UPMC Health Plan (PA)

CommercialPA

ABA billing requirements · Source: UPMC Health Plan — Medical Policy: Applied Behavior Analysis

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 Health Plan is the insurance subsidiary of UPMC, covering ~4M members across PA, WV, and NY. ABA prior auth required. Behavioral health managed through UPMC BH. BCBA must be enrolled with UPMC Health Plan.

CPT & Modifier Rules

CPT rules require a free account

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

Official policy source:UPMC Health Plan — Medical Policy: Applied Behavior Analysis

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

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