Premera BCBS

CommercialWA/AK

ABA billing requirements · Source: Premera BCBS — Medical Policy 3.01.510 Applied Behavior Analysis

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 cadenceEvery 6 months

Documentation Requirements

Parent signatures required Yes

Start/stop times required Yes

Treatment plan componentsBaseline data, Target behaviors, Methods

Progress summary cadenceEvery 6 months

Policy Notes

ABA is considered medically necessary for Autism Spectrum Disorder. Telehealth services are covered. Functional Behavioral Analysis re-assessments are medically necessary no more frequently than every 6 months.

CPT & Modifier Rules

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View H-codes, modifiers, unit limits, and billing restrictions for Premera BCBS.

Official policy source:Premera BCBS — Medical Policy 3.01.510 Applied Behavior Analysis

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

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