32 Health Plan (formerly Tufts Health Commercial)

CommercialMA

ABA billing requirements · Source: 32 Health Plan / Point32Health — ABA Clinical Policy

High confidence

Verified 2026-03-17

Authorization Requirements

Requires prior auth Yes

Initial auth duration6 months

Renewal auth duration6 months

Submission deadline90 days

Unit tracking cadenceMonthly

Requires FBA Yes

Diagnostic eval validity24 months

Re-eval cadenceEvery 6 months

BH carve-out managerCarelon

State licensure requiredLABA (MA Board of Registration of Allied Mental Health Professionals)

Documentation Requirements

Parent signatures required Yes

Start/stop times required Yes

Treatment plan componentsASD diagnosis (DSM-5), BCBA-signed treatment plan with measurable goals, Functional Behavior Assessment (FBA), Behavior Intervention Plan (BIP), Baseline data, Projected discharge criteria, Caregiver training plan

Progress summary cadenceEvery 1 months

Policy Notes

32 Health Plan is the commercial insurance brand launched by Point32Health in 2024, replacing legacy Tufts Health Plan commercial products. Covers MA, NH, ME, CT, and RI. ABA auth managed by Carelon (AIM Specialty Health). Requires BCBA-signed treatment plan, FBA, and monthly progress reports. Telehealth covered with modifier 95. Age limit: through age 21 for ASD diagnosis.

CPT & Modifier Rules

CPT rules require a free account

View H-codes, modifiers, unit limits, and billing restrictions for 32 Health Plan (formerly Tufts Health Commercial).

Official policy source:32 Health Plan / Point32Health — ABA Clinical Policy

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Data last verified: 2026-03-17 · Confidence: High · See our methodology

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