Moda Health

CommercialOR/AK

ABA billing requirements · Source: Moda Health — ABA Services Coverage Policy

High confidence

Verified 2026-03-01

Authorization Requirements

Requires prior auth Yes

Initial auth durationN/A

Renewal auth durationN/A

Submission deadlineN/A

Unit tracking cadenceTotal

Requires FBA Yes

Diagnostic eval validityN/A

Re-eval cadenceN/A

Documentation Requirements

Parent signatures required Yes

Start/stop times required Yes

Treatment plan componentsDeveloped by a Masters or Doctoral Level Behavior Analyst with certification and/or licensure appropriate to the state in which the Behavior Analyst practices, Face-to-face treatment with an appropriately registered, certified, or licensed interventionist or clinician, Frequency and intensity of treatment: number of hours per week of direct services to the patient and family, Planned interventions consistent with ABA techniques, Assessment of the patient’s strengths and weaknesses, Description of how the patient’s strengths and weaknesses are addressed in the individualized treatment plan, Target behaviors and achievable goals in quantifiable terms including mastery criteria, Achievable goals appropriate to the patient’s symptoms, resources, and functioning, Parental Involvement: description of participation of family in patient’s treatment including interventions being employed with family, family education, training, and plan for transferring effective interventions to the family, Promotes the family’s ability to foster the child’s development and independently manage symptoms, Appropriate schedule for supervision by a certified/licensed Behavior Analyst, Plan for reassessment and treatment plan modification

Progress summary cadenceEvery 6 months

Policy Notes

Prior authorization is required for initial assessment and ABA services. Supervision should generally be provided at a rate of at least 2 hours for every 10 hours of direct treatment. Caregiver training is an important component of treatment. ABA interventions must be customized to the strengths, needs, preferences, and environmental circumstances of each individual client and their caregivers, and must be flexible to accommodate changes over time.

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Official policy source:Moda Health — ABA Services Coverage Policy

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

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