Blue Shield of California

CommercialCA

ABA billing requirements · Source: Blue Shield of California — Clinical Guidelines (ABA)

High confidence

Verified 2026-03-01

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 12 months

BH carve-out managerMagellan

State licensure requiredBCBA state registration required via CA Board of Behavioral Sciences

Documentation Requirements

Parent signatures required Yes

Start/stop times required Yes

Treatment plan componentsASD diagnosis, Functional Behavior Assessment, Baseline data, Measurable goals, Intervention strategies, Parent training component, Discharge criteria

Progress summary cadenceEvery 6 months

Policy Notes

Blue Shield of California is a distinct plan from Anthem BCBS CA. ABA prior auth required. Behavioral health managed through Magellan (carve-out for many groups). BCBA must be enrolled with Blue Shield CA. Telehealth ABA covered. Separate from Blue Shield Promise (Medi-Cal).

CPT & Modifier Rules

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

Official policy source:Blue Shield of California — Clinical Guidelines (ABA)

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

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