GEHA (Federal Employee Health Benefits)

Commercial

ABA billing requirements · Source: GEHA — ABA Therapy Documentation Requirements (UMF0035-GEHA)

High confidence

Verified 2026-03-01

Authorization Requirements

Requires prior auth Yes

Initial auth duration12 months

Renewal auth duration12 months

Submission deadline30 days

Unit tracking cadenceTotal

Requires FBA Yes

Diagnostic eval validity36 months

Re-eval cadenceEvery 12 months

BH carve-out managerOptum

Documentation Requirements

Parent signatures required Yes

Start/stop times required Yes

Treatment plan componentsASD diagnosis, Functional Behavior Assessment, Baseline data, Measurable goals, Intervention strategies, Supervision plan, Progress data

Progress summary cadenceEvery 12 months

Policy Notes

GEHA is the 2nd largest FEHB plan (~2M federal employees/retirees). ABA prior auth required — submitted through MyGEHA portal (One Healthcare ID). Behavioral health managed through Optum. Annual auth cycle. BCBA must be enrolled with Optum/GEHA network. Telehealth ABA covered.

CPT & Modifier Rules

CPT rules require a free account

View H-codes, modifiers, unit limits, and billing restrictions for GEHA (Federal Employee Health Benefits).

Official policy source:GEHA — ABA Therapy Documentation Requirements (UMF0035-GEHA)

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

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