UPMC for You (PA Medicaid)

MedicaidPA

ABA billing requirements · Source: UPMC for You — Provider Resources (Behavioral Health)

High confidence

Verified 2026-03-16

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

State licensure requiredLBS (PA State Board of Social Workers, Marriage and Family Therapists and Professional Counselors)

Documentation Requirements

Parent signatures required Yes

Start/stop times required Yes

Treatment plan componentsASD diagnosis, Functional Behavior Assessment, Baseline data, Measurable goals, Intervention strategies, Caregiver training plan

Progress summary cadenceEvery 6 months

Policy Notes

UPMC for You is the Pennsylvania Medicaid MCO operated by UPMC. ABA prior auth required. Behavioral health managed through UPMC BH. BCBA must be enrolled with UPMC for You and Pennsylvania Medicaid.

CPT & Modifier Rules

CPT rules require a free account

View H-codes, modifiers, unit limits, and billing restrictions for UPMC for You (PA Medicaid).

Official policy source:UPMC for You — Provider Resources (Behavioral Health)

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

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