AmeriHealth Caritas

MedicaidLA

ABA billing requirements · Source: AmeriHealth Caritas — Clinical Policy CCP4040 Applied Behavior Analysis

High confidence

Verified 2026-03-01

Authorization Requirements

Requires prior auth Yes

Initial auth durationN/A

Renewal auth durationN/A

Submission deadlineN/A

Unit tracking cadenceWeekly

Requires FBA Yes

Diagnostic eval validityN/A

Re-eval cadenceEvery 6 months

State licensure requiredBCBA state licensure required via LA Licensed Professional Counselors Board

Documentation Requirements

Parent signatures required Yes

Start/stop times required Yes

Treatment plan componentsPerson-centered and individualized goals, Frequency of baseline behaviors and treatment development plan, Long-term, intermediate, and short-term behaviorally defined goals and objectives, Criteria to measure achievement of behavior objectives, Schedule of services and responsible providers, Care coordination, Parent/caregiver training, support, education, and participation, Specific, measurable objectives based on clinical observations, Interventions consistent with ABA techniques

Progress summary cadenceEvery 6 months

Policy Notes

Policy specific to AmeriHealth Caritas Louisiana. Prior authorization is required. Assessments occur every six months. Weekly schedule of expected hours is required in the treatment plan.

CPT & Modifier Rules

CPT rules require a free account

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

Official policy source:AmeriHealth Caritas — Clinical Policy CCP4040 Applied Behavior Analysis

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

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