---
title: "UnitedHealthcare / Optum ABA coverage in Oregon: the intake guide."
url: "https://carelu.com/payers/unitedhealthcare-oregon"
markdown_url: "https://carelu.com/payers/unitedhealthcare-oregon.md"
state: OR (Oregon)
payer: UnitedHealthcare / Optum in Oregon
kind: Commercial insurance
description: "How UnitedHealthcare / Optum covers ABA for Oregon families: Optum’s ABA criteria and reimbursement policy, telehealth limits, Oregon’s 2013 ABA mandate and ORS 743A.168 parity, Oregon licensure, and what intake should verify."
last_reviewed: October 2026
---

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

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

> Optum ABA criteria (BH803ABASCC) + Oregon’s 2013 ABA mandate and ORS 743A.168 parity; no Oregon state supplement; telehealth limited to 97155–97157.

For an intake team in Oregon, a UnitedHealthcare card usually means Optum Behavioral Health administers ABA under its national Supplemental Clinical Criteria, with Oregon’s ABA mandate and parity law layered on for state-regulated plans. UnitedHealthcare is not one of Oregon’s OHP coordinated care organizations, so a UHC card here is commercial (or Medicare).

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Required: the Optum ABA Supplemental Clinical Criteria say "Prior authorization is required for ABA" unless otherwise specified or mandated by contract or law [2]
- **Prior auth for treatment** _(plan-dependent)_: Required; continued treatment is re-reviewed with updated documentation, and under-use below 80% of authorized hours is examined [2]
  - Ask the plan: Optum Provider Express or the behavioral health number on the card: ask what review interval applies to this authorization.
- **Autism diagnosis required?**: Yes: a DSM-5-TR ASD diagnosis by a state-licensed physician, psychologist or other qualified clinician, confirmed with at least one clinically validated tool [2]

## At a glance

- **Covers ABA?:** Yes, for ASD, per Optum’s ABA Supplemental Clinical Criteria
- **State mandate:** Oregon Laws 2013, ch. 771, §2 (SB 365; ABA mandate, compiled after ORS 743A.264, repeal date Jan. 2, 2030) + ORS 743A.168 parity + ORS 743A.190
- **Mandate age:** The ABA section applies when coverage is first requested before age 9 (treatment begun before 9); it does not limit ABA otherwise owed under ORS 743A.168 parity at older ages. ORS 743A.190 covers children under 18 with a pervasive developmental disorder
- **Mandate caps:** No dollar cap. The 2013 section covers ABA up to 25 hours/week and lets insurers require PA up to that level (decision within 30 days); hours above 25 are not limited by the section
- **Exempt from mandate:** Self-funded ERISA employer plans (outside state insurance law); IEP services, family-member services and DHS/OHA services are excluded from the 2013 section
- **Licensure:** Yes: Behavior Analysis Regulatory Board (HLO) licenses behavior analysts and assistant behavior analysts and registers interventionists (ORS 676.802–676.830)
- **Fee schedule:** Not public — Optum pays up to the “Fee Maximum” in your agreement, with credential modifiers (HM/HN/HO/HP)

## The national policy, applied in Oregon

Optum’s ABA Supplemental Clinical Criteria (interim review April 2026) require prior authorization, a DSM-5-TR ASD diagnosis confirmed "using at least one clinically validated tool" (screens such as M-CHAT, second-level tools such as CARS-2, RITA-T, STAT, and formal tools such as ADI-R, ADOS-2 and DISCO), and a credentialed ABA provider (a master’s- or doctoral-level BCBA or a credentialed licensed clinician, with BCaBAs and technicians under direct supervision). Treatment intensity is set from a baseline tool such as VB-MAPP, ABLLS-R, AFLS or Vineland, and "direct case supervision is required 1–2 hours for every 10 hours of direct treatment per week." Optum’s ABA State Mandates supplement (July 2026) has no Oregon entry, so the national criteria apply with Oregon law on top. [2][3]

## The Oregon mandate: what it guarantees

Oregon’s ABA mandate is not in the numbered ORS. It is section 2 of chapter 771, Oregon Laws 2013 (SB 365), printed as a note after ORS 743A.264 and set to be repealed January 2, 2030. It requires a health benefit plan to cover screening for and diagnosis of autism spectrum disorder "by a licensed neurologist, pediatric neurologist, developmental pediatrician, psychiatrist or psychologist, who has experience or training in the diagnosis of autism spectrum disorder," and "medically necessary treatment for autism spectrum disorder and the management of care, for an individual who begins treatment before nine years of age." Treatment "includes applied behavior analysis for up to 25 hours per week," and the section "applies to coverage for up to 25 hours per week of applied behavior analysis for an individual if the coverage is first requested when the individual is under nine years of age." It is not a ceiling: the section "does not limit coverage for any services that are otherwise available" under ORS 743A.168 or 743A.190, including ABA "for more than 25 hours per week" or ABA first requested at age nine or older. ORS 743A.168, Oregon’s behavioral health parity law, requires group and non-grandfathered individual plans to cover medically necessary behavioral health treatment "at the same level as, and subject to limitations no more restrictive than," other medical conditions; ORS 743A.190 separately requires coverage of medically necessary services for a child under 18 diagnosed with a pervasive developmental disorder. Under the 2013 law an insurer may require prior authorization "for coverage of a maximum of 25 hours per week" of ABA recommended in a treatment plan approved by one of the listed professionals, "as long as the insurer makes a prior authorization determination no later than 30 calendar days after receiving the request," may require an updated treatment plan "not more than once every six months," and must continue approved ABA while the child "continues to make progress toward the majority of the goals" and it remains medically necessary. It does not require coverage of services under an IEP, services by a family or household member, or "telemedicine" (a separate statute, ORS 743A.058, now requires telemedicine coverage generally). Covered settings include "the individual’s home or a licensed health care facility" or a setting approved by the licensed provider. The mandate reaches state-regulated plans only; self-funded employer plans answer to ERISA and federal parity. [7]

## Licensure and out-of-state BCBAs

Oregon licenses behavior analysts. ORS 676.806 creates the Behavior Analysis Regulatory Board within the Health Licensing Office; under ORS 676.810 it licenses behavior analysts and assistant behavior analysts (a fingerprint-based records check is required, and BACB certification may be), and under ORS 676.815 the Office registers behavior analysis interventionists, who must be 18, hold a diploma or equivalent, pass the fingerprint check, complete "at least 40 hours of professional training," and "receive ongoing training and supervision" by a licensed behavior analyst, licensed assistant behavior analyst or licensed health care professional. A provisional interventionist registration must issue within five business days of a complete application. Only licensees and registrants may use the titles "licensed behavior analyst," "licensed assistant behavior analyst" or "registered behavior analysis interventionist." OAR 824-040-0010 sets the interventionist supervision floor: direct and indirect supervision "for at least 5 percent of the interventionist’s service hours," with direct supervision at least once per calendar month. What that means for an out-of-state BCBA: the Oregon license rule (OAR 824-030-0010) has no reciprocity, temporary-permit or telehealth exemption; it asks applicants for "an affidavit of licensure from any state where the individual holds or has held a license." The payers’ own definitions point the same way. The commercial mandate defines ABA as provided by an Oregon-licensed health care professional, a behavior analyst or assistant licensed under ORS 676.810, or a registered interventionist; OHP pays directly only a Licensed Behavior Analyst, a licensed health care professional, or a declarant; and the telemedicine statute defines a "health professional" as one "licensed, certified or registered in this state." So plan on an Oregon license before treating an Oregon member, including by telehealth. The Health Licensing Office says it does not give individualized advice on how the law applies to a practice. ORS 676.830 lets each health plan set its own ABA credentialing requirements. [9][10][11][12][13][7][24]

## Claims, coding and rates

Claims timing in Oregon’s commercial market is set by statute. ORS 743B.450 requires an insurer to "pay a clean claim or deny the claim not later than 30 days after the date on which the insurer receives the claim" (or within 30 days of receiving requested additional information), and ORS 743B.452 adds "simple interest of 12 percent per annum" on late payments. For utilization review, ORS 743B.423 generally requires a determination on a non-emergency request "no later than two business days after receipt," but the ABA mandate lets an insurer take up to 30 calendar days on an ABA prior authorization "notwithstanding ORS 743B.423." Approved treatment (other than drugs) is binding for the later of its reasonable duration or "Sixty days after the date that the treatment begins," and an insurer must give participating providers 60 days’ notice before adding new utilization review requirements. Self-funded employer plans follow ERISA instead. [4][1][21][8][7][16][4][1][20]

Optum’s commercial ABA Reimbursement Policy (updated June 2026) requires a credential modifier on every line: HM for an RBT, HN for a BCaBA, HO for a master’s-level BCBA or licensed clinician, HP for a BCBA-D or doctoral-level licensee; indirect work has no separate code and is bundled. It lists maximum units per day (97151 32, 97152 16, 97153 32, 97154 18, 97155 24, 97156–97158 16, 0362T 16, 0373T 32). Optum’s network manual defines the "Fee Maximum" as "The maximum amount a participating provider may be paid for a specific health care service," and says "Reimbursement to clinicians is based upon licensure rather than degree." For a public benchmark, Oregon’s OHP fee-for-service schedule pays 97153 at $14.70 per 15 minutes. [4][1][21][8][7][16][4][1][20]

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. [4][1][21][8][7][16][4][1][20]

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. [4][1][21][8][7][16][4][1][20]

## 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. [21][4]

So box 17 is not a published condition of a UnitedHealthcare ABA claim in Oregon; the authorization is. Enter a referring provider only when one exists. [21][4]

## 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][4]

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][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. [2]

## Intake gates

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

- **Diagnosis recency**: No expiry on the diagnosis; it must be confirmed with severity level using a validated tool. Progress is reviewed over six-month periods. [2]
- **Who may diagnose**: A state-licensed physician, psychologist or other state-licensed clinician qualified to diagnose under DSM-5-TR. For fully insured Oregon plans the mandate covers diagnosis by a licensed neurologist, pediatric neurologist, developmental pediatrician, psychiatrist or psychologist experienced in ASD. [2][7]
- **Diagnostic tools required**: At least one clinically validated tool from a non-exhaustive list: first-level screens (ABC, M-CHAT and others), second-level tools (CARS/CARS-2, RITA-T, STAT), and formal diagnostic tools (ADI-R, ADOS/ADOS-2, DISCO). [2]
- **Referral required?**: No separate physician referral in Optum’s criteria; prior authorization is required. For a fully insured Oregon plan, the 2013 ABA section lets the insurer require an individualized treatment plan approved by a licensed neurologist, pediatric neurologist, developmental pediatrician, psychiatrist or psychologist, updated no more than once every six months, and a re-diagnosis by one of them if the original diagnosis was made by someone else. Self-funded ERISA plans sit outside the statute. [2][7]
- **Age limit** _(plan-dependent)_: Optum’s criteria carry no age criterion; the member’s plan governs. For a fully insured Oregon plan, the 2013 ABA section (ch. 771, §2) applies to ABA first requested before age nine, up to 25 hours a week, and says it does not limit ABA otherwise owed under ORS 743A.168 parity (including at older ages or above 25 hours). Self-funded ERISA plans are outside the statute, so the funding type decides whether this binds. [2][7]
  - Ask the plan: Provider Express benefits check or the behavioral health number on the card: establish fully insured vs. self-funded ERISA first.
- **Telehealth** _(plan-dependent)_: Optum’s Telehealth Billing guide (September 2025), commercial plans: "For ABA services, telehealth is only allowed for these 3 CPT codes: 97155, 97156 or 97157." Claims must carry POS 02 or POS 10. So the 97151 assessment and 97153 technician time are not on Optum’s commercial telehealth list. For a fully insured Oregon plan, ORS 743A.058 requires coverage of a health service delivered by telemedicine when the plan covers it in person, it is medically necessary, and it can be "safely and effectively provided using telemedicine"; the plan may not impose different prior authorization requirements or restrict originating sites, and must pay "the same reimbursement" as in person. The statute defines a "health professional" as one licensed, certified or registered in Oregon. Self-funded employer plans are outside it. [5][7]
  - Ask the plan: Optum Provider Express support: for a fully insured Oregon plan, ask how Optum applies its three-code list alongside ORS 743A.058.
- **Prior-auth decision time** _(plan-dependent)_: Depends on how the plan is funded. For a fully insured Oregon plan, the ABA mandate lets the insurer require prior authorization of up to 25 hours a week of ABA "as long as the insurer makes a prior authorization determination no later than 30 calendar days after receiving the request, notwithstanding ORS 743B.423"; for other utilization review ORS 743B.423 requires a decision "no later than two business days after receipt," with the same two business days to ask for missing information. An approved treatment is binding for the later of its reasonable duration or 60 days after it begins. Self-funded employer (ERISA) plans follow 29 CFR 2560.503-1: pre-service decisions "not later than 15 days after receipt of the claim," one 15-day extension, urgent care within 72 hours. [7][8][16]
  - Ask the plan: At benefits verification ask whether the plan is fully insured (Oregon-regulated) or self-funded (ERISA), and what reauthorization lead time Optum expects.
- **Other insurance (who pays first)** _(plan-dependent)_: For a child on two state-regulated group plans, Oregon’s coordination-of-benefits rule follows the birthday rule: for parents married or living together, "The plan of the parent whose birthday falls earlier in the calendar year is the primary plan" (OAR 836-020-0785); for separated parents a court decree controls when the plan knows of it, and otherwise the custodial parent’s plan pays first, then the custodial parent’s spouse’s, then the non-custodial parent’s. A self-funded plan sets its own order. If the child also has OHP, the commercial plan pays first: OHA "shall be the payer of last resort" and providers "shall make reasonable efforts to obtain payment first from other resources" (OAR 410-120-1280; 42 CFR 433.139). TRICARE pays after this plan (10 U.S.C. 1079(i)(1)); CHAMPVA is the last payer (38 CFR 17.270). [14][15][17][18][19]
  - Ask the plan: Ask UnitedHealthcare/Optum at benefits verification for the member’s coordination-of-benefits order.

## Delivery and billing rules

Coverage decides whether UnitedHealthcare / Optum in Oregon pays. These decide whether the claim survives: staffing and supervision, concurrent billing, per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.

- **Supervision**: Consistent with CASP standards, direct case supervision is required 1–2 hours for every 10 hours of direct treatment per week. Technicians work under a BCBA or licensed behavioral health clinician and should be RBTs or otherwise certified "as allowable by state mandate"; Optum does not recommend parents serving as their own child’s RBT. In Oregon, interventionists must also be registered and supervised for at least 5 percent of service hours (OAR 824-040-0010). [2][11]
- **Concurrent billing (97153 + 97155)**: Allowed with limits. Optum’s reimbursement policy: "Can I report 97153 or 97154 with 97155 concurrently? A. Yes, as long as the criteria in the descriptors of both codes are met. A single QHP may not report 97153 or 97154 with 97155 concurrently." 97155 and 97156 may be billed the same day only at different times. [4]
- **Daily limits / MUEs**: Per-day maximums in the reimbursement policy: 97151 32 units, 97152 16, 97153 32, 97154 18, 97155 24, 97156 16, 97157 16, 97158 16, 0362T 16, 0373T 32. No weekly hour cap; hours must be justified by documented clinical need, and use below 80% of authorized hours over two weeks is reviewed. [4][2]
- **Place of service**: ABA is provided at the least restrictive, most clinically appropriate level and "should not be restricted to specific settings." Not covered: services that are not ABA, "such as 1:1 aid delivered simultaneously during classroom instruction," or services covered under IDEA; school coordination (teacher training, meetings, observations) is covered. [2]
- **Bill as provider**: Every line carries the rendering credential: HM (RBT), HN (BCaBA), HO (BCBA or master’s-level licensed clinician), HP (BCBA-D or doctoral-level licensee); 97151 and 97155–97158 allow HN, HO or HP only. Optum notes state requirements "may supplement, modify or supersede" the HM definition, so Oregon interventionist registration applies. [4][9]
- **Session-note signature** _(ask the plan)_: Not addressed. The criteria and reimbursement policy set what must be documented, not who signs a session note or when. [2][4]
  - Ask the plan: Optum National Network Manual documentation standards and your participating-provider agreement.

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

- **Plan funding type:** Fully insured (Oregon law applies) vs. self-funded ERISA (plan document governs).
- **Diagnosis with a validated tool:** DSM-5-TR ASD and severity level, confirmed with a validated tool (ADOS-2, ADI-R, CARS-2 and others).
- **Baseline measurement:** VB-MAPP, ABLLS-R, AFLS, Vineland or similar to justify intensity.
- **Credential per staff member:** Each claim line needs the right modifier (HM RBT, HN BCaBA, HO BCBA, HP BCBA-D) plus Oregon licensure/registration.

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.

### 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 Oregon?

Yes, under Optum’s national ABA criteria for ASD, with Oregon’s ABA mandate and ORS 743A.168 parity applying to state-regulated plans.

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

No. Optum’s ABA State Mandates supplement (July 2026) has no Oregon entry.

### Can 97153 and 97155 be billed at the same time with UnitedHealthcare?

Yes, by different people: Optum allows 97153 or 97154 concurrently with 97155 when both code descriptors are met, but a single QHP may not report both for the same time.

### Which ABA codes can be done by telehealth with UnitedHealthcare?

On commercial plans Optum allows only 97155, 97156 and 97157, billed with POS 02 or 10. Fully insured Oregon plans are also subject to ORS 743A.058.

### Is UnitedHealthcare an Oregon Health Plan CCO?

No. OHP is delivered by coordinated care organizations such as Health Share, Trillium and PacificSource Community Solutions.

### 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; annual review 8/2025, interim review 4/2026)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/autismABA/abaSCC.pdf)
3. [Optum — ABA State Mandates supplemental criteria (BH 803ABA STM72026, July 2026; no Oregon entry)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/guidelines/scc/ABA_SCC_SM.pdf)
4. [Optum — ABA Reimbursement Policy, Commercial (2022RP501A, updated June 2026)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/guidelines/reimbPolicies/abaReimburs2020s.pdf)
5. [Optum — 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)
6. [Optum Behavioral Health National Provider Network Manual (BH02330, published July 1, 2026, effective Sept. 1, 2026)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/adminResourcesMain/netwmanual/NNManual.pdf)
7. [ORS chapter 743A — ORS 743A.058 (telemedicine), 743A.168 (behavioral health parity), 743A.190 (pervasive developmental disorder), and Oregon Laws 2013, ch. 771, §2 (ABA mandate, compiled as a note after ORS 743A.264)](https://www.oregonlegislature.gov/bills_laws/ors/ors743A.html)
8. [ORS chapter 743B — ORS 743B.423 (utilization review), 743B.450 (prompt payment), 743B.452 (interest)](https://www.oregonlegislature.gov/bills_laws/ors/ors743B.html)
9. [ORS 676.802–676.830 — Applied behavior analysis: Behavior Analysis Regulatory Board, licensure, interventionist registration, titles, health plan credentialing](https://www.oregonlegislature.gov/bills_laws/ors/ors676.html)
10. [OAR 824-030-0010 — Licensing of Behavior Analyst (eff. 2/1/2023)](https://secure.sos.state.or.us/oard/view.action?ruleNumber=824-030-0010)
11. [OAR 824-040-0010 — Training and Supervision of registered behavior analysis interventionists (eff. 2/1/2018)](https://secure.sos.state.or.us/oard/view.action?ruleNumber=824-040-0010)
12. [Oregon Health Licensing Office — Behavior Analysis Regulatory Board](https://www.oregon.gov/oha/PH/HLO/Pages/Board-Behavior-Analysis-Regulatory.aspx)
13. [BACB — U.S. Licensure of Behavior Analysts (Oregon: 2013, OR Behavior Analysis Regulatory Board)](https://www.bacb.com/u-s-licensure-of-behavior-analysts/)
14. [OAR 836-020-0785 — Rules for Coordination of Benefits (order of benefit determination; eff. 1/1/2014)](https://secure.sos.state.or.us/oard/view.action?ruleNumber=836-020-0785)
15. [OAR 410-120-1280 — Billing (third-party resources; OHA as payer of last resort)](https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-120-1280)
16. [29 CFR 2560.503-1 — ERISA claims procedure (eCFR)](https://www.ecfr.gov/api/renderer/v1/content/enhanced/current/title-29?part=2560&section=2560.503-1)
17. [42 CFR 433.139 — Medicaid third-party liability (eCFR)](https://www.ecfr.gov/api/renderer/v1/content/enhanced/current/title-42?part=433&section=433.139)
18. [10 U.S.C. 1079(i)(1) — TRICARE pays after other coverage except Medicaid](https://www.govinfo.gov/content/pkg/USCODE-2023-title10/html/USCODE-2023-title10-subtitleA-partII-chap55-sec1079.htm)
19. [38 CFR 17.270 — CHAMPVA is the last payer (eCFR)](https://www.ecfr.gov/api/renderer/v1/content/enhanced/current/title-38?part=17&section=17.270)
20. [OHA — OHP Fee-for-Service Behavioral Health Fee Schedule, Applied Behavior Analysis tab (update published 7/1/2026)](https://www.oregon.gov/oha/HSD/OHP/DataReportsDocs/bh-fee-schedule0726.xlsx)
21. [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)
22. [Optum — ABA Reimbursement Policy, Commercial (2022RP501A, updated 06/2026)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/guidelines/reimbPolicies/abaReimburs2020s.pdf)
23. [Optum — ABA Supplemental Clinical Criteria (BH803ABASCC)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/autismABA/abaSCC.pdf)
24. [OAR 410-172-0760 — Applied Behavior Analysis (OHA, eff. 01/09/2025)](https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-172-0760)

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.