TRICARE (Autism Care Demonstration)

Government

ABA billing requirements · Source: TRICARE — Autism Care Demonstration Program Policy

High confidence

Verified 2026-03-01

Authorization Requirements

Requires prior auth Yes

Initial auth duration6 months

Renewal auth durationN/A

Submission deadlineN/A

Unit tracking cadenceTotal

Requires FBA Yes

Diagnostic eval validity24 months

Re-eval cadenceEvery 24 months

Documentation Requirements

Parent signatures required Yes

Start/stop times required Yes

Treatment plan componentsGoals, Timelines

Progress summary cadenceEvery 6 months

Policy Notes

Referral and pre-authorization required for all ABA services. Initial authorization for six months. New referral from ASD diagnosing provider required every two years. Comprehensive care plan within 90 days.

CPT & Modifier Rules

CPT rules require a free account

View H-codes, modifiers, unit limits, and billing restrictions for TRICARE (Autism Care Demonstration).

Official policy source:TRICARE — Autism Care Demonstration Program Policy

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

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