Blue Cross Blue Shield of Vermont

CommercialVT

ABA billing requirements · Source: Blue Cross Blue Shield of Vermont — 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 managerBeacon

State licensure requiredBCBA state licensure required via VT Office of Professional Regulation

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 Vermont is an independent BCBS licensee covering ~180K members. ABA prior auth required. Behavioral health managed through Beacon Health Options. BCBA must be enrolled with BCBS VT. Vermont has an autism insurance mandate requiring ABA coverage. Auth submitted via Beacon portal.

CPT & Modifier Rules

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View H-codes, modifiers, unit limits, and billing restrictions for Blue Cross Blue Shield of Vermont.

Official policy source:Blue Cross Blue Shield of Vermont — Medical Policy: Applied Behavior Analysis

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

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