Wellpoint (Anthem Medicaid)

Medicaid

ABA billing requirements · Source: Wellpoint (Anthem Medicaid) — Provider Resources

Medium 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 managerCarelon

Documentation Requirements

Parent signatures required Yes

Start/stop times required Yes

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

Progress summary cadenceEvery 6 months

Policy Notes

Wellpoint is Anthem's Medicaid brand (formerly Amerigroup) operating in IA, TN, TX, VA, and other states. ABA prior auth required. Behavioral health managed through Carelon (Anthem BH subsidiary). BCBA must be enrolled with Wellpoint/Anthem Medicaid in the specific state. Requirements vary by state contract.

CPT & Modifier Rules

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View H-codes, modifiers, unit limits, and billing restrictions for Wellpoint (Anthem Medicaid).

Official policy source:Wellpoint (Anthem Medicaid) — Provider Resources

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

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