Regence BCBS

CommercialOR/WA/UT/ID

ABA billing requirements · Source: Regence BCBS — Applied Behavior Analysis for ASD Policy

High confidence

Verified 2026-03-01

Authorization Requirements

Requires prior auth Yes

Initial auth durationN/A

Renewal auth durationN/A

Submission deadline5 days

Unit tracking cadenceTotal

Requires FBA Yes

Diagnostic eval validityN/A

Re-eval cadenceEvery 12 months

Documentation Requirements

Parent signatures required Yes

Start/stop times required Yes

Treatment plan componentsITP prepared by certified provider, ITP documented in medical record, Detailed description of specific behaviors targeted for therapy, Documentation of current level of functioning and severity using objective measurements and standardized assessment, Detailed description of evidence-based treatments and techniques, Description of training, participation, and progress of guardian(s)/caregiver(s), Clinical justification for number of days per week and hours per day of direct ABA services and supervision, Measurable discharge and/or transition goals

Progress summary cadenceEvery 6 months

Policy Notes

Policy applies to member contracts subject to preauthorization for ABA for ASD. ITP must include 8 criteria. Objective measurements of treatment goals occur at a minimum of every six months, and standardized assessments annually. Documentation for renewal should be submitted within five business days prior to the end of a current authorization (and no more than 30 days prior to the end of the authorization period).

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

Official policy source:Regence BCBS — Applied Behavior Analysis for ASD Policy

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

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