BCBS Illinois (HCSC)

CommercialIL

ABA billing requirements · Source: BCBS Illinois (HCSC) — ABA Medical Policy

High confidence

Verified 2026-03-01

Authorization Requirements

Requires prior auth Yes

Initial auth duration6 months

Renewal auth duration6 months

Submission deadlineN/A

Unit tracking cadenceWeekly

Requires FBA Yes

Diagnostic eval validityN/A

Re-eval cadenceN/A

BH carve-out managerMagellan

State licensure requiredBCBA state licensure required via IL Department of Financial and Professional Regulation

Documentation Requirements

Parent signatures required Yes

Start/stop times required Yes

Treatment plan componentsDeveloping treatment goals, Summarizing and analyzing data, Coordination of care with other professionals, Report progress towards treatment goals, Develop and oversee transition/discharge plan, Training and directing staff on implementation of new/revised treatment protocols

Progress summary cadenceEvery 6 months

Policy Notes

Services are typically requested for up to 40 hours per week. Parent education is authorized per week for the authorization period (typically 26 weeks) for a total of 26 hours. Treatment plans and/or evaluations that exceed eight hours may not be eligible for reimbursement.

CPT & Modifier Rules

CPT rules require a free account

View H-codes, modifiers, unit limits, and billing restrictions for BCBS Illinois (HCSC).

Official policy source:BCBS Illinois (HCSC) — ABA Medical Policy

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

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