UnitedHealthcare Medicare Advantage

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ABA billing requirements · Source: UnitedHealthcare Medicare Advantage — Prior Authorization for Behavioral Health (ABA)

High 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

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

UHC Medicare Advantage plans (AARP MedicareComplete, etc.) added ABA coverage for adults with ASD following the 2025 CMS Physician Fee Schedule. Prior auth required — submitted through UHC Prior Auth portal or Optum. BCBA must be enrolled as Medicare provider AND in UHC MA network. Annual auth cycle.

CPT & Modifier Rules

CPT rules require a free account

View H-codes, modifiers, unit limits, and billing restrictions for UnitedHealthcare Medicare Advantage.

Official policy source:UnitedHealthcare Medicare Advantage — Prior Authorization for Behavioral Health (ABA)

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

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