Aetna Medicare Advantage

Commercial

ABA billing requirements · Source: Aetna Medicare Advantage — Clinical Policy Bulletin: Applied Behavior Analysis

High confidence

Verified 2026-03-16

Authorization Requirements

Requires prior auth Yes

Initial auth duration12 months

Renewal auth duration12 months

Submission deadline14 days

Unit tracking cadenceTotal

Requires FBA Yes

Diagnostic eval validity36 months

Re-eval cadenceEvery 12 months

BH carve-out managerMagellan

Documentation Requirements

Parent signatures required No

Start/stop times required Yes

Treatment plan componentsASD diagnosis (ICD-10 F84.0), Medical necessity documentation, Functional Behavior Assessment, Baseline data, Measurable goals, Intervention strategies, BCBA supervision documentation

Progress summary cadenceEvery 12 months

Policy Notes

Aetna Medicare Advantage plans cover ABA for adults with ASD following 2025 MPFS. Prior auth required — submitted through Aetna NaviMedix portal or Availity. BCBA must be enrolled as Medicare provider AND in Aetna MA network. Annual auth cycle.

CPT & Modifier Rules

CPT rules require a free account

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

Official policy source:Aetna Medicare Advantage — Clinical Policy Bulletin: Applied Behavior Analysis

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Data last verified: 2026-03-16 · Confidence: High · See our methodology

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