Carelon Behavioral Health (Beacon)

Commercial

ABA billing requirements · Source: Carelon Behavioral Health — ABA Treatment Report Guidelines

Medium confidence

Verified 2026-03-01

Authorization Requirements

Requires prior auth Yes

Initial auth durationN/A

Renewal auth durationN/A

Submission deadline30 days

Unit tracking cadenceWeekly

Requires FBA Yes

Diagnostic eval validityN/A

Re-eval cadenceN/A

BH carve-out managerCarelon

Documentation Requirements

Parent signatures required No

Start/stop times required Yes

Treatment plan componentsMember’s identifying information, Basic biopsychosocial information, Member’s capabilities / strengths and family’s support system, Member’s current problem areas / skills deficits relating to their ASD diagnosis, List dates and data source / assessment tools used, List skills to be targeted for increase (Goals), Functional Behavior Assessment (FBA) of target behaviors / presenting problems, Recommended behavioral intervention plan, Preference Assessment, Description of parent / caregiver behavioral management training / knowledge transfer plan, Coordination of care with other professionals, Supervision delivery, Crisis Plan, Summary and program recommendations

Progress summary cadenceEvery 6 months

Policy Notes

The document outlines guidelines for initial and concurrent authorization requests for ABA services. It emphasizes detailed reporting for treatment plans and progress reports. Parent signatures are recommended, not required. Progress reports are due 2-30 days before authorization end date.

CPT & Modifier Rules

CPT rules require a free account

View H-codes, modifiers, unit limits, and billing restrictions for Carelon Behavioral Health (Beacon).

Official policy source:Carelon Behavioral Health — ABA Treatment Report Guidelines

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

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