Medica Health Plans (MN)

CommercialMN

ABA billing requirements · Source: Medica Health Plans — Clinical Policy: Applied Behavior Analysis

High confidence

Verified 2026-03-16

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 6 months

BH carve-out managerOptum

State licensure requiredBCBA state licensure required via MN Board of Social Work

Documentation Requirements

Parent signatures required Yes

Start/stop times required Yes

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

Progress summary cadenceEvery 6 months

Policy Notes

Medica is a regional health plan covering ~1.5M members in MN, ND, SD, NE, IA, and WI. ABA prior auth required. Behavioral health managed through Optum. BCBA must be enrolled with Medica.

CPT & Modifier Rules

CPT rules require a free account

View H-codes, modifiers, unit limits, and billing restrictions for Medica Health Plans (MN).

Official policy source:Medica Health Plans — Clinical Policy: Applied Behavior Analysis

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Data last verified: 2026-03-16 · Confidence: High · See our methodology

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