Pennsylvania Medicaid (MA)

MedicaidPA

ABA billing requirements · Source: Pennsylvania Medicaid — ABA Services Coverage Policy

Medium 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

State licensure requiredLBS (PA State Board of Social Workers, Marriage and Family Therapists and Professional Counselors)

Documentation Requirements

Parent signatures required Yes

Start/stop times required Yes

Treatment plan componentsCoordination efforts with all other behavioral health programs and service systems, Specific behavioral health interventions to address behaviors impeding ADLs

Progress summary cadenceEvery 6 months

Policy Notes

Policy covers ABA for children and adolescents with ASD. Services are provided through Behavioral Health Rehabilitation Services (BHRS). Medical necessity is determined by HealthChoices Contractors. Act 62 requires commercial plans to cover ABA.

CPT & Modifier Rules

CPT rules require a free account

View H-codes, modifiers, unit limits, and billing restrictions for Pennsylvania Medicaid (MA).

Official policy source:Pennsylvania Medicaid — ABA Services Coverage Policy

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

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