Blue Shield Promise Health Plan (CA Medi-Cal)

MedicaidCA

ABA billing requirements · Source: Blue Shield Promise Health Plan — Provider Resources (Behavioral Health)

High confidence

Verified 2026-03-16

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 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, Caregiver training plan

Progress summary cadenceEvery 6 months

Policy Notes

Blue Shield Promise Health Plan is the Medi-Cal MCO operated by Blue Shield of California, distinct from commercial Blue Shield CA. ABA prior auth required. Behavioral health managed through Carelon. BCBA must be enrolled with Blue Shield Promise and California Medi-Cal.

CPT & Modifier Rules

CPT rules require a free account

View H-codes, modifiers, unit limits, and billing restrictions for Blue Shield Promise Health Plan (CA Medi-Cal).

Official policy source:Blue Shield Promise Health Plan — Provider Resources (Behavioral Health)

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Data last verified: 2026-03-16 · Confidence: High · See our methodology

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