Aetna

Commercial

ABA billing requirements · Source: Aetna Clinical Policy Bulletin #0554 — Applied Behavior Analysis

High confidence

Verified 2026-03-01

Authorization Requirements

Requires prior auth Yes

Initial auth duration6 months

Renewal auth duration6 months

Submission deadline30 days

Unit tracking cadenceTotal

Requires FBA Yes

Diagnostic eval validity36 months

Re-eval cadenceEvery 12 months

BH carve-out managerMagellan

Parent signatures required Yes

Start/stop times required Yes

Treatment plan componentsBaseline data, Target behaviors, Measurement procedures, Reinforcement strategies, Crisis plan

Progress summary cadenceEvery 6 months

Requires BCBA supervision. Initial auth up to 6 months. Re-evaluation required annually. Medical necessity review at each renewal.

CPT rules require a free account

View H-codes, modifiers, unit limits, and billing restrictions for Aetna.

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Data last verified: 2026-03-01 · Confidence: High · See our methodology