West Virginia Medicaid

MedicaidWV

ABA billing requirements · Source: West Virginia Medicaid — ABA Services Coverage

High confidence

Verified 2026-03-01

Authorization Requirements

Requires prior auth Yes

Initial auth durationN/A

Renewal auth durationN/A

Submission deadlineN/A

Unit tracking cadenceWeekly

Requires FBA Yes

Diagnostic eval validity24 months

Re-eval cadenceEvery 12 months

Documentation Requirements

Parent signatures required Yes

Start/stop times required Yes

Treatment plan componentsservice goals, objectives, planned service activities

Progress summary cadenceEvery 6 months

Policy Notes

ABA services are available for Medicaid members ages 18 months through age 20 with a primary diagnosis of Autism Spectrum Disorder (ASD) prior to their eighth birthday. Services are limited to a maximum of 40 hours per week and/or eight hours within a 24-hour period. The service week is defined as Sunday 12:00 am through Saturday 11:59 pm. Group services are limited to four members to each staff person.

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View H-codes, modifiers, unit limits, and billing restrictions for West Virginia Medicaid.

Official policy source:West Virginia Medicaid — ABA Services Coverage

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

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