Molina Medicare Advantage

Commercial

ABA billing requirements · Source: Molina Medicare Advantage — Provider Resources

Medium confidence

Verified 2026-03-16

Authorization Requirements

Requires prior auth Yes

Initial auth duration12 months

Renewal auth duration12 months

Submission deadline14 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

Molina Medicare Advantage plans cover ABA for adults with ASD following 2025 MPFS. Prior auth required — submitted through Molina provider portal or Availity. BCBA must be enrolled as Medicare provider AND in Molina MA network. Operates in CA, FL, IL, MI, NM, OH, SC, TX, UT, WA, WI.

CPT & Modifier Rules

CPT rules require a free account

View H-codes, modifiers, unit limits, and billing restrictions for Molina Medicare Advantage.

Official policy source:Molina Medicare Advantage — Provider Resources

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

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