Capital BlueCross (PA)

CommercialPA

ABA billing requirements · Source: Capital BlueCross — Medical Policy: Applied Behavior Analysis

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

State licensure requiredLBS (PA State Board of Social Workers, Marriage and Family Therapists and Professional Counselors)

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

Capital BlueCross is the independent BCBS licensee for central Pennsylvania (Harrisburg, York, Lancaster), covering ~500K members. ABA prior auth required. Behavioral health managed through Carelon. BCBA must be enrolled with Capital BlueCross.

CPT & Modifier Rules

CPT rules require a free account

View H-codes, modifiers, unit limits, and billing restrictions for Capital BlueCross (PA).

Official policy source:Capital BlueCross — Medical Policy: Applied Behavior Analysis

Track policy changes for Capital BlueCross (PA)

Get instant alerts when Capital BlueCross (PA) updates their ABA billing requirements. Watch this payor and never miss a policy change.

Watch this payor — free Browse all 192 payors

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

Inaccurate data? Sign in to submit a correction