Tufts Health Plan

CommercialMA/NH/RI

ABA billing requirements · Source: Tufts Health Plan / Point32Health — ABA InterQual Criteria

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 componentsInitial Applied Behavior Analysis Assessment, Applied Behavior Analysis (ABA) Program-Applied Behavior Analysis Assessment, Applied Behavior Analysis (ABA) Program-Applied Behavior Analysis Consultation with other providers or agencies or school personnel, Applied Behavior Analysis (ABA) Program-Applied Behavior Analysis Parent or Caregiver Training, Applied Behavior Analysis (ABA) Program-Applied Behavior Analysis Supervision, Applied Behavior Analysis (ABA) Program-Applied Behavior Analysis Treatment

Progress summary cadenceEvery 6 months

Policy Notes

ABA criteria will include Down Syndrome as an additional qualifying diagnosis. For ABA Requests for ages 13–20, age alone will not initiate secondary review. Standard InterQual criteria apply.

CPT & Modifier Rules

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

Official policy source:Tufts Health Plan / Point32Health — ABA InterQual Criteria

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

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