Anthem BCBS

Commercial

ABA billing requirements · Source: Anthem BCBS Provider News — ABA Claim Procedure Update

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 cadenceWeekly

Requires FBA Yes

Diagnostic eval validity24 months

Re-eval cadenceEvery 6 months

BH carve-out managerCarelon

Documentation Requirements

Parent signatures required Yes

Start/stop times required Yes

Treatment plan componentsFunctional Behavior Assessment, Baseline data, Measurable goals, Parent training plan, Schedule of services

Progress summary cadenceEvery 6 months

Policy Notes

Shifted to WEEKLY unit tracking effective January 2026. Schedule-first model: schedule must be submitted before auth. Significant operational change for all Anthem-contracted practices.

CPT & Modifier Rules

CPT rules require a free account

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

Official policy source:Anthem BCBS Provider News — ABA Claim Procedure Update

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

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