---
title: "Washington Apple Health ABA coverage: the intake guide."
url: "https://carelu.com/payers/washington-medicaid"
markdown_url: "https://carelu.com/payers/washington-medicaid.md"
state: WA (Washington)
payer: Washington Apple Health (Medicaid)
kind: State Medicaid program
description: "How Washington Apple Health covers ABA under WAC 182-531A: the Center of Excellence evaluation, the three-stage pathway, which codes need prior authorization, the 2026 fee schedule, telemedicine rules, and the five managed care plans that run ABA for most members."
last_reviewed: October 2026
---

# Washington Apple Health ABA coverage: the intake guide.

_Payer Guide · Washington Apple Health · Last updated October 2026 · 21 primary sources_

> Apple Health (HCA) covers ABA for any age under WAC 182-531A: COE evaluation and prescription first, then PA for 97153 and group codes; five MCOs run it for most members.

Washington Apple Health, the state’s Medicaid program run by the Health Care Authority (HCA), covers applied behavior analysis under its own rule, chapter 182-531A WAC, and an ABA billing guide that took effect January 1, 2026. The program is built as a three-stage pathway: a Center of Excellence (COE) evaluates the client and prescribes ABA, a lead behavior analysis therapist (LBAT) assesses the client and writes the treatment plan, and only after prior authorization do services start. The rule sets no age limit.

Most Apple Health clients are in one of five managed care plans: Community Health Plan of Washington, Coordinated Care, Molina Healthcare of Washington, UnitedHealthcare Community Plan and Wellpoint Washington. The plan authorizes and pays for ABA, using the same WAC criteria. HCA authorizes and pays fee-for-service clients directly, including clients enrolled in a Behavioral Health Services Only plan.

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: No for fee-for-service: 97151 and 0362T carry no PA on HCA’s fee schedule and billing guide (97151 is limited to 28 units per assessment, 2 per year). MCO members follow their plan [6][5]
- **Prior auth for treatment**: Yes for 97153, 0373T, 97154, 97158 and the H2020 day program; 97155, 97156 and 97157 need no PA. HCA grants 3- to 6-month authorizations; the request must reach HCA within 60 days of the LBAT’s assessment and plan [6][5][4]
- **Autism diagnosis required?**: Yes, from an HCA-recognized Center of Excellence (COE). The client must have a "qualifying diagnosis": autism spectrum disorder as defined by DSM or DC:0-5, "or other intellectual or developmental disability for which there is evidence ABA is effective," confirmed by a COE together with functional impairment and a reasonable expectation of measurable improvement (WAC 182-531A-0200, -0400). HCA applies the COE requirement "whether the client is fee-for-service or enrolled in a managed care organization." [4][5]

## At a glance

- **Covers ABA?:** Yes, under WAC 182-531A, for ASD or another developmental/intellectual disability for which ABA is effective; no age limit
- **Structure:** Five MCOs (CHPW, Coordinated Care, Molina, UnitedHealthcare, Wellpoint) for most members; HCA fee-for-service for the rest, incl. BHSO enrollees
- **Gatekeeper:** Center of Excellence (COE) evaluation and ABA prescription, required for FFS and MCO members alike
- **FFS prior auth:** PA on 97153, 0373T, 97154, 97158, H2020; none on 97151, 0362T, 97155, 97156, 97157
- **FFS rates (per 15 min, 7/1/2026):** 97151 $18.79 · 97153 $12.40 · 97155 $14.09 · 97156 $18.32 · 0362T $58.80 · 0373T $24.11 · H2020 $571.30/day
- **Who may deliver:** DOH-licensed LBA or LABA as LBAT (or a licensed MHC, LMFT, LICSW, LASW or psychologist with BCBA/BCaBA attestation); DOH-certified CBT
- **Licensure:** Yes: chapter 18.380 RCW (LBA, LABA, CBT); every clinician enrolls as an Apple Health servicing provider
- **Timely filing (FFS):** 365 calendar days from date of service; adjustments within 24 months

## The pathway: COE evaluation, LBAT assessment, then prior authorization

Stage one is the Center of Excellence. A COE is an individual provider, not a clinic, who performs a comprehensive diagnostic evaluation and, if ABA is appropriate, writes a prescription. The evaluation must show how the diagnosis was made or confirmed (formal diagnostic measures with names, dates and results, or the clinical findings), that the client’s behaviors or skill deficits keep them from participating in home, school or community activities or make them a safety risk, that less intrusive interventions were tried or no equally effective alternative exists, and that the COE reasonably expects measurable improvement (WAC 182-531A-0400, -0500). Developmental pediatricians, neurologists, pediatric neurologists, pediatric psychiatrists, psychiatrists and psychologists experienced with autism qualify automatically; ARNPs, physicians, PAs and naturopaths must complete HCA’s COE training and be designated. HCA publishes the COE list. [4][5][7]

Stage two is the LBAT. The family picks the provider and setting ("Neither HCA nor the MCO chooses the client’s ABA provider"), and the LBAT completes an assessment and treatment plan on HCA’s Assessment and Behavior Change Plan form, HCA 13-400, or an equivalent. The plan covers the next six months, must correlate with the COE’s current evaluation, and must coordinate with school, early intervention and other therapies. The PA request "must be received by HCA within 60 days from the date of the assessment and ABA therapy treatment plan," with the COE evaluation and order, the LBAT assessment and plan, and the ABA Level of Support Requirement form, HCA 12-411. Fee-for-service requests go by direct data entry in ProviderOne or by fax to (866) 668-1214 behind form HCA 13-835, at least 15 days before services are to begin. HCA does not authorize ABA retroactively except for delayed eligibility certification, though during recertification the WAC lets HCA retroactively authorize dates of service. [4][5][7]

Stage three is treatment. HCA grants authorization "in three to six-month increments, or longer at HCA’s discretion." Recertification needs a new request, an updated HCA 12-411, and a reevaluation and revised plan showing measurable change, with a projection of outcome, assessment instruments, developmental markers of readiness and evidence of coordination; the WAC says to request it 15 calendar days before the authorization expires, and the billing guide asks for three weeks. HCA may ask the COE to review progress before renewing, and services continue pending recertification. Caregiver training after a client has been approved for ABA needs no separate preauthorization: "All plans have agreed" on that. [4][5][7]

## Which codes need prior authorization, and what Apple Health pays

HCA’s ABA fee schedule (effective July 1, 2026, updated July 29, 2026) pays, per 15-minute unit: 97151 behavior identification assessment $18.79 (LBAT only; 28 units per assessment, 2 assessments a year; no PA); 0362T $58.80 (LBAT on site with two or more CBTs; 2-hour assessments, 3 a year per provider; no PA); 97153 $12.40 (PA); 0373T $24.11 (PA; "do not bill simultaneously with 97155 or 97153"); 97155 $14.09 (no PA); 97156 $18.32 (no PA). Group codes are paid per client and step down with group size: 97154 and 97158 from $12.40 (2 clients, modifier UN) to $8.88 (6 or more, US), both with PA; 97157 from $10.34 to $7.41, no PA. Team conferences pay $28.78 (99366, with the client) and $20.87 (99368). The early childhood intensive behavioral intervention day treatment program bills H2020 at $571.30 per diem with PA. 97152 is not on the schedule. [6][5][4]

The WAC itself allows one initial ABA assessment and plan a year plus up to four more assessments and revisions, one lifetime authorization of day treatment, and supervision of the technician; requests beyond those limits go through a limitation extension, and for clients 20 and younger EPSDT allows published limits to be exceeded on medical necessity review. HCA does not pay for ABA that duplicates services in another setting, is provided by a family member, or is paid for by another state agency. Not covered: autism camps, dolphin and equine therapy, primarily educational services, recreational therapy, respite, safety monitoring, vocational rehabilitation, life coaching, and school-based or early intervention program services unless prior authorized. [6][5][4]

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

Washington licenses behavior analysts. Apple Health ABA is delivered by DOH-credentialed licensed behavior analysts (LBA), licensed assistant behavior analysts (LABA) and certified behavior technicians (CBT). The LBAT must be a DOH-licensed LBA, a LABA supervised by an LBA or licensed psychologist, or a licensed mental health counselor, marriage and family therapist, independent clinical or advanced social worker, or psychologist with a BCBA or BCaBA attestation (form HCA 13-0008) on file; the LBAT enrolls as a servicing provider authorized to supervise ancillary providers (WAC 182-531A-0800). A BCBA licensed in another state cannot treat an Apple Health client from out of state on that license alone: chapter 18.380 RCW requires a Washington license or temporary license to practice ABA, and HCA pays telemedicine to a client in Washington only when the practitioner is licensed in Washington or holds a compact license Washington recognizes. DOH offers reciprocity for substantially equivalent state licenses and a non-renewable 180-day temporary license for nonresidents licensed elsewhere. [4][5][15][16][10][9][17]

Every LBA, LABA and CBT must hold a DOH credential, an NPI and an Apple Health enrollment as a servicing provider under a group’s core provider agreement, be on the roster the group sends each MCO, and have their own NPI in the servicing provider box on claims for dates of service on and after July 1, 2025 (HCA technical assistance, February 2025). HCA’s system "will deny/reject the claim if the servicing provider NPI has not been approved for enrollment." The only taxonomy for ABA is 103K00000X, entered in both the billing and servicing taxonomy fields. Claims must carry the authorization number, and dates, codes, modifiers and units must match the authorization. [4][5][15][16][10][9][17]

## Claims operations: timely filing, EVV, telehealth billing and appeals

Fee-for-service claims must be submitted with a transaction control number assigned "within three hundred sixty-five calendar days" of the date of service, and a claim may be resubmitted or adjusted within 24 months of the service date (WAC 182-502-0150). Bill all units of a code for one date of service on a single line: two lines of the same code for the same day deny as duplicates. Known third parties must be billed first and their timely filing limits met as well. HCA’s January 2026 ABA billing guide does not mention electronic visit verification. For telemedicine, use POS 02 or 10 and modifier 95 for a nonfacility distant site (Telemedicine Policy and Billing Guide, January 2026). An MCO member who disagrees with the plan’s appeal decision may request a state hearing "within one hundred twenty calendar days" of the plan’s appeal resolution, and must ask within ten days to keep a reduced or terminated service going during the hearing (WAC 182-526-0200). [1][2][3][13][5][10][14]

Payment cycle for fee-for-service claims: HCA’s claims page says the ProviderOne submission “deadline is every Tuesday at 5 p.m. for payment the following Monday,” and providers “may see a Friday date on their remittance advice.” Apple Health MCO claims follow each plan’s own payment schedule. [1][2][3][13][5][10][14]

Federal rules bind Apple Health’s own fee-for-service payments: the agency "must pay 90 percent of all clean claims from practitioners, who are in individual or group practice or who practice in shared health facilities, within 30 days of the date of receipt" and 99 percent within 90 days, with the date of receipt being the agency’s date stamp and the date of payment the date of the check or other payment (42 CFR 447.45(d)(2), (3), (5), (6)). The same rule makes 12 months from the date of service the outer limit any state may allow for filing (42 CFR 447.45(d)(1)). Managed care plans are held to the same 90/99 percent clean-claim standard through their state contracts (42 CFR 447.46). [1][2][3][13][5][10][14]

## Does Apple Health require a referring or ordering provider on the ABA claim?

HCA's ProviderOne Billing and Resource Guide applies 42 CFR 455.410: "Any referring, ordering, or prescribing provider must be enrolled with HCA as a fee for service provider," and "The National Provider Identifier (NPI) number of any referring, ordering, or prescribing provider must be listed on any claims for services, supplies, tests, etc. ordered, referred, or prescribed by that provider." On a direct-data-entry claim, "If the service provided is the result of a referral from another provider, check Yes and enter the referring provider's NPI (taxonomy codes are not required for referring providers)." [20][4][5]

Apple Health ABA starts from a Center of Excellence prescription: the COE writes "a prescription for ABA services" (WAC 182-531A-0500), and HCA's ABA billing guide calls it the COE "ordering ABA services." Read together, the COE is the ordering provider whose NPI the claim carries, and the COE must be enrolled with HCA. The ABA billing guide itself adds the authorization number, matching codes and units, and taxonomy 103K00000X in both the billing and servicing fields. It does not separately restate the referring-provider field, so confirm the MCO's edits for managed-care members. [20][4][5]

## Can ABA overlap with speech, OT or PT under Apple Health?

HCA publishes no clock-time ban on ABA alongside speech, OT or PT in a community ABA program. Its rules work through the assessment instead. The LBAT's assessment must list "All services the client has previously received and/or is currently receiving (e.g. school, special education, speech therapy, occupational therapy, etc.)," with "The schedule or dosage of each service," their goals, and the rationale for how ABA will "Be provided in coordination with these services; and Not be redundant or in conflict with these services." [5]

The bans HCA does publish are inside the ABA benefit: day treatment is not authorized "at the same time as adaptive behavior protocol (CPT® code 97153)," and 97153 may not be billed at the same time as H2020. [5]

## Intake gates

The questions that decide whether a family can start with Washington Apple Health (Medicaid), and what they have to bring.

- **Age limit**: No upper age limit. Chapter 182-531A WAC sets no age bound for ABA, and EPSDT (age 20 and younger) lets published limits be exceeded on medical necessity review. For a client first diagnosed at 21 or older, the COE who evaluates and orders ABA must be a psychiatric mental health nurse practitioner or a general practitioner designated by HCA as a COE, or a neurologist, psychiatrist or psychologist; ARNPs, physicians, PAs and naturopaths need additional COE training to prescribe ABA for adults. [4][5]
- **Diagnosis recency**: No fixed expiry is written for the COE evaluation. The clocks are on the treatment side: the LBAT’s plan must "correlate with the COE provider’s current diagnostic evaluation," and the PA request must reach HCA within 60 days of the LBAT’s assessment and plan. [4][5]
- **Who may diagnose**: A Center of Excellence: an individual provider, not a facility. Licensed under Title 18 RCW and experienced in diagnosing and treating ASD, a developmental pediatrician, neurologist, pediatric neurologist, pediatric psychiatrist, psychiatrist or psychologist qualifies whether or not they are on HCA’s COE list. ARNPs (including psychiatric mental health nurse practitioners), physicians, physician assistants and naturopaths qualify only after HCA’s COE training and designation, on a signed COE Attestation form HCA 13-0009 (WAC 182-531A-0800). HCA may, at its discretion, accept a non-COE evaluation, for example a recent evaluation paid by the child’s primary insurance. A COE serving an MCO member must also be contracted with that MCO. [4][5]
- **Diagnostic tools required**: The COE documents "Results of formal diagnostic procedures performed by a provider, including name of measure, dates, and results, as available," or the clinical findings and observations used to confirm the diagnosis (WAC 182-531A-0500). The rule’s examples of ASD diagnostic tools are the ADI and the ADOS. If the COE has them, the evaluation must also include the ASD screening tool and date, a formal cognitive or developmental assessment with verbal, nonverbal and full-scale scores (examples: Mullen, Bayley, Wechsler) and a formal adaptive behavior assessment with domain scores (Vineland, ABAS), plus vision and hearing results. [4][5]
- **Referral required?**: Yes: a COE prescription. "Any person may refer a client" to a COE for an evaluation, including the PCP, a school or early intervention professional, the family or the MCO, though many COEs require a PCP referral and an MCO may require prior authorization for the COE evaluation. If the COE concludes ABA is appropriate it writes "a prescription for ABA services" and sends the evaluation and prescription to the chosen ABA provider or the family (WAC 182-531A-0500). The COE evaluation and order go in with the first PA request. [4][5]
- **Telehealth**: HCA’s ABA billing guide (January 1, 2026) lists the ABA codes allowed by telemedicine. Allowed: 97155, 97156 and 97157, plus team conferences 99366 and 99368. Allowed with limits: 97151, but only for indirect work (caregiver interviews and rating scales, treatment plan development, record review, scoring); direct observation and direct assessment of the child may not be done remotely. In the day treatment program (H2020), direct ABA must be in person in the clinic, and CBT supervision may be by audio-visual telemedicine only while an LBAT stays on site. Not allowed by telemedicine: 0362T, 0373T, 97153, 97154 and 97158. For telemedicine the originating site is where the client is (where the caregiver is, for caregiver training). Bill POS 02, or POS 10 when the client is at home, and add modifier 95 when the distant site is a nonfacility; to bill for a client located in Washington the practitioner must be licensed in Washington or hold a compact license Washington recognizes, and no behavior analyst compact is on HCA’s list. [5][10]
- **Prior-auth decision time**: HCA’s medical necessity rule gives the agency 15 days from receiving a request to approve, deny or ask for more information; the provider then has 30 days to send it, and HCA decides within five business days of receiving it (WAC 182-501-0165). The federal floor for state agencies, in force since January 1, 2026, is "in no case later than 7 calendar days" for a standard request "unless a shorter minimum timeframe is established under State law" (42 CFR 440.230(e)). Submit at least 15 days before services start or the current authorization ends. MCO members follow their plan’s clock (42 CFR 438.210(d): 7 calendar days for rating periods starting on or after January 1, 2026). [11][18][5][24]
- **Other insurance (who pays first)**: Apple Health pays after other coverage. Providers must bill known third parties and meet their timely filing limits (WAC 182-502-0150; WAC 182-501-0200). For ABA specifically: if a private policy has an ABA benefit that has not been exhausted, HCA PA is not required; PA is required when the private benefit is exhausted, when the private plan has no ABA benefit, or when the client has Medicare. If Apple Health becomes primary, the client must go through HCA’s ABA PA review, so HCA suggests choosing a provider enrolled with both the private insurer and Apple Health. Responsible third parties may not deny an HCA claim solely for lack of their own prior authorization (WAC 182-501-0200(4)). [5][12][13][19]

## Delivery and billing rules

Coverage decides whether Washington Apple Health (Medicaid) 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**: The lead behavior analysis therapist (LBAT) must "Supervise a minimum of five percent of the total direct care per week provided by the CBT (e.g., one hour of supervision per twenty hours of care)," and a CBT must be "supervised directly by an LBAT for at least five percent of total direct care per week" (WAC 182-531A-0700) and review the client’s progress with the LBAT at least every two weeks. When a LABA fills the LBAT role, the LABA and the supervising LBA or licensed psychologist share those duties. DOH’s licensing rule layers on top: at least two face-to-face contacts a month with each CBT and direct supervision and observation of at least five percent of the CBT’s monthly hours, seeing the CBT with each client at least once every three months (WAC 246-805-330). [5][4][16]
- **Daily limits / MUEs**: 97151: 28 units per assessment, 2 assessments per calendar year. 0362T: 2-hour assessments, 3 per calendar year per client per provider. Inpatient 97153 and 0373T: 780 units per calendar year. Day treatment (H2020): at least half of the 3-hour day for 12 hours a week, up to 15 hours a week (3 hours a day, 5 days), normally 48 service days. Other treatment units are set by the authorization; extra units go through a limitation extension. Underneath the program rule sit federal claim edits, which are a different thing from the authorization: section 6507 of the Affordable Care Act requires state Medicaid programs to apply CMS’s Medicaid NCCI methodologies, including medically unlikely edits (MUEs), to fee-for-service claims (a state may ask CMS to deactivate an individual edit; for managed care plans it is optional). CMS’s published Medicaid MUE table for practitioner services, dates of service October 1 – December 31, 2026, sets the per-provider, per-member, per-day values at 97151 32 units, 97152 16, 97153 32, 97154 18, 97155 24, 97156 16, 97157 16, 97158 16, 0362T 16 and 0373T 32. HCA’s own limits above are authorization and fee-schedule limits. [22][23][6][5][4]
- **Session-note signature**: The LBAT must sign the treatment plan and get the family’s signed approval. A CBT must document each visit (target behavior, interventions, response, technique changes, plan for next visit, graphed data) and "Maintain signed and dated documentation of family’s confirmation that a visit occurred." Daily documentation must include the client’s name, date, time in the program, clinicians, goals and strategies, format, data, and "The signature, title and credentials of the person completing the daily documentation"; supervision notes and a service log (dates, times, type and location of service) must be kept. [5][4]
- **Place of service**: Home, center, community (a school, daycare, inpatient unit or playground, for example) or an HCA-approved day treatment program, or a mix. Services in community settings such as a school or restaurant "must be included in the ABA therapy treatment plan" (WAC 182-531A-0600). Not covered unless prior authorized: "School-based health care services or early intervention program-based services" (WAC 182-531A-1000). Inpatient ABA is limited to short-term, focused treatment of severe harmful behavior that is preventing discharge, ordered by a COE. The day treatment program (H2020) is typically authorized once in a lifetime for 48 service days. [4][5]
- **Bill as provider**: The rendering clinician. Every LBA, LABA and CBT must hold a DOH credential, an NPI and an Apple Health enrollment as a servicing provider under a group’s core provider agreement, be on the roster the group sends each MCO, and have their own NPI in the servicing provider box on claims for dates of service on and after July 1, 2025 (HCA technical assistance, February 2025). HCA’s system "will deny/reject the claim if the servicing provider NPI has not been approved for enrollment." The only taxonomy for ABA is 103K00000X, entered in both the billing and servicing taxonomy fields. Claims must carry the authorization number, and dates, codes, modifiers and units must match the authorization. [5][9]
- **Concurrent billing (97153 + 97155):** Not published / unverified. Verify via: HCA ABA program, ABA@hca.wa.gov: ask whether a CBT’s 97153 and the LBAT’s 97155 may be billed for overlapping time. [6][5]

## What intake should collect for Washington Apple Health (Medicaid)

- **Which Apple Health card:** CHPW, Coordinated Care (incl. Apple Health Core Connections foster care), Molina, UnitedHealthcare, Wellpoint, or fee-for-service/BHSO. Enrollment can change monthly.
- **COE evaluation and ABA prescription:** From an HCA-recognized Center of Excellence: diagnosis, functional impairment, tried-and-failed or no-alternative statement, and the prescription.
- **COE extras if available:** ASD screening tool, cognitive/developmental and adaptive behavior scores, vision and hearing results.
- **Other insurance:** If private coverage has an ABA benefit that is not exhausted, HCA PA is not required; bill the private plan first.
- **Forms:** HCA 13-400 assessment and plan (or equivalent) and HCA 12-411 Level of Support; HCA 13-835 cover sheet for faxed FFS requests.

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

## Common questions

### What is the weekly billing cutoff for Apple Health fee-for-service claims?

Tuesday at 5 p.m. for payment the following Monday (HCA’s ProviderOne schedule). MCO claims follow each plan’s own schedule.

### Does Washington Apple Health cover ABA therapy?

Yes, under chapter 182-531A WAC, for autism spectrum disorder or another intellectual or developmental disability for which ABA is effective, with no age limit. A Center of Excellence must evaluate the client and prescribe ABA first.

### What is a Center of Excellence (COE) in Washington?

An individual provider, not a facility, who completes the comprehensive diagnostic evaluation and writes the ABA prescription. Developmental pediatricians, neurologists, pediatric neurologists, pediatric psychiatrists, psychiatrists and psychologists experienced with autism qualify; ARNPs, physicians, PAs and naturopaths qualify after HCA’s COE training and designation.

### Does the ABA assessment need prior authorization?

Not for fee-for-service clients: 97151 and 0362T carry no PA on HCA’s fee schedule. Treatment does: 97153, 0373T, 97154, 97158 and the H2020 day program. MCO members follow their plan’s rules, and some MCOs require PA for the COE evaluation itself.

### What does Apple Health pay for ABA?

Per 15 minutes from July 1, 2026: 97151 $18.79, 97153 $12.40, 97155 $14.09, 97156 $18.32, 0362T $58.80, 0373T $24.11; group codes are paid per client on a sliding scale; the H2020 day program pays $571.30 a day. MCOs pay contracted rates.

### Can a BCBA licensed in another state treat an Apple Health client in Washington, including by telehealth?

Not on the out-of-state license alone. Washington requires a DOH license (or a 180-day temporary license for nonresidents licensed elsewhere) to practice ABA, and HCA pays telemedicine to a client located in Washington only if the practitioner is licensed in Washington or holds a recognized compact license. There is no behavior analyst compact on HCA’s list.

### Which ABA codes can be billed by telehealth to Apple Health?

97155, 97156, 97157, 99366 and 99368; 97151 for indirect activities only. 97153, 97154, 97158, 0362T and 0373T may not be delivered by telemedicine. Bill POS 02 or 10 with modifier 95 for a nonfacility distant site.

### What is the timely filing limit for Apple Health ABA claims?

Fee-for-service: 365 calendar days from the date of service, with adjustments allowed within 24 months (WAC 182-502-0150). Each MCO sets its own limit in its contract; CHPW, for example, uses 12 months from the date of service.

### Does Apple Health require the referring or ordering provider NPI on ABA claims?

Yes, when the service was ordered or referred, which Apple Health ABA always is: HCA requires the NPI of "any referring, ordering, or prescribing provider" on claims for services they ordered, and that provider must be enrolled with HCA. For ABA that is the COE that prescribed it.

### Can a child get ABA and speech therapy at the same time under Apple Health?

HCA sets no clock-time ban, but the ABA assessment must list every other therapy with its schedule and explain how ABA will be coordinated with it and "Not be redundant or in conflict" with it.

## Primary sources

1. [42 CFR 447.45 — Timely claims payment (clean-claim definition; 90% in 30 days, 99% in 90 days) (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-447/subpart-A/section-447.45)
2. [42 CFR 447.46 — Timely claims payment by MCOs (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-447/subpart-A/section-447.46)
3. [HCA — Prior authorization, claims, and billing (ProviderOne claims submission deadlines)](https://www.hca.wa.gov/billers-providers-partners/prior-authorization-claims-and-billing)
4. [Chapter 182-531A WAC — Applied behavior analysis (Apple Health ABA rules: COE evaluation, stages, provider requirements, PA)](https://app.leg.wa.gov/wac/default.aspx?cite=182-531A&full=true)
5. [HCA — Washington Apple Health Applied Behavior Analysis (ABA) Program Billing Guide (January 1, 2026)](https://www.hca.wa.gov/assets/billers-and-providers/aba-services-bg-20260101.pdf)
6. [HCA — ABA Treatment Fee Schedule (effective July 1, 2026; last updated July 29, 2026)](https://www.hca.wa.gov/assets/billers-and-providers/aba-20260701.xlsx)
7. [HCA — Index of ABA Centers of Excellence (COE list)](https://www.hca.wa.gov/assets/billers-and-providers/index-coe-applied-behavioral-analysis.pdf)
8. [HCA — Apple Health managed care (plan list and phone numbers)](https://www.hca.wa.gov/free-or-low-cost-health-care/i-need-medical-dental-or-vision-care/apple-health-managed-care)
9. [HCA — ABA Provider Technical Assistance webinar slides, with DOH and all five Apple Health MCOs (February 27, 2025)](https://www.hca.wa.gov/assets/billers-and-providers/aba-provider-technical-assistance-february-27-2025.pdf)
10. [HCA — Washington Apple Health Telemedicine Policy and Billing Guide (January 1, 2026)](https://www.hca.wa.gov/assets/billers-and-providers/telemedicine-policy-and-billing-bg-20260101.pdf)
11. [WAC 182-501-0165 — Medical necessity determination process (agency decision timeframes)](https://app.leg.wa.gov/WAC/default.aspx?cite=182-501-0165)
12. [WAC 182-501-0200 — Third-party resources](https://app.leg.wa.gov/WAC/default.aspx?cite=182-501-0200)
13. [WAC 182-502-0150 — Time limits for providers to bill the agency](https://app.leg.wa.gov/WAC/default.aspx?cite=182-502-0150)
14. [WAC 182-526-0200 — Enrollee appeals of a managed care organization action (hearing deadlines)](https://app.leg.wa.gov/WAC/default.aspx?cite=182-526-0200)
15. [Chapter 18.380 RCW — Applied behavior analysis (licensure of behavior analysts, assistant behavior analysts and certified behavior technicians)](https://app.leg.wa.gov/RCW/default.aspx?cite=18.380&full=true)
16. [Chapter 246-805 WAC — Applied behavior analysis (DOH rules: supervision, reciprocity, temporary license)](https://app.leg.wa.gov/WAC/default.aspx?cite=246-805&full=true)
17. [BACB — U.S. Licensure of Behavior Analysts (Washington: 2015, WA State Department of Health)](https://www.bacb.com/u-s-licensure-of-behavior-analysts/)
18. [42 CFR 440.230(e) — State Medicaid agency prior-authorization timeframes (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-440/subpart-B/section-440.230)
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. [HCA — ProviderOne Billing and Resource Guide (September 2025 edition, posted February 2026): Providers required to enroll; DDE claim questions](https://www.hca.wa.gov/assets/billers-and-providers/providerone-billing-and-resource-guide.pdf)
21. [HCA — Provider Alerts 2026 (index of Apple Health provider alerts)](https://www.hca.wa.gov/billers-providers-partners/provider-alerts-2026)
22. [CMS — NCCI for Medicaid (ACA § 6507: states must apply compatible NCCI methodologies to Medicaid fee-for-service claims; optional for MCOs; deactivation requests)](https://www.cms.gov/medicare/coding-billing/ncci-medicaid)
23. [CMS — Medicaid NCCI MUE edit file, practitioner services, effective October 1, 2026 (dates of service 10/1–12/31/2026)](https://www.cms.gov/medicare/coding-billing/ncci-medicaid/medicaid-ncci-edit-files)
24. [42 CFR 438.210(d) — Medicaid managed care authorization timeframes (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-438/subpart-D/section-438.210)

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.