Medicare Part B

Government

ABA billing requirements · Source: CMS 2025 Physician Fee Schedule Final Rule — ABA CPT Codes Added

High confidence

Verified 2026-03-01

Authorization Requirements

Requires prior auth No

Initial auth duration12 months

Renewal auth duration12 months

Submission deadline365 days

Unit tracking cadenceTotal

Requires FBA Yes

Diagnostic eval validity36 months

Re-eval cadenceEvery 12 months

Documentation Requirements

Parent signatures required No

Start/stop times required Yes

Treatment plan componentsASD diagnosis (ICD-10 F84.0), Medical necessity documentation, Functional Behavior Assessment, Baseline data, Measurable goals, Intervention strategies, BCBA supervision documentation

Progress summary cadenceEvery 12 months

Policy Notes

Medicare Part B added ABA CPT codes (97151-97158) to the 2025 Physician Fee Schedule, enabling coverage for adults with ASD. No prior auth required under traditional Medicare. However, Medicare Advantage plans may require prior auth. BCBA must be enrolled as Medicare provider. Note: coverage is for adults (18+) with ASD diagnosis.

CPT & Modifier Rules

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View H-codes, modifiers, unit limits, and billing restrictions for Medicare Part B.

Official policy source:CMS 2025 Physician Fee Schedule Final Rule — ABA CPT Codes Added

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

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