---
title: "UnitedHealthcare ABA coverage in Nevada: the intake guide."
url: "https://carelu.com/payers/unitedhealthcare-nevada"
markdown_url: "https://carelu.com/payers/unitedhealthcare-nevada.md"
state: NV (Nevada)
payer: UnitedHealthcare / Optum in Nevada
kind: Commercial insurance
description: "How UnitedHealthcare covers ABA for Nevada families: Optum’s ABA criteria for UHC-branded plans, HPN’s InterQual review for Health Plan of Nevada and Sierra plans, Nevada’s autism mandate ($72,000 ABA cap; under 18, or 22 in high school), licensure and PA deadlines."
last_reviewed: October 2026
---

# UnitedHealthcare ABA coverage in Nevada: the intake guide.

_Payer Guide · UnitedHealthcare · Nevada · Last updated October 2026 · 23 primary sources_

> Two UHC tracks in Nevada: Optum criteria for UHC-branded plans; HPN/Sierra plans reviewed by HPN on InterQual. Plus Nevada’s NRS 689B.0335 mandate.

UnitedHealthcare has two faces in Nevada. National UnitedHealthcare-branded plans route ABA to Optum Behavioral Health and its ABA Supplemental Clinical Criteria. UnitedHealth’s local Nevada companies, Health Plan of Nevada (HMO), Sierra Health and Life and Sierra Health-Care Options, moved ABA to their own behavioral health team on November 1, 2025, reviewing every request against InterQual. The card tells you which track applies. On top of either sits Nevada’s autism mandate for state-regulated plans. Health Plan of Nevada also runs a Nevada Medicaid plan, which has its own guide.

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Required on Optum-managed plans: the ABA Supplemental Clinical Criteria require prior authorization for ABA “unless otherwise specified or mandated by contract or law.” Health Plan of Nevada, Sierra Health and Life and Sierra Health-Care Options require PA “for all ABA therapy services” from 11/1/2025 [5][10]
- **Prior auth for treatment** _(plan-dependent)_: Required. Optum plans: through Provider Express, with the review interval set per authorization. HPN/Sierra plans: through HPN’s Online Provider Center, reviewed on InterQual [5][10]
  - Ask the plan: The behavioral health number on the card: confirm whether Optum or HPN manages ABA for this plan and what review interval it sets.
- **Autism diagnosis required?**: Yes: DSM-5 ASD with severity level “confirmed and documented by the diagnosing clinician using at least one clinically validated tool” (Optum) [5]

## At a glance

- **Covers ABA?:** Yes, for ASD (Optum ABA criteria; HPN/Sierra on InterQual)
- **State mandate:** NRS 689B.0335 (group), 695C.1717 (HMO), 689C.1655 (small employer); individual plans must offer it as an option (NRS 689A.0435)
- **Mandate age:** Under 18, or until 22 if enrolled in high school
- **Mandate caps:** ABA up to the actuarial equivalent of $72,000 per year; no visit limits within it
- **Exempt from mandate:** Self-funded ERISA employer plans; individual plans only need to offer an option
- **Licensure:** Required: Nevada Board of Applied Behavior Analysis licenses behavior analysts and BCaBAs and registers RBTs (NRS 641D)
- **Fee schedule:** Not public — Optum pays up to the “Fee Maximum” in your agreement, by credential (HM/HN/HO/HP modifiers)

## Which UnitedHealthcare track applies

Optum-managed plans: the ABA Supplemental Clinical Criteria (BH803ABASCC; review 04/2026) require prior authorization for ABA “unless otherwise specified or mandated by contract or law,” a DSM-5 diagnosis and severity level confirmed with a validated tool, direct case supervision of “1–2 hours for every 10 hours of direct treatment per week,” and explanation when use falls below 80% of authorized hours. Optum’s ABA State Mandates supplement (effective July 2026) has sections for Arizona and California (commercial), Kansas, Massachusetts and New York (Medicaid) and Pennsylvania (commercial), and none for Nevada, so no Nevada-specific Optum criteria modify the commercial policy; Optum’s National Network Manual does carry Nevada Regulatory Requirements for contracts. [5][6][3][10]

Health Plan of Nevada, Sierra Health and Life and Sierra Health-Care Options: from November 1, 2025, “our Behavioral Health team will review all ABA therapy authorization requests, according to InterQual guidelines. A copy of the guidelines is available upon request. … prior authorization is required for all ABA therapy services, regardless of billed charges per service line.” Contracted providers submit through the Online Provider Center (provider.healthplanofnevada.com); non-contracted providers use phone 702-240-8733 or fax 702-341-7681. Provider Services: 702-242-7088 (option 2, then 5) or 1-800-745-7065. [5][6][3][10]

## The Nevada mandate: what it guarantees

Nevada’s autism mandate is written separately into each insurance chapter. For group policies, NRS 689B.0335 says a health benefit plan “must provide coverage for screening for and diagnosis of autism spectrum disorders and for treatment of autism spectrum disorders to persons covered by the policy of group health insurance under the age of 18 years or, if enrolled in high school, until the person reaches the age of 22 years.” HMOs (NRS 695C.1717) and small-employer plans (NRS 689C.1655) carry the same text. Individual policies are different: NRS 689A.0435 only requires the plan to “provide an option of coverage,” with a maximum benefit “of not less than” the same amount. The cap is set in subsection 2: coverage is subject to “A maximum benefit of the actuarial equivalent of $72,000 per year for applied behavior analysis treatment,” plus the policy’s ordinary cost sharing. Inside that cap the insurer “shall not limit the number of visits,” may not charge higher cost sharing or impose a longer wait than for other outpatient care, and “shall accept as dispositive any diagnosis of an autism spectrum disorder that is rendered in accordance with the statewide standard” set under NRS 427A.872. Treatment “must be identified in a treatment plan” prescribed and provided by a provider acting within scope, and the insurer “may request a copy of and review a treatment plan.” The statute defines behavioral therapy as therapy “provided by a licensed psychologist, licensed behavior analyst, licensed assistant behavior analyst or registered behavior technician,” and it does not require an insurer to reimburse a school for school services. The current text was last amended in 2025 and binds policies “delivered, issued for delivery or renewed on or after January 1, 2026.” It reaches state-regulated plans only; self-funded employer plans answer to ERISA. [11][2][13][1]

## Licensure and credentialing

Nevada licenses behavior analysts. Under NRS Chapter 641D a “behavior analyst” is a person with current BCBA or BCBA-D certification “and is licensed as a behavior analyst pursuant to this chapter”; an assistant behavior analyst is a licensed BCaBA; and a registered behavior technician must be BACB-certified and “registered as such pursuant to this chapter.” The Board of Applied Behavior Analysis (NRS 641D.200) issues those credentials, and the BACB’s licensure table lists Nevada with the NV Applied Behavior Analysis Board. Practicing ABA without the license or registration is prohibited (NRS 641D.900) and is a gross misdemeanor (NRS 641D.910); exemptions cover physicians, psychologists and certain other licensed professionals, family members acting at a behavior analyst’s direction, and school-district employees serving pupils (NRS 641D.110). An assistant behavior analyst or RBT may practice only under supervision by a licensed behavior analyst or a BCBA-certified licensed psychologist (an RBT may also be supervised by a qualified licensed assistant behavior analyst), and supervisors must follow BACB supervision rules (NRS 641D.610). Expect every payer to credential against the Nevada license number, not just the BACB number. [16][18]

## Can an out-of-state BCBA treat a Nevada member, including by telehealth?

Not without a Nevada license. NRS 641D.900 bars anyone from engaging “in the practice of applied behavior analysis unless he or she is licensed or registered as required by the provisions of this chapter.” Telehealth does not get around that: NRS 629.031 counts “A behavior analyst, assistant behavior analyst or registered behavior technician” as a provider of health care, and NRS 629.515 says that before a provider at a distant site “may use telehealth to direct or manage the care or render a diagnosis of a patient who is located at an originating site in this State,” the provider “must hold a valid license or certificate to practice his or her profession in this State.” A BCBA directing a Nevada child’s program from another state is therefore treated as practicing in Nevada and is “subject to the laws and jurisdiction of the State of Nevada.” The fast path is licensure by endorsement under NRS 641D.340: a behavior analyst who holds “a corresponding valid and unrestricted license as a behavior analyst” in another state or D.C. may apply, and unless the Board denies for good cause it must issue the license within 45 days of the application or 10 days after the fingerprint background report, whichever is later. Payers add their own layer: credential the clinician with each plan before billing. [16][17]

## What does UnitedHealthcare pay for ABA in Nevada?

UnitedHealthcare publishes no ABA rate table. Optum’s National Network Manual (effective Sept. 1, 2026) defines the Fee Maximum as the most a participating provider may be paid for a service and says “Reimbursement to clinicians is based upon licensure rather than degree.” Optum’s commercial ABA Reimbursement Policy (2022RP501A) puts the credential on every line: HM for an RBT, HN for a BCaBA, HO for a master’s-level BCBA, HP for a doctoral-level provider, noting that state requirements “may supplement, modify or supersede this policy.” Claims timing for state-regulated group policies is set by NRS 689B.255: the insurer “shall approve or deny a claim … within 21 days after the insurer receives the claim, if the claim is submitted electronically, or 30 days” on paper, and must pay an approved claim within the same period or owe interest “at a rate of 10 percent per annum.” A request for more information must come “within 20 working days” of receipt, and the clock restarts at 21 or 30 days from the additional information. A denial must state the reasons and the criteria the insurer applied. Self-funded plans follow their own documents and ERISA. For a public benchmark, Nevada Medicaid’s 07/2026 schedule pays 97153 at $30.10 per 15 minutes when billed by a BCBA and $13.01 by an RBT. [3][9][11][23]

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

Not for ABA. Optum, which manages UnitedHealthcare’s behavioral benefit, says in its National Network Manual (effective September 1, 2026) that a claim must carry the coding (ICD diagnosis, CPT/HCPCS and modifiers), the member ID number, customary charges, and the provider’s TIN and NPI. Paper Form 1500 claims add the member and subscriber names and dates of birth, the length of session, the type and duration of service, and the clinician’s name, credentials, Tax ID and NPI. A referring provider is not on either list. [3][4]

UnitedHealthcare’s 2026 administrative guide requires the referring provider’s name and NPI only on laboratory, DME, imaging and home health claims. For every other claim, it requires “a valid billing NPI, rendering NPI and relevant taxonomy code(s)” and says “we encourage you to submit the referring health care provider’s NPI.” In short, the referring NPI is optional on an ABA claim, and leaving it off is not a denial reason under either document. [3][4]

## Claim filing and payment rules in Nevada

Nevada sets the payment clock for state-regulated plans. A group or blanket insurer "shall approve or deny a claim ... within 21 days after the insurer receives the claim, if the claim is submitted electronically, or 30 days after the insurer receives the claim, if the claim is not submitted electronically," must pay an approved claim within the same period, and owes interest at 10 percent a year after that (NRS 689B.255; the individual-market rule, NRS 689A.410, is the same). A request for more information must come within 20 working days, and the clock restarts on receipt of it. The HMO section that used to carry the same rule (NRS 695C.185) is shown as repealed in 2025, so for an HMO product check the contract. Self-funded employer plans follow ERISA instead. [9][11][1][2][3][4]

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. [9][11][1][2][3][4]

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. [9][11][1][2][3][4]

## 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. [5]

## Intake gates

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

- **Who may diagnose**: Optum: a “state licensed clinician qualified to make such diagnosis” under DSM-5-TR. Nevada’s ABA licensure law excludes diagnosis from ABA practice (NRS 641D.080). [5][16]
- **Diagnostic tools required**: At least one clinically validated tool from Optum’s non-exhaustive list: screens (M-CHAT and others), second-level tools (CARS/CARS-2, RITA-T, STAT) and formal diagnostic tools (ADI-R, ADOS/ADOS-2, DISCO). [5]
- **Referral required?**: No separate physician referral in Optum’s criteria; prior authorization is the gate (HPN/Sierra: PA for all ABA therapy). For a state-regulated Nevada plan, autism treatment “must be identified in a treatment plan” and be prescribed by a provider of health care acting within scope, and the insurer “may request a copy of and review a treatment plan” (NRS 689B.0335(5)). Self-funded ERISA plans sit outside the statute. [5][10][11]
- **Age limit** _(plan-dependent)_: Optum’s criteria carry no age criterion; the benefit plan governs. For state-regulated Nevada group, small-employer and HMO plans, the mandate covers members “under the age of 18 years or, if enrolled in high school, until the person reaches the age of 22 years,” with ABA capped at the actuarial equivalent of $72,000 a year (NRS 689B.0335, 689C.1655, 695C.1717). Individual policies need only offer the coverage as an option (NRS 689A.0435). Self-funded ERISA plans are outside the statute. [5][11][2][13][1]
  - Ask the plan: Benefits check on the member ID: establish Nevada-insured vs. self-funded first.
- **Diagnosis recency** _(plan-dependent)_: Optum sets no expiry on the diagnosis but requires severity confirmed with a validated tool and reassesses progress over time. HPN/Sierra review on licensed InterQual criteria. [5][10]
  - In licensed criteria: HPN Behavioral Health (702-240-8733) for HPN/Sierra plans; Optum for UHC-branded plans.
- **Telehealth** _(plan-dependent)_: Optum’s Telehealth Billing guide (updated September 2025), commercial plans: “For ABA services, telehealth is only allowed for these 3 CPT codes: 97155, 97156 or 97157,” billed with POS 02 or 10. The 97151 assessment and 97153 are not on that list. Ask Optum how it applies the list to a Nevada-insured plan, since state law forbids treating telehealth differently. For a state-regulated group policy, NRS 689B.0369 requires coverage of services “provided to an insured through telehealth to the same extent as though provided in person,” bars the insurer from requiring prior authorization for a telehealth service “that is not required for that service when provided in person,” and forbids refusing coverage because of the originating site (the home counts) or the technology used; pay parity in the same amount applies to mental health treatment, including audio-only. NRS 629.515 separately requires the clinician to hold a Nevada license. Self-funded employer plans are outside the state statute. [7][11][17]
  - Ask the plan: Optum Provider Express or HPN Provider Services: ask which ABA codes are payable by telehealth on this Nevada plan.
- **Prior-auth decision time** _(plan-dependent)_: Depends on how the plan is funded. State-regulated plans fall under Nevada’s prior-authorization statute: unless a shorter period applies, a health carrier must respond “within: (1) Two business days after it receives the request; or (2)” any longer period the CAQH CORE Prior Authorization and Referrals Operating Rules allow, and in any case “within 7 calendar days after receiving the request” (NRS 687B.970). If the carrier violates that section for a particular request, “the request shall be deemed approved” (NRS 687B.990). The procedure “may not discriminate among persons licensed to provide the covered care.” 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 (or HPN) publishes no Nevada-specific ABA turnaround or reauthorization lead time. [15][19]
  - Ask the plan: At benefits verification ask whether the plan is Nevada-insured or self-funded (ERISA), who manages ABA, and the reauthorization lead time.
- **Other insurance (who pays first)** _(plan-dependent)_: For a child on two group policies, Nevada uses the birthday rule: when parents are not divorced or separated, “the primary policy is the policy of the parent whose birthday falls earlier in the year”; for divorced or separated parents the custodial parent’s policy pays first, then the custodial parent’s spouse’s, then the non-custodial parent’s, unless a court decree assigns responsibility (NRS 689B.064). A policy that does not coordinate is always primary. That rule binds state-regulated group policies; a self-funded plan sets its own order. If the child also has Nevada Medicaid, UnitedHealthcare pays first: Medicaid is the payer of last resort (42 CFR 433.139), and Nevada Medicaid tells providers to “Always follow other payers’ billing requirements. If the other payer denies a claim because you did not follow their requirements, Medicaid will also deny the claim.” TRICARE pays after this plan (10 U.S.C. 1079(i)(1)). [11][20][21][22]
  - Ask the plan: Ask UnitedHealthcare at benefits verification for the coordination-of-benefits order, and record every other coverage the child has.

## Delivery and billing rules

Coverage decides whether UnitedHealthcare / Optum in Nevada 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: “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 clinician, and Optum does not recommend parents serving as their own child’s RBT. In Nevada, BCaBAs and RBTs practice only under supervision meeting NRS 641D.610. HPN/Sierra publish no ratio of their own (InterQual is licensed). [5][16]
- **Daily limits / MUEs**: Optum’s commercial ABA reimbursement policy (2022RP501A, which applies to Commercial and Individual Exchange plans) sets a maximum frequency per day for each code: 97151 32 units (8 hrs), 97152 16 (4 hrs), 97153 32 (8 hrs), 97154 18 (4.5 hrs), 97155 24 (6 hrs), 97156 16 (4 hrs), 97157 16 (4 hrs), 97158 16 (4 hrs), 0362T 16 (4 hrs) and 0373T 32 (8 hrs). CMS MUEs otherwise apply, and billing more than 32 units of 97153 in a day "may be subject to non-reimbursement or recovery." There are no weekly unit caps. Weekly hours come from the authorization. No numeric daily cap in Optum’s criteria; hours must be justified by clinical need, and use below 80% of authorized hours must be explained. For state-regulated Nevada plans the mandate caps ABA at the actuarial equivalent of $72,000 a year and bars visit limits within it. [9][5][11]
- **Place of service**: Optum provides ABA at the least restrictive, most clinically appropriate level and excludes services that are not ABA, “such as 1:1 aid delivered simultaneously during classroom instruction,” and services covered under IDEA. Nevada’s mandate does not require reimbursing a school for school services (NRS 689B.0335(7)). [5][11]
- **Bill as provider** _(plan-dependent)_: Optum commercial: each line carries the rendering credential, HM (RBT), HN (BCaBA), HO (master’s-level BCBA) or HP (doctoral), per the ABA Reimbursement Policy. HPN/Sierra publish no rule. [9]
  - Ask the plan: For HPN/Sierra plans, HPN Provider Services (702-242-7088): ask whose NPI and which modifier go on technician lines.
- **Concurrent billing (97153 + 97155)** _(ask the plan)_: Not addressed in Optum’s criteria or HPN’s notice. [5][10]
  - Ask the plan: Optum Provider Express support or HPN Provider Services (702-242-7088), or your provider agreement.
- **Session-note signature** _(ask the plan)_: Not addressed. Optum’s criteria set coverage documentation, not who signs a session note or by when; HPN publishes nothing. [5][10]
  - Ask the plan: Optum National Network Manual documentation standards, or HPN Provider Services for HPN/Sierra plans.

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

- **Which UHC company:** UHC-branded (Optum manages ABA) vs. Health Plan of Nevada / Sierra (HPN reviews on InterQual). It changes the portal, criteria and phone numbers.
- **Plan funding type:** Fully insured Nevada plan (mandate applies) vs. self-funded ERISA (plan document governs).
- **Child’s age and school status:** The mandate stops at 18, or 22 if the child is still enrolled in high school.
- **Diagnosis with a validated tool:** DSM-5 ASD and severity level with a validated tool (ADI-R, ADOS-2, CARS-2 and others).

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

## 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.

### How fast must a Nevada insurer pay a clean ABA claim?

A group or individual insurer must approve or deny within 21 days of an electronic claim (30 days on paper) and pay within the same period, with 10% annual interest after that (NRS 689B.255, 689A.410). Self-funded employer plans follow ERISA instead.

### 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.

### Who reviews ABA for Health Plan of Nevada commercial members?

Since November 1, 2025, HPN’s own Behavioral Health team, using InterQual, for Health Plan of Nevada, Sierra Health and Life and Sierra Health-Care Options. UHC-branded plans use Optum.

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

No. Optum’s ABA State Mandates supplement does not list Nevada, so the national criteria apply, with Nevada’s mandate layered on for state-regulated plans.

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

Optum’s commercial guide allows only 97155, 97156 and 97157 by telehealth. Nevada-insured plans must cover telehealth on the same basis as in person under NRS 689B.0369, so ask Optum how it applies the list to your plan.

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

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

## Primary sources

1. [NRS 689A.410 — Individual health insurance: approval or denial of claims, payment and interest](https://www.leg.state.nv.us/NRS/NRS-689A.html)
2. [NRS chapter 695C — Health maintenance organizations (NRS 695C.185 shown as repealed by ch. 366, Statutes of Nevada 2025)](https://www.leg.state.nv.us/NRS/NRS-695C.html)
3. [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)
4. [2026 UnitedHealthcare Care Provider Administrative Guide (Commercial): Timely filing of corrected claims; Subrogation and COB](https://www.uhcprovider.com/content/dam/provider/docs/public/admin-guides/2026-UHC-Administrative-Guide.pdf)
5. [Optum ABA Supplemental Clinical Criteria (BH803ABASCC; review 04/2026)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/autismABA/abaSCC.pdf)
6. [Optum — ABA State Mandates supplemental criteria (BH803ABASTM, effective July 2026)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/guidelines/scc/ABA_SCC_SM.pdf)
7. [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)
8. [Optum National Network Manual (effective Sept. 1, 2026; lists Nevada Regulatory Requirements)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/adminResourcesMain/netwmanual/NNManual.pdf)
9. [Optum — ABA Reimbursement Policy, Commercial (2022RP501A)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/guidelines/reimbPolicies/abaReimburs2020s.pdf)
10. [Health Plan of Nevada — Update to prior authorization process for ABA therapy services (provider news, Oct. 22, 2025)](https://healthplanofnevada.com/content/dam/hpnv-public-sites/health-plan-of-nevada/provider/provider-news/2025/Oct%2022%202025%20ABA%20provider%20news%20email.html)
11. [NRS Chapter 689B — Group health insurance (689B.0335 autism, 689B.0369 telehealth, 689B.064 order of benefits, 689B.255 claims)](https://www.leg.state.nv.us/NRS/NRS-689B.html)
12. [NRS 695C.1717 — Health maintenance organizations: coverage for autism spectrum disorders](https://www.leg.state.nv.us/NRS/NRS-695C.html)
13. [NRS 689C.1655 — Small employer health benefit plans: coverage for autism spectrum disorders](https://www.leg.state.nv.us/NRS/NRS-689C.html)
14. [NRS 689A.0435 — Individual health insurance: option of coverage for autism spectrum disorders](https://www.leg.state.nv.us/NRS/NRS-689A.html)
15. [NRS 687B.900–687B.990 — Prior authorization (response deadlines; violation deems request approved)](https://www.leg.state.nv.us/NRS/NRS-687B.html)
16. [NRS Chapter 641D — Applied Behavior Analysis (licensure, endorsement, supervision, prohibited acts)](https://www.leg.state.nv.us/NRS/NRS-641D.html)
17. [NRS 629.031 and 629.515 — Provider of health care defined; Nevada license required for telehealth to a patient in Nevada](https://www.leg.state.nv.us/NRS/NRS-629.html)
18. [BACB — U.S. Licensure of Behavior Analysts (Nevada: NV Applied Behavior Analysis Board)](https://www.bacb.com/u-s-licensure-of-behavior-analysts/)
19. [29 CFR 2560.503-1 — ERISA claims procedure (eCFR)](https://www.ecfr.gov/current/title-29/section-2560.503-1)
20. [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)
21. [Nevada Medicaid and Nevada Check Up Billing Manual (updated July 10, 2026)](https://www.medicaid.nv.gov/Downloads/provider/nv_billing_general.pdf)
22. [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)
23. [Nevada Medicaid — Provider Type 85 ABA Reimbursement Schedule (rate data as of 07/2026)](https://www.nevadamedicaid.nv.gov/siteassets/content/resources/rates/pt-85-fee-schedule-072026.xlsx)

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.