Centene / WellCare / Ambetter

Medicaid

ABA billing requirements · Source: Centene/Ambetter — Clinical Policy CP.MP.104 Applied Behavior Analysis

High confidence

Verified 2026-03-01

Authorization Requirements

Requires prior auth Yes

Initial auth duration12 months

Renewal auth duration12 months

Submission deadlineN/A

Unit tracking cadenceTotal

Requires FBA Yes

Diagnostic eval validity6 months

Re-eval cadenceEvery 12 months

Parent signatures required Yes

Start/stop times required Yes

Treatment plan componentsIndividualized goals, Projected time to achieve goals, Measurable objectives, Parent/caregiver training and support

Progress summary cadenceEvery 12 months

Age limit < 21 years. Diagnosis must be confirmed by age 8. Treatment plan updated monthly and submitted for review every 12 months.

CPT rules require a free account

View H-codes, modifiers, unit limits, and billing restrictions for Centene / WellCare / Ambetter.

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