CareFirst BlueCross BlueShield Community Health Plan (MD Medicaid)

MedicaidMD

ABA billing requirements · Source: CareFirst BCBS Community 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 licensure required via MD Department of Health and Mental Hygiene

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

CareFirst BCBS Community Health Plan is the Maryland Medicaid MCO operated by CareFirst. ABA prior auth required. Behavioral health managed through Carelon. BCBA must be enrolled with CareFirst Community Health Plan and Maryland Medicaid.

CPT & Modifier Rules

CPT rules require a free account

View H-codes, modifiers, unit limits, and billing restrictions for CareFirst BlueCross BlueShield Community Health Plan (MD Medicaid).

Official policy source:CareFirst BCBS Community 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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