UnitedHealthcare Community Plan (Medicaid)

Medicaid

ABA billing requirements · Source: UnitedHealthcare Community Plan — Provider Resources (Medicaid)

High confidence

Verified 2026-03-01

Authorization Requirements

Requires prior auth Yes

Initial auth duration6 months

Renewal auth duration6 months

Submission deadline14 days

Unit tracking cadenceTotal

Requires FBA Yes

Diagnostic eval validity36 months

Re-eval cadenceEvery 6 months

BH carve-out managerOptum

Documentation Requirements

Parent signatures required Yes

Start/stop times required Yes

Treatment plan componentsASD diagnosis, Functional Behavior Assessment, Baseline data, Target behaviors, Intervention strategies, Generalization plan, Caregiver training

Progress summary cadenceEvery 6 months

Policy Notes

UHC Community Plan is UnitedHealthcare's Medicaid MCO brand operating in AZ, FL, IA, IN, KY, MD, MI, MS, MO, NM, NY, OH, OK, TN, TX, VA, WI, and other states. ABA prior auth required. Behavioral health managed through Optum. BCBA must be enrolled with UHC Community Plan in the specific state. Distinct from commercial UHC.

CPT & Modifier Rules

CPT rules require a free account

View H-codes, modifiers, unit limits, and billing restrictions for UnitedHealthcare Community Plan (Medicaid).

Official policy source:UnitedHealthcare Community Plan — Provider Resources (Medicaid)

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

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