Highmark BCBS

CommercialPA

ABA billing requirements · Source: Highmark BCBS — ABA Medical Policy

Medium 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 validityN/A

Re-eval cadenceEvery 6 months

State licensure requiredLBS (PA State Board of Social Workers, Marriage and Family Therapists and Professional Counselors)

Documentation Requirements

Parent signatures required Yes

Start/stop times required Yes

Treatment plan componentsTreatment goals, Objectives, Measurable outcomes

Progress summary cadenceEvery 6 months

Policy Notes

Policy is for Pennsylvania commercial plans. Treatment plan may be reviewed every six months. Functional behavioral analysis is a treatment intervention. Treatment plan must be developed by a physician or psychologist and include defined and measurable treatment goals, objectives, and measurable outcomes.

CPT & Modifier Rules

CPT rules require a free account

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

Official policy source:Highmark BCBS — ABA Medical Policy

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

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