CareSource

MedicaidOH

ABA billing requirements · Source: CareSource — Medical Policy MM-0028 Applied Behavior Analysis

High confidence

Verified 2026-03-01

Authorization Requirements

Requires prior auth Yes

Initial auth duration6 months

Renewal auth duration6 months

Submission deadlineN/A

Unit tracking cadenceTotal

Requires FBA Yes

Diagnostic eval validity24 months

Re-eval cadenceEvery 6 months

State licensure requiredBCBA state licensure required via OH Counselor, Social Worker and Marriage & Family Therapist Board

Documentation Requirements

Parent signatures required No

Start/stop times required Yes

Treatment plan componentsbiopsychosocial information, rationale for ABA services, goals related to core deficits, Behavioral Intervention Plan and/or a Plan of Care (POC), requested number of ABA hours per week, plan to modify the intensity and duration of treatment over time, coordination with other behavioral health and medical providers

Progress summary cadenceEvery 6 months

Policy Notes

Medical necessity review is required every 6 months. Initial behavior assessment not to exceed 6-10 hours every 6 months. Continuation requests are submitted every 6 months. Parent signatures are no longer required as of 10/23/2024. Policy is specific to Ohio Medicaid.

CPT & Modifier Rules

CPT rules require a free account

View H-codes, modifiers, unit limits, and billing restrictions for CareSource.

Official policy source:CareSource — Medical Policy MM-0028 Applied Behavior Analysis

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

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