Priority Health

CommercialMI

ABA billing requirements · Source: Priority Health — ABA Medical 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 componentsBaseline data, Target behaviors, Methods

Progress summary cadenceEvery 6 months

Policy Notes

Supervision of line staff by the BCBA should occur at a minimum of 1 hour of supervision for every 15 hours of treatment with the member. Treatments not based in scientific evidence or unproven are excluded.

CPT & Modifier Rules

CPT rules require a free account

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

Official policy source:Priority Health — ABA Medical Policy

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

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