A public record of payor policy changes affecting ABA therapy billing — authorization rules, unit tracking, documentation requirements, and rate changes. Updated weekly from official payor policy documents.
4
Active Changes
4
Critical Severity
8
Total Tracked
Recent Policy Changes
Showing 8 of 8 total
CriticalMonitoringRate Change
New York Medicaid 12.5% rate cut (second phase) scheduled for April 2026
New York Medicaid·Effective 2026-04-01·NY
MediumMonitoringAge Limit
Hawaii proposes eliminating age 13 ABA coverage cap and $25,000 annual benefit limit
Hawaii Medicaid·Effective 2026-07-01·HI
CriticalMonitoringHour Cap
Indiana proposes 30-hour weekly cap and 3-year lifetime limit for comprehensive ABA
Indiana Medicaid·Effective 2026-07-01·IN
HighActiveDocumentation
BCBS Texas updates preservice review requirements for ABA
BCBS Texas·Effective 2026-04-01·TX
CriticalActiveUnit Tracking
Anthem shifts to weekly unit tracking for all ABA CPT codes
Anthem BCBS·Effective 2026-01-01·National — all Anthem BCBS states
MediumActiveCPT Coverage
Harvard Pilgrim expands ABA coverage to include Down Syndrome diagnoses
Harvard Pilgrim Health Care·Effective 2026-01-01·MA, ME, NH, RI
CriticalResolvedRate Change
NC Medicaid 10% ABA rate cut blocked by court injunction — rates restored
The public log shows recent changes. Subscribers get the full action steps, a weekly email digest, 81-payor authorization rules, CPT modifier requirements, a payor comparison tool, and an ROI calculator — all in one place.