SCAN Health Plan (CA Medicare Advantage)

CommercialCA

ABA billing requirements · Source: SCAN Health Plan — Medicare Advantage Provider Resources

Medium confidence

Verified 2026-03-16

Authorization Requirements

Requires prior auth Yes

Initial auth duration12 months

Renewal auth duration12 months

Submission deadline14 days

Unit tracking cadenceTotal

Requires FBA Yes

Diagnostic eval validity36 months

Re-eval cadenceEvery 12 months

State licensure requiredBCBA state registration required via CA Board of Behavioral Sciences

Documentation Requirements

Parent signatures required No

Start/stop times required Yes

Treatment plan componentsASD diagnosis (ICD-10 F84.0), Medical necessity documentation, Functional Behavior Assessment, Baseline data, Measurable goals, Intervention strategies, BCBA supervision documentation

Progress summary cadenceEvery 12 months

Policy Notes

SCAN Health Plan is the largest not-for-profit Medicare Advantage plan in CA, serving ~300,000 members. ABA coverage added following 2025 MPFS. Prior auth required. BCBA must be enrolled as Medicare provider AND in SCAN network. Serves Southern CA, Central Valley, and Bay Area markets.

CPT & Modifier Rules

CPT rules require a free account

View H-codes, modifiers, unit limits, and billing restrictions for SCAN Health Plan (CA Medicare Advantage).

Official policy source:SCAN Health Plan — Medicare Advantage Provider Resources

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Data last verified: 2026-03-16 · Confidence: Medium · See our methodology

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