA:** yes — Same open question as abaBenefitBucket — confirm whether the carved-out BH benefit populates deductible detail on this feed.
- **Cost-share type:** plan-dependent — Both copay and coinsurance are structurally supported per plan; which applies to a given member is plan-document-specific.
- **271 response quality for ABA:** high

### Code-level coverage

| Code | Covered | Prior auth | Unit cap | Place of service | Telehealth | Modifiers |
| --- | --- | --- | --- | --- | --- | --- |
| 97151 | Yes | Required — Optum ABA two-step authorization (assessment auth first, then treatment auth) via Provider Express, with continued-service reviews every 4-6 months. | 32 units/day (≤8 hrs) per day | — | — | HN, HO, HP |
| 97152 | Yes | Required — Optum ABA two-step authorization (assessment auth first, then treatment auth) via Provider Express, with continued-service reviews every 4-6 months. | 16 units/day (≤4 hrs) per day | — | — | HN, HM, HO, HP |
| 97153 | Yes | Required — Optum ABA two-step authorization (assessment auth first, then treatment auth) via Provider Express, with continued-service reviews every 4-6 months. | 32 units/day (≤8 hrs) per day | — | — | HN, HM, HO, HP |
| 97154 | Yes | Required — Optum ABA two-step authorization (assessment auth first, then treatment auth) via Provider Express, with continued-service reviews every 4-6 months. | 18 units/day (≤4.5 hrs) per day | — | — | HN, HM, HO, HP |
| 97155 | Yes | Required — Optum ABA two-step authorization (assessment auth first, then treatment auth) via Provider Express, with continued-service reviews every 4-6 months. | 24 units/day (≤6 hrs) per day | — | — | HN, HO, HP |
| 97156 | Yes | Required — Optum ABA two-step authorization (assessment auth first, then treatment auth) via Provider Express, with continued-service reviews every 4-6 months. | 16 units/day (≤4 hrs) per day | — | — | HN, HO, HP |
| 97157 | Yes | Required — Optum ABA two-step authorization (assessment auth first, then treatment auth) via Provider Express, with continued-service reviews every 4-6 months. | 16 units/day (≤4 hrs) per day | — | — | HN, HO, HP |
| 97158 | Yes | Required — Optum ABA two-step authorization (assessment auth first, then treatment auth) via Provider Express, with continued-service reviews every 4-6 months. | 16 units/day (≤4 hrs) per day | — | — | HN, HO, HP |
| 0362T | Yes | Required — Optum ABA two-step authorization (assessment auth first, then treatment auth) via Provider Express, with continued-service reviews every 4-6 months. | 16 units/day (≤4 hrs) per day | — | — | — |
| 0373T | Yes | Required — Optum ABA two-step authorization (assessment auth first, then treatment auth) via Provider Express, with continued-service reviews every 4-6 months. | 32 units/day (≤8 hrs) per day | — | — | — |

Code notes:

- **97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, 0362T, 0373T:** Unit caps and modifiers sourced from Optum's national ABA Reimbursement Policy (2022RP501A) — the ABA Supplemental Clinical Criteria contains no CPT codes at all; applied here absent a confirmed Nebraska-specific override (Optum's ABA State Mandates supplement has no Nebraska entry). Separately, Nebraska's mandate (Neb. Rev. Stat. § 44-7,106) caps behavioral health treatment including ABA at 25 hrs/week for state-regulated plans — a benefits-layer cap, distinct from these per-code unit caps. Verify via: Provider Express / UHC provider services.

### Contacts

- **Benefits by phone:** Yes
- **Provider services phone:** 1-877-614-0484
- **Hours:** Monday-Friday, 7 a.m.-7 p.m. CT
- **Portal:** [Provider Express](https://public.providerexpress.com)

Questions to ask on a verification call:

- Can you confirm the daily/weekly unit caps for each ABA code for this specific plan, versus Optum's national default?
- Which places of service are allowed, and is telehealth permitted for any ABA codes under this plan?
- Does ABA ride on the medical or the behavioral-health benefit for eligibility purposes, and is a second EDI hop required beyond the primary UHC payer ID?
- Can you confirm the correct EDI payer ID for Availity/Change Healthcare submissions for this specific commercial plan?

### VOB data sources

- https://pverify.com/wp-content/uploads/2026/03/pVerifyPayers_All-Payers-List-3-2026.pdf (accessed 2026-07-23)
- https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/autismABA/abaSCC.pdf (accessed 2026-07-23)
- https://www.caqh.org/sites/default/files/CAQH%20CORE%20Eligibility%20Benefits%20(270_271)%20Data%20Content%20Rule%20vEB2.0.pdf (accessed 2026-07-23)
- https://www.uhcprovider.com/content/dam/provider/docs/public/resources/edi/EDI-270-271-Companion-Guide-005010X279A1.pdf (accessed 2026-07-23)
- https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/guidelines/reimbPolicies/abaReimburs2020s.pdf (accessed 2026-07-23)
- https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/guidelines/scc/ABA_SCC_SM.pdf (accessed 2026-07-23)
- https://nebraskalegislature.gov/laws/statutes.php?statute=44-7,106 (accessed 2026-07-23)
- https://public.providerexpress.com/content/ope-provexpr/us/en/contact-us.html (accessed 2026-07-23)
- https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/adminResourcesMain/netwmanual/NNManual.pdf (accessed 2026-10-14)

## Common questions

### Does UnitedHealthcare require graphs for ABA reassessments?

Optum’s criteria require updated progress data in the same measures used at baseline (mastery rates, change scores, updated standardized adaptive measures) at every continued review; they do not require graphs as such.

### Does UnitedHealthcare accept H0031 or H0032 for ABA?

Optum’s commercial ABA reimbursement policy lists only CPT 97151–97158, 0362T and 0373T as reimbursable ABA codes, each with a credential modifier; no H-code (H0031, H0032, H2014, H2019) is on the list.

### What is UnitedHealthcare’s timely filing limit for ABA claims, and when does it pay?

Optum requires everything needed to process the claim within 90 calendar days of the date of service and corrections within 90 days of first receipt; clean, authorized claims are paid within 45 calendar days or as state law requires. No weekly payment cutoff is published.

### Does UnitedHealthcare cover ABA therapy in Nebraska?

Yes — under the carrier's national policy for ASD, layered on Nebraska's mandate (Neb. Rev. Stat. § 44-7,106) for state-regulated plans. Self-funded employer plans are exempt from the mandate, so always verify plan funding type first.

### What does the Nebraska autism mandate require?

Coverage of ASD screening, diagnosis, and treatment for individuals under 21, with behavioral health treatment including ABA capped at 25 hours per week — and insurer treatment reviews limited to once every 6 months. Non-grandfathered individual and small-group ACA plans are exempt, as are self-funded ERISA plans by preemption.

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

Not on the commercial side — Optum's ABA State Mandates supplement (BH 803ABA) has no Nebraska entry, so standard Optum criteria apply. On the Medicaid side it's the opposite: Optum runs a dedicated NE Heritage Health ABA program with its own forms and workflow — see the UHC Community Plan of Nebraska guide.

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

Commercial ABA rates are not published — they are negotiated in your participating-provider agreement. Nebraska's Medicaid schedule is an unusually low benchmark after the August 2025 cuts, so treat commercial rate-setting as a first-order contracting conversation.

### 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 plans the Nebraska mandate reaches, the insurer may review treatment at most once every 6 months, at its own cost.

### Does UnitedHealthcare (Optum) require RBT certification for ABA technicians?

Optum's ABA criteria say technicians "should be registered behavior technicians (RBT) or another appropriately certified behavior technician as allowable by state mandate," working under BCBA or licensed-clinician supervision. They also advise against a parent serving as the RBT for their own child.

### Can the ABA assessment be done by telehealth with UnitedHealthcare?

No, not on commercial plans. Optum's telehealth billing guide allows only 97155, 97156 and 97157 by telehealth for ABA, so 97151 and 97152 are delivered in person. Supervision (97155) and caregiver training can be remote once the provider has completed Optum's virtual-visits attestation.

### What is UnitedHealthcare’s clean-claim payment turnaround in Nebraska?

Thirty calendar days for an electronic clean claim, 45 for paper (Neb. Rev. Stat. § 44-8004). The Act does not reach self-insured employer plans.

### Does UnitedHealthcare require a taxonomy code on the claim in Nebraska?

Yes. The 2026 administrative guide requires a valid billing NPI, rendering NPI and relevant taxonomy code on all claims and encounters.

### Does UnitedHealthcare require a referring provider NPI on ABA claims?

No published rule requires one. UnitedHealthcare exempts network mental health services from PCP referral requirements, and Optum gates ABA on prior authorization instead.

### Can ABA overlap with speech therapy under UnitedHealthcare?

Optum publishes no clock-time rule, but its criteria say ABA must not duplicate other medical or behavioral services, and they weigh participation in other therapies when setting hours. Document the other therapies and schedule around them.

## Primary sources

1. [Optum Behavioral Health National Network Manual (BH02330, published July 1, 2026, effective Sept. 1, 2026): Coordination of Benefits; Timely Filing; Payment Timelines](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/adminResourcesMain/netwmanual/NNManual.pdf)
2. [Optum ABA Supplemental Clinical Criteria (BH803ABASCC)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/autismABA/abaSCC.pdf)
3. [Optum — ABA State Mandates supplemental criteria (BH 803ABA, Jan 2026)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/guidelines/scc/ABA_SCC_SM.pdf)
4. [Neb. Rev. Stat. § 44-7,106 (full text)](https://nebraskalegislature.gov/laws/statutes.php?statute=44-7,106)
5. [NE DHHS — Behavior Analyst licensure page](https://dhhs.ne.gov/licensure/Pages/Behavior-Analyst.aspx)
6. [Optum — Applied Behavior Analysis (ABA) Reimbursement Policy, Commercial (2022RP501A)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/guidelines/reimbPolicies/abaReimburs2020s.pdf)
7. [Provider Bulletin 25-14 — ABA Rates (July 1, 2025)](https://dhhs.ne.gov/Medicaid%20Provider%20Bulletins/Provider%20Bulletin%2025-14.pdf)
8. [NE Heritage Health Medicaid ABA Program Quick Reference Guide (Optum BH4233)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/autismABA/neaba/neNEMedicaidQRG.pdf)
9. [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)
10. [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)
11. [Optum — Medical Records Documentation for Reviews of ABA Services (BH02325, 6/1/2026)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/autismABA/OBHS_ABA_Services_Documentation_Protocols.pdf)
12. [2026 UnitedHealthcare Care Provider Administrative Guide (Commercial) — services not requiring a referral](https://www.uhcprovider.com/content/dam/provider/docs/public/admin-guides/2026-UHC-Administrative-Guide.pdf)
13. [Neb. Rev. Stat. § 44-8004 — Health Care Prompt Payment Act, clean-claim deadlines](https://nebraskalegislature.gov/laws/statutes.php?statute=44-8004)
14. [Neb. Rev. Stat. § 44-8002 — Health Care Prompt Payment Act, definitions](https://nebraskalegislature.gov/laws/statutes.php?statute=44-8002)
15. [Optum Autism/ABA FAQ (BH3632, October 2021)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/autismABA/abaFAQ.pdf)
16. [Nebraska LB 77 (2025) — Ensuring Transparency in Prior Authorization Act, slip law](https://nebraskalegislature.gov/FloorDocs/109/PDF/Slip/LB77.pdf)
17. [29 CFR 2560.503-1(f)(2) — Group health plan claim decision timeframes (eCFR)](https://www.ecfr.gov/current/title-29/section-2560.503-1)
18. [210 NAC 39 — Nebraska Coordination of Benefits Regulation, §006.04(B)](https://doi.nebraska.gov/sites/default/files/doc/Chapter%2039.pdf)
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. [32 CFR 199.8 — TRICARE double coverage (eCFR)](https://www.ecfr.gov/current/title-32/subtitle-A/chapter-VII/subchapter-M/part-199/section-199.8)
21. [38 CFR 17.276(d) — CHAMPVA last payer to other health insurance (eCFR)](https://www.ecfr.gov/current/title-38/section-17.276)

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.