---
title: Aetna Better Health of Florida ABA / BA coverage (MMA plan).
url: "https://carelu.com/payers/aetna-better-health-florida"
markdown_url: "https://carelu.com/payers/aetna-better-health-florida.md"
state: FL (Florida)
payer: Aetna Better Health of Florida
kind: Medicaid managed care plan (MCO)
parent_program: Florida Medicaid (AHCA)
description: "How Aetna Better Health of Florida administers the Medicaid Behavior Analysis benefit — BSN-delegated network contracting, the July 2025 universal PA start after extended carve-in continuity, BA office hours, and which process details remain unverified."
last_reviewed: September 2026
vob_data_updated: 2026-07-23
---

# Aetna Better Health of Florida ABA / BA coverage (MMA plan).

_Payer Guide · Aetna Better Health (FL) · Last updated September 2026 · 3 primary sources_

> BA contracting runs through third-party BSN; universal PA from 7/1/2025 (per plan notices).

Aetna Better Health of Florida (ABHFL) administers the Behavior Analysis benefit on the AHCA criteria with no distinct clinical policy of its own — but with one structural quirk that matters before any member is ever served: BA network contracting and credentialing are delegated to a third party, Behavioral Services Network (BSN), rather than run through Aetna directly. A transparency note up front: aetnabetterhealth.com blocks automated access, so this guide's process specifics (PA channels, portal details) are thinner and flagged where unverified — the state-policy requirements, which bind every MMA plan, are the reliable floor.

This plan administers the **Florida Medicaid (AHCA)** ABA benefit: the state rules are the floor, and this page covers what the plan layers on top. Read it together with the [Florida Medicaid — Behavior Analysis Services (AHCA) guide](https://carelu.com/payers/florida-medicaid).

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Required — the state BA policy requires PA on all BA services; ABHFL submission specifics are not publicly verifiable (plan site blocks access) — confirm channel in the portal [3]
- **Prior auth for treatment**: Required — per the state policy; ABHFL-specific process details unverified — confirm via Availity/plan portal [3]
- **Autism diagnosis required?**: No — state BA policy applies: physician referral + order + CDE, no autism-diagnosis requirement [3]

## At a glance

- **Plan type:** SMMC MMA plan (CVS Health/Aetna), in-house UM
- **Clinical rules:** AHCA BA Coverage Policy — no distinct ABHFL clinical policy found
- **Prior auth:** Required for all BA per state policy; universal PA from 7/1/2025 per plan notices
- **BA contracting:** Delegated to Behavioral Services Network (BSN) — info@bsnnet.com, 305-907-7470
- **Provider support:** Recurring "BA Provider Open Office Hours" covering PA, claims, Availity
- **Rates:** Contracted; state fee schedule baseline

## The BSN contracting layer

To join ABHFL's BA network, providers contract and credential through Behavioral Services Network, Inc. (BSN) — info@bsnnet.com, 305-907-7470 — a distinct entry point from Aetna's own credentialing machinery and from every other Florida plan. For a group planning multi-plan participation, BSN is a separate pipeline to start early. Once in network, ABHFL publishes a set of BA-specific artifacts (a BA one-pager, FAQ, claims update, and change-of-provider form) and holds recurring "BA Provider Open Office Hours" covering the PA process, claims timely filing, and Availity — the best venue for resolving the process details this guide can't verify from published sources. [1][2]

## Authorization: the state floor, and what's unverified

The AHCA coverage policy binds ABHFL like every MMA plan: PA on all BA services, the referral + order + CDE gate (no autism diagnosis required), Vineland-3/BASC-3 documentation, and up-to-6-month authorizations that the plan cannot make more stringent. Plan notices indicate ABHFL ran extended carve-in continuity into mid-2025, with universal PA applying to all members receiving BA from July 1, 2025 — i.e., ABHFL held the transition window open longer than the AHCA 90-day baseline. What we could not verify against a primary source, because the plan's site blocks automated access: the exact submission channel (general ABHFL guidance points to Availity) and any BA-specific form. Confirm the current channel in the portal or at the plan's BA office hours before the first submission, and treat this guide's state-policy facts as the dependable part. [3][1]

## Intake gates

The questions that decide whether a family can start with Aetna Better Health of Florida, and what they have to bring.

- **Age limit**: Follows the Florida Medicaid rule: BA is for recipients under the age of 21, with EPSDT available above the coverage-policy and fee-schedule limits. The coverage policy binds every MMA plan — “the provision of services to recipients enrolled in a Florida Medicaid managed care plan must not be subject to more stringent service coverage limits than specified in Florida Medicaid policies” — so ABHFL cannot narrow the age window even though its own BA one-pager and FAQ could not be retrieved (aetnabetterhealth.com returns HTTP 403 to automated clients). [3]
- **Who may diagnose**: The state rule, which ABHFL cannot narrow: the referral comes from an independent physician or qualifying practitioner (PCP in family practice, internal medicine or pediatrics; a developmental-behavioral, neurodevelopmental, pediatric-neurology or adult/child-psychiatry specialist; or a child psychologist), and the CDE must be led by a licensed practitioner working within their medical, developmental or psychological scope of practice. [3]
- **Diagnostic tools required**: The state pair: the Vineland-3 Comprehensive Parent Interview Form for all recipients, plus the Maladaptive Behavior Domain for ages 3 and older, and the BASC-3 PRQ for ages 2 through 18, with complete scoring reports submitted with every prior-authorization request and re-administration every 12 months. [3]
- **Referral required?**: Required — the state gate applies: an independent physician referral, a physician’s order for BA services, and a Comprehensive Diagnostic Evaluation performed to national evidence-based practice standards. Plan notices indicate ABHFL ran extended carve-in continuity into mid-2025, with universal prior authorization applying to all members receiving BA from July 1, 2025. What is not publicly verifiable is the submission channel and whether a BA-specific ABHFL form exists — the plan’s general guidance points to Availity. [3][1]
  - Ask the plan: The ABHFL provider portal or a BA Provider Open Office Hours session for the live submission channel and any plan-specific BA form.
- **Prior-auth decision time**: Aetna Better Health of Florida is faster than the contract. Its manual: “For Medicaid members, routine prior authorization requests will be completed within four (4) calendar days of receipt of the request. A four (4) day extension can be provided if additional information is needed.” Urgent requests “will be processed within 48 hours of the Plan’s receipt of the request unless additional information is required.” No reauthorization lead time is published. The AHCA contract floor is 5 days standard and 2 days expedited. [4][5]
- **Other insurance (who pays first)**: Aetna Better Health of Florida waives its own PA when another payer is primary: “If other insurance is the primary payer before Aetna Better Health of Florida, prior authorization of a service is not required, unless it is known that the service provided is not covered by the primary payer. If the service is not covered by the primary payer, the provider must follow our prior authorization rules.” Bill the other insurer first and send its EOB or remittance advice with the claim; claims without it “will be denied in most cases.” When the primary does not cover the service or the benefit is exhausted, get an updated letter from the primary carrier every January and July. Filing deadlines differ inside the manual: 90 days after the primary’s final determination (citing the SMMC contract) in one place, 180 days from the EOB in another. File within 90 to satisfy both. Florida Medicaid pays last. Rule 59G-1.052 says: “Florida Medicaid is the payer of last resort. Providers must exhaust all TPL sources of payment, such as Medicare, TRICARE, private health insurance … prior to submitting or resubmitting a claim.” The AHCA contract binds every MMA plan to that rule. [4][6]

## Delivery and billing rules

Coverage decides whether Aetna Better Health of Florida pays. These decide whether the claim survives: staffing and supervision, concurrent billing, per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.

- **Supervision**: The state floor: supervision of BCaBAs and RBTs per the Council of Autism Service Providers practice standards, as specified in the supervision plan inside the approved behavior plan, which must name the authorized supervisors. Rendering is credential-chained — Lead Analyst (BCBA, FL-CBA or Ch. 490/491 licensee), BCaBA under a BCBA, RBT under a BCBA or BCaBA. No ABHFL supervision ratio is publicly verifiable. [3]
  - Ask the plan: ABHFL provider relations, or Behavioral Services Network (BSN) — the plan’s delegated BA contracting and credentialing partner — for anything the plan layers on top.
- **Session-note signature**: The state rule: “session notes must be signed and dated by the rendering practitioner,” with date, time, location, duration, behaviors observed, skills targeted, the recipient’s response, protocol modification or therapist direction, an explanation if the parent or guardian was absent, and the participants; the behavior assessment and behavior plan are signed by the Lead Analyst and the parent or guardian. [3]
- **Place of service**: The state rule: a school-based request must include the IEP, or a 504 plan, or documentation naming the school and explaining that neither exists; 1:1 shadow, personal care assistance, companion and chaperone services are non-covered “regardless of activity or setting,” as are caregiver/childcare services and travel time; BA is non-covered on the same day as behavioral health overlay, therapeutic behavioral on-site, or therapeutic group care services. [3]
- **Bill as provider**: The state enrollment structure governs the claim: a professional claim (837P / CMS-1500) under an individually enrolled rendering practitioner — Lead Analyst 392, BCaBA 391, RBT 390 — with 390s and 391s enrollable only as members of an enrolled BA group (393). Network entry is the ABHFL-specific step: BA contracting and credentialing are delegated to Behavioral Services Network, Inc. (BSN) rather than run through Aetna, so a group must complete BSN credentialing before any of those NPIs can bill. [3][1]
- **Concurrent billing (97153 + 97155)** _(ask the plan)_: The state rule is the floor: the supervisee is not reimbursed when the supervisor is reimbursed for the same time period, and simultaneous services by more than one BA provider are non-covered unless medically necessary, prior authorized and indicated in the approved behavior plan. ABHFL publishes no retrievable BA reimbursement policy of its own. [3]
  - Ask the plan: ABHFL provider services or a BA Provider Open Office Hours session — ask whether 97155 pays alongside 97153 when analyst, technician and member are all present.

## What intake should collect for Aetna Better Health of Florida

- **BSN credentialing status:** BA network entry runs through BSN, not Aetna — confirm contracting is complete before quoting start dates.
- **Referral + order + CDE:** The state eligibility gate applies; no autism diagnosis required.
- **Vineland-3 & BASC-3 scoring reports:** The state documentation stack applies to ABHFL requests.
- **Current PA channel:** Verify the live submission path (Availity/portal/fax) with the plan — published specifics are unverified.

Free verification-call checklist (PDF): https://carelu.com/downloads/aba-verification-call-checklist.pdf

## Verification of benefits (VOB) data

How Aetna Better Health of Florida ABA benefits route and read on an eligibility check. Data last updated 2026-07-23.

### EDI routing

- **Payer ID (pVerify):** 00980
- **Payer ID (Availity):** 128FL
- **Supports 270/271 eligibility:** Yes
- **Behavioral health administrator:** Behavioral Services Network (BSN) — BA network contracting/credentialing delegate only
- **BH administrator payer ID:** 128FL (same as ABHFL medical — BSN publishes no distinct EDI/claims payer ID of its own) — Confirm directly with ABHFL provider services or BSN (info@bsnnet.com, 305-907-7470) whether BA claims specifically require a routing marker distinct from the standard 128FL EDI ID — neither BSN's site nor the ABHFL Quick Reference Guide states one exists, but this is an absence of evidence, not confirmation.
- **ABA rides on:** medical benefit — Same as administratorPayerId.
- **Two-hop verification required:** No — Same as administratorPayerId.

### Code-level coverage

| Code | Covered | Prior auth | Unit cap | Place of service | Telehealth | Modifiers |
| --- | --- | --- | --- | --- | --- | --- |
| 97151 | Yes | Required | 24 units per initial behavior assessment (max); the reassessment variant, billed with modifier TS, caps at 18 units — same $19.05/unit rate either way. per per assessment/reassessment (not daily) — a new authorization is required each time, not a recurring daily allotment. | home (categorical — no CMS POS-code number published anywhere in FL BA documentation, state or plan level), office/clinic (categorical), school (categorical — IEP/504 plan, or a documented explanation, required with the PA request per the coverage policy §7.2), community/other (categorical, per plan PA-form checkboxes) | No — not authorized for this code under the AHCA BA Coverage Policy. Only 97156 (family/caregiver training) has a stated telehealth allowance in Florida Medicaid BA; every other code is telehealth:'No' by policy design, not by omission. | TS — reassessment variant, same $19.05 rate, separate 18-unit cap (vs. 24 for the initial assessment) |
| 97152 | Yes | Required | 8 units per assessment (max). per per assessment (not daily). | home (categorical — no CMS POS-code number published anywhere in FL BA documentation, state or plan level), office/clinic (categorical), school (categorical — IEP/504 plan, or a documented explanation, required with the PA request per the coverage policy §7.2), community/other (categorical, per plan PA-form checkboxes) | No — not authorized for this code under the AHCA BA Coverage Policy. Only 97156 (family/caregiver training) has a stated telehealth allowance in Florida Medicaid BA; every other code is telehealth:'No' by policy design, not by omission. | — |
| 97153 | Yes | Required | No code-specific unit cap on the fee schedule; counts toward the aggregate 40 hrs/week (≈160 units/week) BA-intervention cap set by the coverage policy §4.2.2. per week (aggregate across all treatment codes together, not per-code). | home (categorical — no CMS POS-code number published anywhere in FL BA documentation, state or plan level), office/clinic (categorical), school (categorical — IEP/504 plan, or a documented explanation, required with the PA request per the coverage policy §7.2), community/other (categorical, per plan PA-form checkboxes) | No — not authorized for this code under the AHCA BA Coverage Policy. Only 97156 (family/caregiver training) has a stated telehealth allowance in Florida Medicaid BA; every other code is telehealth:'No' by policy design, not by omission. | XP — concurrent-supervision supervisee line, not separately reimbursed (the supervisor bills 97153/97155/97155-HN instead) |
| 97154 | Yes | Required | Max 6 participants per group (coverage policy §4.2.2); the group also counts toward the aggregate 40 hrs/week cap. Rendered by Lead Analyst, BCaBA, or RBT. per week (aggregate) plus a 6-participant group-size ceiling. | home (categorical — no CMS POS-code number published anywhere in FL BA documentation, state or plan level), office/clinic (categorical), school (categorical — IEP/504 plan, or a documented explanation, required with the PA request per the coverage policy §7.2), community/other (categorical, per plan PA-form checkboxes) | No — not authorized for this code under the AHCA BA Coverage Policy. Only 97156 (family/caregiver training) has a stated telehealth allowance in Florida Medicaid BA; every other code is telehealth:'No' by policy design, not by omission. | UN (2 clients, $7.58/unit), UP (3 clients, $7.08/unit), UQ (4 clients, $6.58/unit), UR (5 clients, $6.08/unit), US (6 clients, $5.58/unit) |
| 97155 | Yes | Required | No code-specific unit cap on the fee schedule; counts toward the aggregate 40 hrs/week cap. per week (aggregate across all treatment codes). | home (categorical — no CMS POS-code number published anywhere in FL BA documentation, state or plan level), office/clinic (categorical), school (categorical — IEP/504 plan, or a documented explanation, required with the PA request per the coverage policy §7.2), community/other (categorical, per plan PA-form checkboxes) | No — not authorized for this code under the AHCA BA Coverage Policy. Only 97156 (family/caregiver training) has a stated telehealth allowance in Florida Medicaid BA; every other code is telehealth:'No' by policy design, not by omission. | HN — BCaBA tier, $15.37/unit (vs. $19.17 Lead Analyst base rate), XP — concurrent-supervision supervisee line, not separately reimbursed |
| 97156 | Yes | Required | No code-specific cap on direct/in-person units; the TELEHEALTH variant (GT modifier) is separately capped at 2 hrs/week (8 units/week). per week (telehealth portion); aggregate 40 hrs/week cap governs the rest. | home (categorical — no CMS POS-code number published anywhere in FL BA documentation, state or plan level), office/clinic (categorical), school (categorical — IEP/504 plan, or a documented explanation, required with the PA request per the coverage policy §7.2), community/other (categorical, per plan PA-form checkboxes) | Yes — the ONLY Florida Medicaid BA code with a confirmed telehealth allowance. GT modifier, up to 2 hrs/week, per Rule 59G-1.057, F.A.C. (coverage policy §4.2.2, FL.CP.BH.500). Not confirmed whether the telehealth allowance extends to BCaBA-rendered (HN-modifier) training — both the coverage policy and Sunshine's clinical policy name the "Lead Analyst" specifically. Separately: Sunshine's general (non-BA) telehealth billing notice instructs POS 02 with NO GT/95/CR modifier appended, which appears to conflict with the BA-specific GT-modifier requirement — an unresolved discrepancy, flagged rather than guessed at; confirm the correct billing combination with each plan before submitting a 97156 telehealth claim. | GT — telemedicine delivery, same $19.05 rate, capped at 2 hrs/wk, HN — BCaBA tier, $15.24/unit (vs. $19.05 Lead Analyst base rate) |
| 97157 | No — absent from both the 2025 and 2026 AHCA Behavior Analysis fee schedules and not listed among the covered service categories in the Dec 2024 coverage policy §4.2.2. Cross-confirmed absent from Sunshine Health's own coding table (FL.CP.BH.500) and Humana's Florida Medicaid PA list too — three independent primary sources agree on the omission. This is NOT a formal written exclusion statement (no document states "97157 is excluded"), so treat this as verified-absent-from-the-billable-set rather than a proven-impossible claim. | N/A — not on the state's billable BA code set per the fee schedule and PA lists reviewed. | N/A per N/A | — | N/A | — |
| 97158 | Yes | Required | Max 6 participants per group; rendered by Lead Analyst or BCaBA only (NOT RBT, per the coverage policy — contrast 97154, which RBTs can render). per week (aggregate) plus a 6-participant group-size ceiling. | home (categorical — no CMS POS-code number published anywhere in FL BA documentation, state or plan level), office/clinic (categorical), school (categorical — IEP/504 plan, or a documented explanation, required with the PA request per the coverage policy §7.2), community/other (categorical, per plan PA-form checkboxes) | No — not authorized for this code under the AHCA BA Coverage Policy. Only 97156 (family/caregiver training) has a stated telehealth allowance in Florida Medicaid BA; every other code is telehealth:'No' by policy design, not by omission. | UN (2 clients, $9.58/unit), UP (3 clients, $9.08/unit), UQ (4 clients, $8.58/unit), UR (5 clients, $8.08/unit), US (6 clients, $7.58/unit) |
| 0362T | Yes | Required, and conditioned on medical necessity for the extra-technician protocol per the coverage policy. | 16 units per initial assessment or reassessment (max). per per assessment/reassessment. | home (categorical — no CMS POS-code number published anywhere in FL BA documentation, state or plan level), office/clinic (categorical), school (categorical — IEP/504 plan, or a documented explanation, required with the PA request per the coverage policy §7.2), community/other (categorical, per plan PA-form checkboxes) | No — not authorized for this code under the AHCA BA Coverage Policy. Only 97156 (family/caregiver training) has a stated telehealth allowance in Florida Medicaid BA; every other code is telehealth:'No' by policy design, not by omission. | — |
| 0373T | Yes | Required, and conditioned on medical necessity for the extra-technician protocol. | No distinct unit cap beyond the underlying code's session limits — the fee schedule doesn't publish one separately for this add-on. | home (categorical — no CMS POS-code number published anywhere in FL BA documentation, state or plan level), office/clinic (categorical), school (categorical — IEP/504 plan, or a documented explanation, required with the PA request per the coverage policy §7.2), community/other (categorical, per plan PA-form checkboxes) | No — not authorized for this code under the AHCA BA Coverage Policy. Only 97156 (family/caregiver training) has a stated telehealth allowance in Florida Medicaid BA; every other code is telehealth:'No' by policy design, not by omission. | — |

Code notes:

- **97151:** Physician referral + order + Comprehensive Diagnostic Evaluation gate the very first assessment request (no autism-diagnosis requirement) — see the guide's prose for the intake sequence. These are the statewide AHCA BA Coverage Policy mechanics, binding on Aetna Better Health of Florida per the policy's plan-compliance clause (§1.2); Aetna Better Health of Florida's own documents don't restate full code-level unit-cap/POS detail beyond what's marked 'verified' above — confirm any 'inferred' field with Aetna Better Health of Florida provider relations before quoting a family.
- **97152, 97156, 97158:** These are the statewide AHCA BA Coverage Policy mechanics, binding on Aetna Better Health of Florida per the policy's plan-compliance clause (§1.2); Aetna Better Health of Florida's own documents don't restate full code-level unit-cap/POS detail beyond what's marked 'verified' above — confirm any 'inferred' field with Aetna Better Health of Florida provider relations before quoting a family.
- **97153:** Billed at the SAME $12.26/unit rate whether rendered by an RBT, BCaBA, or Lead Analyst — Florida does not tier 97153 by staff credential (contrast 97155/97156, which do via the HN modifier). These are the statewide AHCA BA Coverage Policy mechanics, binding on Aetna Better Health of Florida per the policy's plan-compliance clause (§1.2); Aetna Better Health of Florida's own documents don't restate full code-level unit-cap/POS detail beyond what's marked 'verified' above — confirm any 'inferred' field with Aetna Better Health of Florida provider relations before quoting a family.
- **97154:** The modifier documents group size, not staff credential — rate scales DOWN as the group grows. These are the statewide AHCA BA Coverage Policy mechanics, binding on Aetna Better Health of Florida per the policy's plan-compliance clause (§1.2); Aetna Better Health of Florida's own documents don't restate full code-level unit-cap/POS detail beyond what's marked 'verified' above — confirm any 'inferred' field with Aetna Better Health of Florida provider relations before quoting a family.
- **97155:** Rendered by Lead Analyst or BCaBA only — RBTs do not bill 97155 in Florida. These are the statewide AHCA BA Coverage Policy mechanics, binding on Aetna Better Health of Florida per the policy's plan-compliance clause (§1.2); Aetna Better Health of Florida's own documents don't restate full code-level unit-cap/POS detail beyond what's marked 'verified' above — confirm any 'inferred' field with Aetna Better Health of Florida provider relations before quoting a family.
- **97157:** If a family reports a Florida plan authorizing/paying 97157, verify directly with that plan — it would be an accommodation outside the state fee schedule, not the documented default. ABHFL publishes no BA code-level table of its own — the state-verified absence applies here by the same plan-compliance clause as every other MMA plan. These are the statewide AHCA BA Coverage Policy mechanics, binding on Aetna Better Health of Florida per the policy's plan-compliance clause (§1.2); Aetna Better Health of Florida's own documents don't restate full code-level unit-cap/POS detail beyond what's marked 'verified' above — confirm any 'inferred' field with Aetna Better Health of Florida provider relations before quoting a family.
- **0362T:** Requires an on-site physician/QHP plus 2+ technicians for severe/destructive-behavior assessment support; billed alongside 97151/97151-TS, not standalone. These are the statewide AHCA BA Coverage Policy mechanics, binding on Aetna Better Health of Florida per the policy's plan-compliance clause (§1.2); Aetna Better Health of Florida's own documents don't restate full code-level unit-cap/POS detail beyond what's marked 'verified' above — confirm any 'inferred' field with Aetna Better Health of Florida provider relations before quoting a family.
- **0373T:** Requires an on-site physician/QHP plus 2+ technicians for severe/destructive-behavior exposure treatment; billed alongside 97153/97155. These are the statewide AHCA BA Coverage Policy mechanics, binding on Aetna Better Health of Florida per the policy's plan-compliance clause (§1.2); Aetna Better Health of Florida's own documents don't restate full code-level unit-cap/POS detail beyond what's marked 'verified' above — confirm any 'inferred' field with Aetna Better Health of Florida provider relations before quoting a family.

### Medicaid rates

Source: AHCA Behavior Analysis Fee Schedule (2025 and 2026 — rates identical across both years). No ABHFL-specific rate schedule is publicly posted — MCOs must not impose limits more stringent than this state schedule, which serves as the reference baseline (AHCA BA Coverage Policy §1.2). Effective 2025-01-01.

| Code | Rate | Unit | Modifier tiers |
| --- | --- | --- | --- |
| 97151 | $19.05 | 15min | TS: $19.05 (reassessment; same rate, 18-unit cap vs. 24 for the initial assessment) |
| 97152 | $12.19 | 15min | — |
| 97153 | $12.26 | 15min | XP: Not reimbursed (concurrent-supervision supervisee line) |
| 97154 | $7.58 (2 clients, UN) | 15min | UN: $7.58 (2 clients); UP: $7.08 (3); UQ: $6.58 (4); UR: $6.08 (5); US: $5.58 (6) |
| 97155 | $19.17 (Lead Analyst) | 15min | HN: $15.37 (BCaBA); XP: Not reimbursed (concurrent-supervision supervisee line) |
| 97156 | $19.05 (Lead Analyst) | 15min | GT: $19.05 (telemedicine — same rate, capped at 2 hrs/week); HN: $15.24 (BCaBA) |
| 97157 | Not on the AHCA fee schedule (2025 or 2026) — not confirmed reimbursable under Florida Medicaid BA. | 15min | — |
| 97158 | $9.58 (2 clients, UN) | 15min | UN: $9.58 (2 clients); UP: $9.08 (3); UQ: $8.58 (4); UR: $8.08 (5); US: $7.58 (6) |
| 0362T | $12.19 | 15min | — |
| 0373T | $12.19 | 15min | — |

### Contacts

- **Provider services phone:** 1-800-441-5501
- **Phone menu path:** Behavioral Health prior-auth (MMA): 1-833-365-2474 — a distinct line from Physical Health PA, 1-860-607-8056.
- **Hours:** Member Services: Monday–Friday, 7:30 a.m.–7:00 p.m. Eastern. Availity technical support: Monday–Friday, 8 a.m.–8 p.m. Eastern (except holidays), 1-800-282-4548.
- **Portal:** [Availity Essentials](https://availity.com/)
- **Fax:** 1-844-235-1340

Questions to ask on a verification call:

- What payer ID should we use for Change Healthcare eligibility checks, and do you support real-time 270/271 on payer ID 128FL?
- Does BA claims routing require a payer ID distinct from 128FL, and does ABA ride on the medical benefit or a behavioral-health carve-out through BSN?
- Which service-type code do you return ABA benefit details under?
- Does the deductible apply to ABA, and is the cost share a copay or coinsurance?
- Is any copay charged per visit or per day, and does the out-of-pocket max apply to ABA?
- What’s the cap period for 0373T?

### VOB data sources

- https://pverify.com/wp-content/uploads/2026/03/pVerifyPayers_All-Payers-List-3-2026.pdf (accessed 2026-07-23)
- https://www.aetnabetterhealth.com/content/dam/aetna/medicaid/florida/provider/pdf/abhfl_quick_reference_guide.pdf (accessed 2026-07-23)
- https://bsnnet.com/ (accessed 2026-07-23)
- https://portal.flmmis.com/FLPublic/Portals/0/StaticContent/Public/COMPANION%20GUIDES/FMMIS_5010_270_271_Companion%20Guide_v4_0_04272023.pdf (accessed 2026-07-23; source document older than 18 months)
- https://www.flrules.org/gateway/readRefFile.asp?refId=17525&filename=Florida%20Medicaid%20Behavior%20Analysis%20Services%20Coverage%20Policy.pdf (accessed 2026-07-23)
- https://ahca.myflorida.com/content/download/26138/file/2025%20Behavior%20Analysis%20Fee%20Schedule.pdf (accessed 2026-07-23)
- https://ahca.myflorida.com/content/download/28096/file/2026%20BA%20Fee%20Schedule.pdf (accessed 2026-07-23)

## Common questions

### Does Aetna Better Health of Florida cover ABA?

Yes — it administers the state Behavior Analysis benefit on AHCA criteria: no autism diagnosis required, the physician referral + order + CDE gate, and PA on all BA services (universal PA from July 1, 2025 per plan notices).

### How do I join Aetna Better Health of Florida's ABA network?

Through Behavioral Services Network (BSN), the plan's delegated BA contracting and credentialing partner — info@bsnnet.com or 305-907-7470 — not through Aetna directly.

### Where do ABHFL BA authorizations get submitted?

The plan's general PA guidance points to Availity, but ABHFL's BA-specific submission details aren't publicly verifiable — confirm the current channel in the portal or at the plan's BA Provider Open Office Hours.

## Primary sources

1. [ABHFL — BA Provider Open Office Hours notice (02/24/2025)](https://www.aetnabetterhealth.com/content/dam/aetna/medicaid/florida/pdf/ABHFL_BA_Office_Hours_Provider_Notice_02.24.2025.pdf)
2. [ABHFL — provider materials & forms](https://www.aetnabetterhealth.com/florida/providers/materials-forms.html)
3. [Florida Medicaid BA Services Coverage Policy (Dec 2024)](https://www.flrules.org/gateway/readRefFile.asp?refId=17525&filename=Florida%20Medicaid%20Behavior%20Analysis%20Services%20Coverage%20Policy.pdf)
4. [Aetna Better Health of Florida — Provider Manual, MMA and Comprehensive LTC (published 8/7/2026)](https://www.aetnabetterhealth.com/content/dam/aetna/medicaid/florida/provider/pdf/abhfl_medicaid_comprehensive_ltc_provider_manual.pdf)
5. [AHCA SMMC Model Health Plan Contract — Attachment II Core Provisions (update 10/1/2025), §V.6 and §XI.D](https://ahca.myflorida.com/content/download/27248/file/Attachment%20II-%20-%20Core%20Contract%20Provisions%20Oct%202025.pdf)
6. [Rule 59G-1.052, F.A.C. — Third-Party Liability Requirements (AHCA)](https://ahca.myflorida.com/content/download/5929/file/59G_1052_TPL_Requirements.pdf?version=1)

Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed September 2026; it is general information, not billing, legal, or clinical advice. Always verify current requirements against the payer's live policy and a benefits check for the specific member.

Source: Carelu ABA Payer Directory — https://carelu.com/payers. Free to cite with attribution.