New Jersey Medicaid (FamilyCare)

MedicaidNJ

ABA billing requirements · Source: New Jersey Medicaid — ABA Services 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 componentsBehavior identification assessments, Supporting assessments, Adaptive behavior treatment

Progress summary cadenceEvery 6 months

Policy Notes

Effective April 1, 2020, ABA services are available to any NJ FamilyCare Medicaid eligible individuals with a diagnosis of ASD under the age of 21. For individuals enrolled in a Medicaid managed care organization (MCO), the MCO is responsible for providing all ABA services. For individuals enrolled in Medicaid, but waiting to be enrolled with a MCO, the State is responsible for fee-for-service (FFS) coverage of all medically necessary ABA services.

CPT & Modifier Rules

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View H-codes, modifiers, unit limits, and billing restrictions for New Jersey Medicaid (FamilyCare).

Official policy source:New Jersey Medicaid — ABA Services Policy

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

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