Clarification For Providers of Applied Behavior Analysis (ABA) Services

Date: 09/25/23

As a reminder, Superior HealthPlan requires prior authorization be obtained for all Applied Behavior Analysis (ABA) services prior to the delivery of service. This includes evaluation and re-evaluation procedure code 97151, an initial course of ABA treatment, and for subsequent recertifications for treatment procedure codes 97153, 97154, 97155, 97156, 97158.

As a clarification: Re-evaluation procedure code 97151 for recertification of treatment requires authorization.

Utilization review for prior authorization requests are managed by Magellan Healthcare. Prior authorization requests for dates of services on or after February 1, 2022 can be submitted to Magellan Healthcare by:

• Fax: 1-888-656-0368
• Phone: 1-800-424-4812

Additional provider training and resources can be located at the following links:

• Autism Applied Behavioral Analysis Provider Orientation (PDF)
• Autism Benefit Services Initial/Continued Treatment Plan Template (PDF)

For any questions, or if you are interested in providing services for this benefit, please contact your local Account Manager.

Please note: This article is a clarification to the previously posted article: RESOURCES AVAILABLE: New Medicaid Benefit for Applied Behavior Analysis Services - Prior Authorization Required