Oscar Health

Commercial

ABA billing requirements · Source: Oscar Health — Provider Resources (Behavioral Health)

Medium 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

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

Oscar Health is a tech-forward ACA marketplace insurer operating in 18+ states. ABA prior auth required. Behavioral health managed through Optum. BCBA must be enrolled with Oscar Health. Primarily serves ACA exchange market.

CPT & Modifier Rules

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View H-codes, modifiers, unit limits, and billing restrictions for Oscar Health.

Official policy source:Oscar Health — Provider Resources (Behavioral Health)

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

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