PacificSource Health Plans

CommercialOR/ID/MT

ABA billing requirements · Source: PacificSource — ABA Medical Policy

High confidence

Verified 2026-03-01

Authorization Requirements

Requires prior auth Yes

Initial auth duration6 months

Renewal auth duration6 months

Submission deadlineN/A

Unit tracking cadenceWeekly

Requires FBA Yes

Diagnostic eval validityN/A

Re-eval cadenceEvery 6 months

Documentation Requirements

Parent signatures required Yes

Start/stop times required Yes

Treatment plan componentsProposed schedule for services, Baseline description of targeted behaviors, Objective baseline measurements (frequency, intensity, duration), Measurable, achievable goals for each behavior, Clinical justification for the number of days per week and hours per day of direct ABA services provided to the member and the family, and the hours per week of direct face-to-face supervision of the treatment being delivered and observation of the child in their natural setting, Discharge or transition criteria

Progress summary cadenceEvery 6 months

Policy Notes

Prior authorization is required for all ABA services in six-month increments. ABA cannot exceed 40 hours (4,160 combined units) a week. Reevaluation of behavioral and developmental assessments is required every 6 months.

CPT & Modifier Rules

CPT rules require a free account

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

Official policy source:PacificSource — ABA Medical Policy

Track policy changes for PacificSource Health Plans

Get instant alerts when PacificSource Health Plans updates their ABA billing requirements. Watch this payor and never miss a policy change.

Watch this payor — free Browse all 192 payors

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

Inaccurate data? Sign in to submit a correction