Blue Cross Blue Shield of Missouri (Anthem)

CommercialMO

ABA billing requirements · Source: Anthem Blue Cross Blue Shield Missouri — Medical Policy: Applied Behavior Analysis

High confidence

Verified 2026-03-17

Authorization Requirements

Requires prior auth Yes

Initial auth duration6 months

Renewal auth duration6 months

Submission deadline14 days

Unit tracking cadenceTotal

Requires FBA Yes

Diagnostic eval validity36 months

Re-eval cadenceEvery 6 months

BH carve-out managerCarelon

State licensure requiredBCBA state licensure required via MO State Committee of Psychologists

Documentation Requirements

Parent signatures required Yes

Start/stop times required Yes

Treatment plan componentsASD diagnosis, Functional Behavior Assessment, Baseline data, Measurable goals, Intervention strategies, Caregiver training plan

Progress summary cadenceEvery 6 months

Policy Notes

Blue Cross Blue Shield of Missouri is operated by Anthem (now Elevance Health) and covers ~1.5M members statewide. ABA prior auth required. Behavioral health managed through Carelon (Anthem subsidiary). BCBA must be enrolled with Anthem MO. Distinct from BCBS KC (which serves the KC metro straddling MO/KS border). Auth submitted via Availity portal.

CPT & Modifier Rules

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View H-codes, modifiers, unit limits, and billing restrictions for Blue Cross Blue Shield of Missouri (Anthem).

Official policy source:Anthem Blue Cross Blue Shield Missouri — Medical Policy: Applied Behavior Analysis

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Data last verified: 2026-03-17 · Confidence: High · See our methodology

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