EmblemHealth

CommercialNY

ABA billing requirements · Source: EmblemHealth — ABA Services Coverage Policy

Low confidence

Verified 2026-03-01

Authorization Requirements

Requires prior auth Yes

Initial auth durationN/A

Renewal auth durationN/A

Submission deadlineN/A

Unit tracking cadenceTotal

Requires FBA Yes

Diagnostic eval validityN/A

Re-eval cadenceN/A

State licensure requiredLBA (NY Education Department Office of the Professions)

Documentation Requirements

Parent signatures required Yes

Start/stop times required Yes

Treatment plan componentsBaseline data, Target behaviors, Methods

Progress summary cadenceEvery 6 months

Policy Notes

No specific commercial ABA policy document found. Information inferred from general behavioral health policies and search results. EmblemHealth covers ABA services for Medicaid members.

CPT & Modifier Rules

CPT rules require a free account

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

Official policy source:EmblemHealth — ABA Services Coverage Policy

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

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