L.A. Care Health Plan (CA)

MedicaidCA

ABA billing requirements · Source: L.A. Care Health Plan — Provider Resources (Behavioral Health)

High confidence

Verified 2026-03-01

Authorization Requirements

Requires prior auth Yes

Initial auth duration6 months

Renewal auth duration6 months

Submission deadline14 days

Unit tracking cadenceTotal

Requires FBA Yes

Diagnostic eval validity36 months

Re-eval cadenceEvery 12 months

State licensure requiredBCBA state registration required via CA Board of Behavioral Sciences

Documentation Requirements

Parent signatures required Yes

Start/stop times required Yes

Treatment plan componentsASD diagnosis, Functional Behavior Assessment, Baseline data, Measurable goals, Intervention strategies, Parent training component

Progress summary cadenceEvery 6 months

Policy Notes

L.A. Care Health Plan is the largest publicly operated health plan in the US, serving LA County Medi-Cal members. ABA prior auth required. Behavioral health managed through Carelon (Beacon). BCBA must be enrolled with L.A. Care and Carelon. Also offers Covered California (commercial) plans.

CPT & Modifier Rules

CPT rules require a free account

View H-codes, modifiers, unit limits, and billing restrictions for L.A. Care Health Plan (CA).

Official policy source:L.A. Care Health Plan — Provider Resources (Behavioral Health)

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

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