For an intake team in Wyoming, a UnitedHealthcare card means three layers: Optum Behavioral Health’s national ABA criteria, Wyoming’s parity-based autism coverage (Bulletin 01-2019, since Wyoming has no autism statute), and the plan’s funding type, which decides whether the bulletin applies. Wyoming Medicaid has no managed care plans, so a UHC card here is commercial or Medicare.
UnitedHealthcare administers ABA through Optum Behavioral Health under the ABA Supplemental Clinical Criteria (BH803ABASCC; interim review April 2026): prior authorization for ABA, assessment first and treatment second, with continued-service review looking hard at use below 80% of authorized hours. Optum’s ABA State Mandates supplement (annual review July 2026) covers Arizona, California, Connecticut, Florida, Indiana, Kansas, Kentucky, Maryland, Massachusetts, New Jersey, New York, Ohio, Pennsylvania and Virginia; Wyoming is not there, so no Wyoming-specific criteria modify the commercial policy. Optum’s National Network Manual points to separate "Wyoming Regulatory Requirements" for contract terms.[1][2][5][10]
The criteria want the diagnosis from "a state licensed physician, psychologist, or other state licensed clinician," and the credentialed ABA provider to be a BCBA or licensed behavioral health clinician, with technicians who "should be registered behavior technicians (RBT) or another appropriately certified behavior technician as allowable by state mandate." In Wyoming the BCBA also needs the state behavior-analyst license.[1][2][5][10]
Wyoming has no autism insurance statute, and intake should say so plainly. The state’s autism coverage comes from mental-health parity. W.S. 26-20-701 (the Mental Health and Substance Use Disorder Insurance Parity Act, House Enrolled Act 89, signed February 27, 2019) requires individual and group health insurance policies, nonprofit service contracts and HMO contracts to meet the federal Mental Health Parity and Addiction Equity Act. On April 19, 2019 the Insurance Department issued Bulletin No. 01-2019 applying it to autism: "treatments for Autism Spectrum Disorder cannot be excluded from the mental health services in an insurance policy," for "all individual and group health insurance policies that offer mental health benefits and are under the jurisdiction of the Department," effective "no later than July 1, 2019." Three lines matter most for ABA. "Exclusion of Applied Behavior Analysis (ABA) therapy to treat children with autism spectrum disorder on the basis that ABA therapy is experimental or investigational treatment will not be allowed." Autism benefits "may not be subject to any separate cost-sharing requirements or treatment limitation that only apply to mental health/substance use disorder benefits," and any quantitative or non-quantitative limit (including preauthorization and medical-necessity rules) must match what applies to medical/surgical benefits in the same classification. And carriers may still review medical necessity, including periodic review of continuing treatment, if the review is no more stringent than for medical/surgical care. The bulletin defines treatment as "evidence-based care and related equipment prescribed or ordered for an individual diagnosed with an autism spectrum disorder by a licensed physician or a licensed psychologist who determines the care to be medically necessary, including but not limited to behavioral health treatment." It sets no age limit and no dollar cap. Its limits: a bulletin is weaker than a statute; it reaches only policies that include mental health coverage; and self-funded employer plans regulated by ERISA are outside the Department’s jurisdiction.[6][7][8]
Wyoming licenses behavior analysts. Since 2022 (HB0110, Enrolled Act 18) the State Board of Psychology "shall issue a license as a behavior analyst or an assistant behavior analyst" to an applicant who "holds a current certification as a board certified behavior analyst" (or BCaBA) verified with the certifying entity (W.S. 33-27-124(a)); the Board’s rules name "The BACB" as "the sole certifying entity recognized by the Board" and require BACB verification, license verification from every other state, proof of lawful presence and fingerprint cards (Rules ch. 4, § 4-3). A licensed assistant behavior analyst practices "only under the supervision of a licensed behavior analyst or licensed psychologist" (33-27-124(c)); the Board’s rule requires that supervision to be "at least two percent (2%) of the total behavior-analytic service hours provided per month," with at least one meeting a month (Board Rules ch. 14, § 14-5). Behavior technicians are not licensed: 33-27-125(a)(viii) exempts a technician "under the supervision of a licensed behavior analyst or licensed assistant behavior analyst," who may not design assessment or intervention plans, and (ix) exempts a caregiver working under that analyst’s direction. Representing yourself as a behavior analyst and practicing without a license or an exemption is a misdemeanor (33-27-119(b)). For a BCBA licensed in another state there is no shortcut written down for behavior analysts: 33-27-124(b) lets the Board license someone "currently licensed as a behavior analyst … in good standing in another jurisdiction that has licensure requirements comparable to" Wyoming’s, but that is still a Wyoming license, and the Board’s temporary 30-day license (Rules ch. 3, § 3-1) is written only for psychologists. Payers add their own floor: Wyoming Medicaid says a telehealth provider "must be licensed by, or otherwise under the jurisdiction of, the appropriate State of Wyoming licensing board," and BCBSWY says telemedicine providers "must be licensed in Wyoming." Plan on a Wyoming license for any BCBA treating a Wyoming child, including by telehealth. Credentialing has a state clock: under W.S. 26-56-102 a carrier must acknowledge an application within 7 calendar days, flag an incomplete one within 30, and "conclude the process of credentialing … within sixty (60) calendar days," and once you are credentialed with a contract in effect it must pay covered services "beginning with the date the health carrier received a completed credentialing application." Commercial ABA rates are negotiated and unpublished; the only public benchmark is the Wyoming Medicaid fee schedule (97153 $12.30 and 97155 $24.60 per 15-minute unit from July 1, 2026).[10][11][12][21][22][13][23][24][8][18]
Wyoming’s insurance code sets three clocks that apply to fully insured plans. Claims: "Claims for benefits under a life, accident or health insurance policy shall be rejected or accepted and paid by the insurer … within forty-five (45) days after receipt of the proofs of loss and supporting evidence" (W.S. 26-15-124(a)); a court can add attorney’s fees and 10% interest when a refusal to pay is unreasonable. Prior authorization: the Ensuring Transparency in Prior Authorization Act (W.S. 26-55, effective July 1, 2024) requires a decision on a non-urgent request "within five (5) calendar days of obtaining all necessary information" and on an urgent one within 72 hours, after which an urgent request "shall be considered authorized"; it defines urgent services to "include mental and behavioral health care services." Outpatient authorizations must be valid for "not less than one (1) year," an approval cannot be revoked if the service is delivered within 45 business days, a new plan must honor a prior plan’s authorization for at least 90 days, a peer-to-peer must be offered within 5 business days of a denial, and since January 1, 2026 a provider whose requests for a service were at least 90% approved (minimum five requests) in the past 12 months is exempt from PA for that service for a year (26-55-112). Telehealth: a policy covering mental health may not deny coverage for a service "delivered using remote audio or audio-visual delivery systems" if it would cover it in person, may not charge higher cost-sharing, and may not pay the provider less than in person (W.S. 26-20-701(b)). Autism treatment counts as mental health under the Department’s Bulletin 01-2019. Whether a given ABA code is "covered in person" is still the plan’s call, and self-funded ERISA plans sit outside all three statutes.[8][9][6][3][4][5][1]
Optum’s commercial ABA reimbursement policy (updated June 2026) adds the coding rules: every line carries a credential modifier (HM for an RBT, HN for a BCaBA, HO for a master’s-level BCBA, HP for a BCBA-D), "There is no CPT code for reporting indirect services separately," and Optum "allows 32 units per day for CPT code 97153."[8][9][6][3][4][5][1]
Billing details from Optum’s own documents. Codes: the commercial ABA reimbursement policy (2022RP501A) covers ABA billed "with CPT codes 97151-97158" plus 0362T and 0373T, each line with its credential modifier; it lists no HCPCS H-code. Telehealth: claims "must include either POS 02 or POS 10" (10 when the member is at home), and "Optum will not reimburse for services billed with only telehealth modifiers"; modifiers 93, 95, FQ, GT and GQ are optional, and commercial ABA telehealth covers only 97155, 97156 and 97157. Filing: claims are due "no more than 90 calendar days from the date of service, or as allowed by state or federal law or the member’s specific benefit plan," and "Any corrections or additions to a claim should be made within 90 days of initial claim receipt." Payment: clean claims with any required authorization are generally paid within 45 calendar days of receipt or as state and federal law requires, which may exclude claims needing a coordination-of-benefits determination. Reauthorization (Supplemental Clinical Criteria): each continued-service review needs progress for every target "including the same modes of measurement that were utilized for baseline," with "rate and percentage of mastered programs, rates of mastered targets, change scores for any outcome measures, updated standardized adaptive measures"; inadequate progress over a 6-month period requires an analysis and modified interventions. Graphs are not named. Supervision: "direct case supervision is required 1–2 hours for every 10 hours of direct treatment per week," with no published cap on technicians per BCBA.[8][9][6][3][4][5][1]
UnitedHealthcare publishes no ABA rate table; Optum pays from the contract. Optum’s National Network Manual (effective Sept. 1, 2026) defines the "Fee Maximum" as "The maximum amount a participating provider may be paid for a specific health care service provided to a member," adding that "Reimbursement to clinicians is based upon licensure rather than degree." The ABA reimbursement policy makes the credential level part of every claim line through the HM/HN/HO/HP modifiers. Ask Optum network management for your rate sheet. For a public benchmark, Wyoming Medicaid pays 97153 at $12.30 per 15 minutes from July 1, 2026; commercial contracts are negotiated separately.[5][3][18]
The questions that decide whether a family can start with UnitedHealthcare / Optum in Wyoming, and what they have to bring. Each maps onto something intake should ask on the first call.
No expiry on the diagnosis; it must be confirmed with severity level using validated tools. Use below 80% of authorized hours triggers review.[1]
"A state licensed physician, psychologist, or other state licensed clinician qualified to make such diagnosis."[1]
At least one clinically validated tool from Optum’s non-exhaustive list, which includes formal diagnostic tools such as the ADI, ADOS/ADOS-2 and DISCO.[1]
No separate physician referral in the SCC; prior authorization is required, run as a two-step Optum flow on Provider Express. Wyoming’s Bulletin 01-2019 defines covered autism treatment as care "prescribed or ordered for an individual diagnosed with an autism spectrum disorder by a licensed physician or a licensed psychologist," so keep that prescription or order on file for a fully insured plan. Self-funded ERISA plans sit outside the bulletin.[1][6]
The SCC carry no age criterion; the member’s benefit plan governs. For fully insured Wyoming plans that include mental health coverage, Bulletin 01-2019 sets no age limit and no dollar cap, and bars autism-only limits that do not apply to medical/surgical benefits. Self-funded ERISA plans are outside it, so plan funding type decides whether that binds.[1][6]
Ask the plan: Provider Express benefits check or the behavioral health number on the card: establish fully insured vs. self-funded ERISA first.
Three codes. Optum’s Telehealth Billing guide (updated September 2025), commercial: "For ABA services, telehealth is only allowed for these 3 CPT codes: 97155, 97156 or 97157," billed with POS 02 or 10. So the 97151 assessment and technician 97153 are not on Optum’s telehealth list. For a fully insured Wyoming plan, W.S. 26-20-701(b) says a policy covering mental health may not "deny coverage for mental health or substance use services delivered using remote audio or audio-visual delivery systems … if coverage would be provided for the same services when delivered in person." Ask Optum how it applies the three-code list to a fully insured Wyoming plan. Optum’s guide makes modifiers 93, 95, FQ, GT and GQ optional; the POS is what marks the claim as telehealth, and the authorization does not need a telehealth flag in any Optum document read.[4][8]
Ask the plan: Optum Provider Express support, (866) 209-9320: ask whether the plan is fully insured in Wyoming and which ABA codes it will pay by telehealth.
Depends on how the plan is funded. Fully insured plans fall under W.S. 26-55: a non-urgent prior-authorization decision is due "within five (5) calendar days of obtaining all necessary information to complete the review," and an urgent one within 72 hours, after which it "shall be considered authorized." The Act defines urgent health care services to "include mental and behavioral health care services," which read literally puts behavioral health requests, ABA included, on the 72-hour clock; ask the carrier how it applies that. An outpatient authorization must be valid for "not less than one (1) year" (one year for a chronic condition), and a peer-to-peer must be offered within 5 business days of an adverse determination. 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. UnitedHealthcare/Optum publishes no Wyoming-specific ABA turnaround or reauthorization lead time.[8][9][14]
Ask the plan: At benefits verification ask whether the plan is fully insured (Wyoming-regulated) or self-funded (ERISA), whether UnitedHealthcare/Optum treats ABA as an urgent behavioral health service under W.S. 26-55-102(a)(x), and what authorization length and reauthorization lead time it will use.
Wyoming’s Insurance Department rule on coordination of benefits (Rules ch. 10, § 10-3, amended effective 9/13/2023) sets the order: the plan covering the person "other than as a dependent" is primary; for a child whose parents "are married or are 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 a parent longest). For divorced or separated parents a court decree assigning health coverage decides; with none, the custodial parent’s plan pays first, then the custodial parent’s spouse’s, then the non-custodial parent’s, then that parent’s spouse’s. If the plans cannot agree within 45 calendar days after receiving everything needed to pay, they pay in equal shares. Self-funded ERISA plans are not bound by the rule and follow their plan documents. If the child also has Wyoming Medicaid, UnitedHealthcare/Optum pays first: Medicaid "is the payer of last resort" and pays no more than the remaining patient responsibility (42 CFR 433.139; Wyoming Medicaid CMS-1500 manual ch. 7). TRICARE pays after this plan (10 U.S.C. 1079(i)(1)); CHAMPVA is the last payer (38 CFR 17.270).[19][20][8][15][23][16][17]
Ask the plan: Ask UnitedHealthcare/Optum at benefits verification for the member’s coordination-of-benefits order (and whether the plan uses the birthday rule), and record every other coverage the child has.
Coverage decides whether UnitedHealthcare / Optum in Wyoming pays. These decide whether the claim survives: how sessions must be staffed and supervised, what may be billed concurrently, the per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.
"Consistent with CASP standards of care, direct case supervision is required 1 – 2 hours for every 10 hours of direct treatment per week." Technicians work under a BCBA or licensed behavioral health clinician and should be RBTs or otherwise certified "as allowable by state mandate"; Optum does not recommend parents serving as their own child’s RBT. Optum’s criteria publish no cap on the number of technicians per BCBA.[1]
Yes, for different people: Optum’s reimbursement policy answers "Can I report 97153 or 97154 with 97155 concurrently?" with "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 on the same day must be separate, distinct and at different times.[3]
CMS medically unlikely edits apply to commercial ABA, and "Optum allows 32 units per day for CPT code 97153"; billing more "may be subject to non-reimbursement or recovery." Clinically, requested hours must be justified, and use below 80% of authorized hours triggers explanation at continued-service review.[3][1]
ABA is provided at the least restrictive, most clinically appropriate level. Not covered: services that are not ABA, "such as 1:1 aid delivered simultaneously during classroom instruction," or services covered under IDEA; school coordination is allowed.[1]
The credentialed ABA provider is a BCBA or licensed behavioral health clinician; BCaBAs and technicians work under that provider. Each claim line carries the rendering credential modifier: HM (RBT), HN (BCaBA), HO (master’s-level BCBA or licensed clinician), HP (BCBA-D or doctoral licensed provider).[1][3]
Not addressed. The SCC set what must be documented for coverage, not who signs a session note or when.[1]
Ask the plan: Optum Provider Express National Network Manual (documentation standards) and the participating-provider agreement.
No. Optum’s commercial ABA policy uses CPT 97151–97158, 0362T and 0373T with credential modifiers.
The criteria ask for progress measured the same way as baseline, mastery rates, change scores and updated standardized adaptive measures; graphs are not named.
Optum: 90 calendar days from the date of service unless state law or the plan allows longer, with corrections within 90 days of the first claim’s receipt.
Yes, under Optum’s national ABA criteria for ASD. Fully insured Wyoming plans with mental health coverage are also bound by Bulletin 01-2019. Self-funded employer plans follow their own documents.
No. Optum’s ABA State Mandates supplement does not list Wyoming, so the national criteria and two-step authorization apply.
Optum’s commercial telehealth guide allows only 97155, 97156 and 97157 by telehealth, billed POS 02 or 10. Fully insured Wyoming plans are also subject to W.S. 26-20-701(b), which bars denying a covered mental health service only because it is delivered remotely, so ask Optum how it applies the list to your plan.
Yes, when a technician and a different QHP each meet their code’s descriptor; a single QHP cannot report both concurrently.
UHC/Optum publishes no ABA rates. You are paid up to the Fee Maximum in your Optum agreement, with a credential modifier on each line (HM RBT, HN BCaBA, HO BCBA, HP BCBA-D). Wyoming Medicaid’s 97153 rate ($12.30 per 15 minutes) is the only public benchmark.
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.
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