---
title: Aetna Better Health of New Jersey ABA coverage (NJ FamilyCare MCO).
url: "https://carelu.com/payers/aetna-better-health-new-jersey"
markdown_url: "https://carelu.com/payers/aetna-better-health-new-jersey.md"
state: NJ (New Jersey)
payer: Aetna Better Health of New Jersey
kind: Medicaid managed care plan (MCO)
parent_program: NJ FamilyCare
description: "How Aetna Better Health administers NJ FamilyCare ABA — the published rate sheet mirroring the state FFS schedule, MUE unit limits, Availity submission, PA turnaround times, and the one open rate question on 97153."
last_reviewed: September 2026
vob_data_updated: 2026-07-23
---

# Aetna Better Health of New Jersey ABA coverage (NJ FamilyCare MCO).

_Payer Guide · Aetna Better Health (NJ) · Last updated September 2026 · 7 primary sources_

> Closest to the state baseline: published rate sheet mirrors the FFS schedule, MUE limits verbatim.

Aetna Better Health of New Jersey is the most transparent of the five NJ FamilyCare MCOs about hewing to the state baseline: its published ABA Program sheet copies the DMAHS rates and unit limits verbatim. There's no distinct Aetna clinical ABA policy layered on top — authorization runs through the standard behavioral-health PA machinery on Availity, with defined turnaround clocks. The open question worth carrying into contracting: the published rate sheet still shows the launch-era $11.20 on 97153, and whether Aetna followed the state's 2022 increase to $15.00 is unverified.

This plan administers the **NJ FamilyCare** ABA benefit: the state rules are the floor, and this page covers what the plan layers on top. Read it together with the [NJ FamilyCare (New Jersey Medicaid) guide](https://carelu.com/payers/new-jersey-medicaid).

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Required — ABA is on the PA list; urgent requests decided in 24 hours, routine in 7 days [8][2]
- **Prior auth for treatment**: Required — via Availity or the BH prior authorization form; progress reports via Availity or fax (844) 404-3972 [3][2]
- **Autism diagnosis required?**: Yes — ASD (F84.0–F84.9) by a qualified healthcare professional (state baseline) [4]

## At a glance

- **Plan type:** NJ FamilyCare MCO (Aetna Medicaid)
- **Clinical rules:** State baseline — no distinct published ABA clinical policy
- **Prior auth:** Required — urgent decided in 24h, routine in 7 days
- **Published rates:** 97151/97156 $25.00 · 97155 $21.25 · 97153 $11.20 on the 2020 sheet (state since raised to $15.00 — verify)
- **Unit limits:** State suggested limits adopted verbatim as MUE claim edits
- **Submission:** Availity (provider ID 46320); ABA fax (844) 404-3972

## The state schedule, republished

Aetna's ABA Program sheet (effective 4/1/2020) publishes rates identical to the state FFS schedule — 97151 $25.00, 97153 $11.20, 97155 $21.25, 97156 $25.00, 0362T $25.00, 0373T $16.40 — and adopts the state's suggested daily unit limits verbatim, explicitly labeling them MUE (medically-unlikely-edit) limits: functionally claim edits, not soft guidance. The catch is the technician rate: the state raised 97153 from $11.20 to $15.00 effective February 1, 2022, and whether Aetna followed on its own schedule is unverified — make it an explicit contracting question rather than an assumption. [1][6]

## Authorization mechanics

ABA sits on the plan's prior-authorization list, with urgent requests decided within 24 hours and routine requests within 7 days. Requests go through Availity or on the plan's behavioral-health prior authorization form; progress reports upload via Availity or fax to (844) 404-3972, and the plan phone is 1-855-232-3596. Claims run through Availity or Office Ally under provider ID 46320; appeals go to NJAppealsandGrievances@AETNA.com. Named clinical ABA contacts (per the state's BH integration contact sheet) are Alyx Llorens and Vincenza Stone. The plan also maintains a published ABA/DIR provider directory PDF — useful for checking how your listing appears to referring families. [2][8][3]

## Intake gates

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

- **Age limit**: Two published numbers, and they differ in precision rather than in substance. The founding DMAHS newsletter sets the benefit for "any Medicaid eligible child, under the age of 21, who has been diagnosed with ASD as defined by ICD 10 diagnoses F84.0 through F84.9 by a qualified healthcare provider," delivered under EPSDT, which reaches "individuals under the age of twenty-one." Optum's New Jersey Medicaid entry adds the floor as well as the ceiling: "ABA services shall be made available to children 18 months to 21 years of age based on medical necessity," and its NJ FamilyCare provider orientation repeats it — "Must be 18 months – 21 years old," including in the specialized FamilyCare carve-out. No hour caps are attached to the age band. Aetna Better Health of New Jersey publishes no deviation from this, and its own material was checked for one. [4][5]
- **Who may diagnose**: New Jersey names them twice, and the second list is narrower than the first. The newsletter's general test: "The need for ABA services must be determined by a qualified healthcare professional (QHP) capable of making a diagnosis of autism. QHPs include licensed health care professionals, who are qualified by education, training, or licensure/regulation (when applicable) to perform a professional service within his/her scope of practice." The enumerated list of acceptable QHPs "for the diagnosis and treatment planning for adaptive behavior services" is then: Physicians; Psychologists, which "Requires an active board certified behavior analyst (BCBA) certification in good standing and a qualifying doctoral-level degree (BCBA-D)"; and BCBAs, who appear for treatment planning rather than diagnosis. Optum's NJ entry restates the split: the diagnosis comes from "a physician or psychologist," and "It is not uncommon for one QHP to make the diagnosis (such as a physician) and a separate QHP (such as a BCBA) to develop and supervise the treatment plan." [4][5]
- **Diagnostic tools required**: None required — and New Jersey is one of the few states that says so in terms. Optum's NJ Medicaid entry: "A comprehensive diagnostic evaluation is not required to access ABA services," with "ABA services … available to any child diagnosed with autism spectrum disorder as defined by ICD-10 diagnoses F84.0 through F84.9." The DMAHS newsletter names no instrument either. That makes this the friendliest diagnostic bar of the three states on this page — intake should not queue a New Jersey family for an ADOS-2 before starting the authorization. Aetna Better Health of New Jersey publishes no deviation from this, and its own material was checked for one. [5][4]
- **Referral required?**: No PCP referral and no physician order. The sequence the state sets is QHP determination, then MCO authorization: "Once an individual is properly diagnosed with ASD, the MCO shall authorize a QHP to assess the child for the development of a proposed treatment plan," and treatment follows "Contingent upon approval of the treatment plan." The genuine intake asset sits one step earlier — members still fee-for-service pending MCO enrollment are covered through Gainwell with no prior authorization required at all, so enrollment status, not a referral, is the routing question. Plan practice adds paperwork rather than a referral: Horizon wants an ASD diagnosis "script" from a QHP attached to the assessment request, which is the diagnosis document under another name. Aetna Better Health is the plan that hews closest to the state baseline — its published ABA Program sheet copies the DMAHS rates and unit limits verbatim — and adds no referral requirement of its own; what it adds is a clock, with urgent requests decided in 24 hours and routine in 7 days. [4][1]
- **Prior-auth decision time**: Aetna Better Health of New Jersey's provider manual: urgent pre-service decisions "Within twenty-four (24) hours of receipt of necessary information, but no later than 72 hours from receipt of request"; non-urgent pre-service "Within seven (7) calendar days (or sooner as required by the needs of the member) of receipt of necessary information sufficient to make an informed decision"; continued/extended services within 24 hours of receipt of necessary information, no later than 72 hours. These apply "Unless otherwise required by the New Jersey Division of Medical Assistance and Health Services (DMAHS) or state law." Note the older BH prior authorization request form still reads "Routine services processed within 14 days" — the manual's 7-day standard is the current one. Federal floor for every NJ FamilyCare MCO: standard decisions within 7 calendar days of the request for contract rating periods starting on or after January 1, 2026 (14 days before that), extendable by up to 14 calendar days at the member's or provider's request or when the plan justifies needing more information; expedited within 72 hours. [8][9]
- **Other insurance (who pays first)**: Aetna Better Health of New Jersey's manual: "If other insurance is the primary payer before Aetna Better Health of New Jersey, 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." So a commercial plan that covers ABA → its authorization only; one that excludes ABA → Aetna's PA before services. Submit COB claims within 60 days of the primary insurer's EOB or 180 days from the date of service, whichever is later. State rule underneath: NJ FamilyCare pays last: "All TPL, for example, health insurance, Medicare, CHAMPUS, prepaid health plans… shall, if available, be used first and to the fullest extent." Bill the commercial plan first; supplementation claims "shall not be filed with the program unless accompanied by a statement of payment, Explanation of Benefits (EOB), or denial from the other carrier." Two traps: "No program payments shall be made when the third-party payer requires a contracting or participating provider to accept that third-party payer's payment as payment in full," and when NJ FamilyCare is secondary it pays the lesser of its allowed amount minus other payments, or the patient liability. TRICARE and CHAMPVA both pay ahead of Medicaid: TRICARE rules state "Medicaid is not a double coverage plan. In any double coverage situation involving Medicaid, CHAMPUS is always the primary payer," and CHAMPVA "assumes primary payer status" over Medicaid. [8][10][11][12]
- **Diagnosis recency** _(ask the plan)_: Not published. Neither the DMAHS newsletter nor Optum's New Jersey entry sets a maximum age for the diagnostic evaluation, and the state's written position runs the other way: Optum's NJ Medicaid entry says flatly that "A comprehensive diagnostic evaluation is not required to access ABA services," so there is no comprehensive evaluation whose recency could be gated. What is dated in New Jersey is the authorization rather than the diagnosis — Horizon issues 32 units of 97151 valid for 30 days, and treatment authorizations run in 6-month spans. [4][5]
  - Ask the plan: Aetna Better Health of New Jersey provider services (1-855-232-3596) or the plan's named ABA clinical contacts on the DMAHS BH integration contact sheet.
- **Telehealth** _(ask the plan)_: The state is silent and the carrier layer is not. Neither the founding DMAHS newsletter nor the daily unit guide addresses telehealth, remote delivery, modifiers or place-of-service codes for ABA. The one published New Jersey position is Optum's, for its own line of business: BCBAs and licensed BH clinicians in contracted ABA practices may deliver ABA supervision and caregiver training by telehealth if the practice is an approved Optum virtual-visits provider (attestation on Provider Express) and flags virtual delivery to the Care Advocate at authorization — then bills "the same procedure code you would use for an in-person service, 97155 or 97156, on your claim with the “02” place of service code." Direct technician treatment is not in that carve-out. Aetna Better Health of New Jersey publishes no ABA telehealth position. [4][7]
  - Ask the plan: Aetna Better Health of New Jersey provider services (1-855-232-3596) or the plan's named ABA clinical contacts on the DMAHS BH integration contact sheet.

## Delivery and billing rules

Coverage decides whether Aetna Better Health of New Jersey 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.

- **Concurrent billing (97153 + 97155)**: New Jersey says yes, in writing, and draws the line precisely. “If the QHP is overseeing the activities of the technician, the time of direct supervision by the QHP shall be concurrently billable using code 97155.” But “billing for 97155 is limited to time where the QHP is either engaged directly with the patient or is directing a technician in implementing a modified protocol with the patient. Billing for supervision where the technician is not present is not allowed.” Two other concurrency rules ride along: 97156 may be billed while the RBT delivers direct treatment to the child “in a separate location”; and for 0373T “providers may not bill for the QHP time concurrently” and billing is limited to a single technician’s face-to-face time, never the combined time of multiple technicians (three technicians for two hours bills eight units, not twenty-four). This is NJ FamilyCare state policy and the operative floor for Aetna Better Health of New Jersey; no plan-specific deviation was found in Aetna Better Health of New Jersey’s published material. [4]
  - Ask the plan: Aetna Better Health of New Jersey provider services, to confirm the plan has not layered its own concurrency edit on top.
- **Daily limits / MUEs**: New Jersey publishes its own table rather than adopting a CMS MUE regime, and labels it guidance: the limits “are for guidance purposes only and may be overridden when medically necessary based on individual need” under EPSDT. Per day, in 15-minute units: 97151 32, 97152 8, 97153 32, 97154 12, 97155 24, 97156 16, 97157 16, 97158 16, 0362T 8, 0373T 32. Treat them as soft ceilings the plans enforce as edits — a request above them needs explicit EPSDT medical-necessity framing rather than a quiet resubmission. Aetna Better Health of New Jersey publishes no daily table of its own, so the state guide is what to plan against. [4]
  - Ask the plan: Aetna Better Health of New Jersey’s provider manual / claim-edit list.
- **Place of service** _(plan-dependent)_: This one has moved and the two live sources disagree. The founding DMAHS newsletter is flat: “ABA services may be provided in the therapist’s office, a community setting or the child’s home. Services may not be provided within a school facility.” Optum’s ABA State Mandates document (annual review 7/2026), whose NJ Medicaid entry tracks the same state policy, now reads: “Services may be provided in the school setting as long as services are not provided during normal school hours.” Office, home and community are settled; school is plan-dependent and moving; group home is addressed by neither. Neither position is republished by Aetna Better Health of New Jersey, so resolve it with the plan before scheduling school-based sessions. [4][5]
  - Ask the plan: Aetna Better Health of New Jersey provider services.

## What intake should collect for Aetna Better Health of New Jersey

- **ASD diagnosis + QHP script:** The state baseline applies — diagnosis from a physician/psychologist opens the assessment authorization.
- **Urgency classification:** Urgent requests get 24-hour decisions vs. 7 days routine — classify honestly but deliberately.
- **Requested units vs. MUE limits:** Aetna runs the state daily limits as hard claim edits — plan intensity within them or document the EPSDT override.
- **Current 97153 contract rate:** The published sheet predates the state's $15.00 increase — confirm what your contract actually pays.

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

## Verification of benefits (VOB) data

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

### EDI routing

- **Payer ID (pVerify):** 000942 — pVerify 000942 = "AETNA BETTER HEALTH (NJ)" (legacy line "Aetna Better Health NJ-REV" 00921 also exists).
- **Payer ID (Availity):** 46320 — Provider/claims ID 46320 per the Aetna Better Health of NJ provider QRG (Availity / Office Ally).
- **Payer ID (Change Healthcare / Optum):** 46320 — Change Healthcare/Optum lists 46320 = "Aetna Better Health of New Jersey" (supports 270/271).
- **Supports 270/271 eligibility:** Yes
- **Behavioral health administrator:** none (Aetna administers BH in-house)
- **BH administrator payer ID:** 46320
- **ABA rides on:** medical benefit
- **Two-hop verification required:** No

### Code-level coverage

| Code | Covered | Prior auth | Unit cap | Place of service | Telehealth | Modifiers |
| --- | --- | --- | --- | --- | --- | --- |
| 97151 | Yes | Required via the MCO (assessment + treatment) — NO prior authorization while a member is FFS pending MCO enrollment (a real fast-start window for newly eligible children). | 32 units/day — state "suggested" MUE limit, run by the MCOs as a claim edit; overridable under EPSDT medical necessity per day | home, office/clinic (11), community, telehealth, school (outside normal school hours — see Optum NJ entry) | Allowed; school-setting services permitted outside normal school hours per Optum's Nov 2025 NJ entry (a looser position than the state's original 2020 no-school rule) — confirm per MCO. | Provider-specialty based (RBT / BCaBA render direct codes; BCBA / BCBA-D render assessment/protocol/family codes), H0032 retired for ABA by Horizon eff. 7/15/2026 — use the 97151–97158 / 0362T / 0373T set |
| 97152 | Yes | Required via the MCO (assessment + treatment) — NO prior authorization while a member is FFS pending MCO enrollment (a real fast-start window for newly eligible children). | 8 units/day — state "suggested" MUE limit, run by the MCOs as a claim edit; overridable under EPSDT medical necessity per day | home, office/clinic (11), community, telehealth, school (outside normal school hours — see Optum NJ entry) | Allowed; school-setting services permitted outside normal school hours per Optum's Nov 2025 NJ entry (a looser position than the state's original 2020 no-school rule) — confirm per MCO. | Provider-specialty based (RBT / BCaBA render direct codes; BCBA / BCBA-D render assessment/protocol/family codes), H0032 retired for ABA by Horizon eff. 7/15/2026 — use the 97151–97158 / 0362T / 0373T set |
| 97153 | Yes | Required via the MCO (assessment + treatment) — NO prior authorization while a member is FFS pending MCO enrollment (a real fast-start window for newly eligible children). | 32 units/day — state "suggested" MUE limit, run by the MCOs as a claim edit; overridable under EPSDT medical necessity per day | home, office/clinic (11), community, telehealth, school (outside normal school hours — see Optum NJ entry) | Allowed; school-setting services permitted outside normal school hours per Optum's Nov 2025 NJ entry (a looser position than the state's original 2020 no-school rule) — confirm per MCO. | Provider-specialty based (RBT / BCaBA render direct codes; BCBA / BCBA-D render assessment/protocol/family codes), H0032 retired for ABA by Horizon eff. 7/15/2026 — use the 97151–97158 / 0362T / 0373T set |
| 97154 | Yes | Required via the MCO (assessment + treatment) — NO prior authorization while a member is FFS pending MCO enrollment (a real fast-start window for newly eligible children). | 12 units/day — state "suggested" MUE limit, run by the MCOs as a claim edit; overridable under EPSDT medical necessity per day | home, office/clinic (11), community, telehealth, school (outside normal school hours — see Optum NJ entry) | Allowed; school-setting services permitted outside normal school hours per Optum's Nov 2025 NJ entry (a looser position than the state's original 2020 no-school rule) — confirm per MCO. | Provider-specialty based (RBT / BCaBA render direct codes; BCBA / BCBA-D render assessment/protocol/family codes), H0032 retired for ABA by Horizon eff. 7/15/2026 — use the 97151–97158 / 0362T / 0373T set |
| 97155 | Yes | Required via the MCO (assessment + treatment) — NO prior authorization while a member is FFS pending MCO enrollment (a real fast-start window for newly eligible children). | 24 units/day — state "suggested" MUE limit, run by the MCOs as a claim edit; overridable under EPSDT medical necessity per day | home, office/clinic (11), community, telehealth, school (outside normal school hours — see Optum NJ entry) | Allowed; school-setting services permitted outside normal school hours per Optum's Nov 2025 NJ entry (a looser position than the state's original 2020 no-school rule) — confirm per MCO. | Provider-specialty based (RBT / BCaBA render direct codes; BCBA / BCBA-D render assessment/protocol/family codes), H0032 retired for ABA by Horizon eff. 7/15/2026 — use the 97151–97158 / 0362T / 0373T set |
| 97156 | Yes | Required via the MCO (assessment + treatment) — NO prior authorization while a member is FFS pending MCO enrollment (a real fast-start window for newly eligible children). | 16 units/day — state "suggested" MUE limit, run by the MCOs as a claim edit; overridable under EPSDT medical necessity per day | home, office/clinic (11), community, telehealth, school (outside normal school hours — see Optum NJ entry) | Allowed; school-setting services permitted outside normal school hours per Optum's Nov 2025 NJ entry (a looser position than the state's original 2020 no-school rule) — confirm per MCO. | Provider-specialty based (RBT / BCaBA render direct codes; BCBA / BCBA-D render assessment/protocol/family codes), H0032 retired for ABA by Horizon eff. 7/15/2026 — use the 97151–97158 / 0362T / 0373T set |
| 97157 | Yes | Required via the MCO (assessment + treatment) — NO prior authorization while a member is FFS pending MCO enrollment (a real fast-start window for newly eligible children). | 16 units/day — state "suggested" MUE limit, run by the MCOs as a claim edit; overridable under EPSDT medical necessity per day | home, office/clinic (11), community, telehealth, school (outside normal school hours — see Optum NJ entry) | Allowed; school-setting services permitted outside normal school hours per Optum's Nov 2025 NJ entry (a looser position than the state's original 2020 no-school rule) — confirm per MCO. | Provider-specialty based (RBT / BCaBA render direct codes; BCBA / BCBA-D render assessment/protocol/family codes), H0032 retired for ABA by Horizon eff. 7/15/2026 — use the 97151–97158 / 0362T / 0373T set |
| 97158 | Yes | Required via the MCO (assessment + treatment) — NO prior authorization while a member is FFS pending MCO enrollment (a real fast-start window for newly eligible children). | 16 units/day — state "suggested" MUE limit, run by the MCOs as a claim edit; overridable under EPSDT medical necessity per day | home, office/clinic (11), community, telehealth, school (outside normal school hours — see Optum NJ entry) | Allowed; school-setting services permitted outside normal school hours per Optum's Nov 2025 NJ entry (a looser position than the state's original 2020 no-school rule) — confirm per MCO. | Provider-specialty based (RBT / BCaBA render direct codes; BCBA / BCBA-D render assessment/protocol/family codes), H0032 retired for ABA by Horizon eff. 7/15/2026 — use the 97151–97158 / 0362T / 0373T set |
| 0362T | Yes | Required via the MCO (assessment + treatment) — NO prior authorization while a member is FFS pending MCO enrollment (a real fast-start window for newly eligible children). | 8 units/day — state "suggested" MUE limit, run by the MCOs as a claim edit; overridable under EPSDT medical necessity per day | home, office/clinic (11), community, telehealth, school (outside normal school hours — see Optum NJ entry) | Allowed; school-setting services permitted outside normal school hours per Optum's Nov 2025 NJ entry (a looser position than the state's original 2020 no-school rule) — confirm per MCO. | Provider-specialty based (RBT / BCaBA render direct codes; BCBA / BCBA-D render assessment/protocol/family codes), H0032 retired for ABA by Horizon eff. 7/15/2026 — use the 97151–97158 / 0362T / 0373T set |
| 0373T | Yes | Required via the MCO (assessment + treatment) — NO prior authorization while a member is FFS pending MCO enrollment (a real fast-start window for newly eligible children). | 32 units/day — state "suggested" MUE limit, run by the MCOs as a claim edit; overridable under EPSDT medical necessity per day | home, office/clinic (11), community, telehealth, school (outside normal school hours — see Optum NJ entry) | Allowed; school-setting services permitted outside normal school hours per Optum's Nov 2025 NJ entry (a looser position than the state's original 2020 no-school rule) — confirm per MCO. | Provider-specialty based (RBT / BCaBA render direct codes; BCBA / BCBA-D render assessment/protocol/family codes), H0032 retired for ABA by Horizon eff. 7/15/2026 — use the 97151–97158 / 0362T / 0373T set |

Code notes:

- **97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, 0362T, 0373T:** Aetna's published ABA Program sheet adopts the state suggested daily limits verbatim as MUE (medically-unlikely-edit) claim limits. Urgent requests decided in 24h, routine in 7 days; submit via Availity or the BH prior authorization form; progress reports via Availity or fax (844) 404-3972.

### Medicaid rates

Source: Aetna Better Health of NJ — ABA Program rate sheet (eff. 4/1/2020), read in full: mirrors the state FFS LAUNCH schedule and reproduces the suggested daily unit limits verbatim as MUE limits. NOTE: this 2020 sheet still shows the launch-era $11.20 on 97153 and $11.20 on 97152 — the state raised 97153 to $15.00 eff 2/1/2022, and whether Aetna followed on its own schedule is UNVERIFIED. Confirm the current contracted 97153 rate directly with the plan. Effective 2020-04-01.

| Code | Rate | Unit | Modifier tiers |
| --- | --- | --- | --- |
| 97151 | $25.00 | 15min | suggestedDailyUnits: 32 |
| 97152 | $11.20 | 15min | suggestedDailyUnits: 8 |
| 97153 | $11.20 (launch sheet; state since raised to $15.00 — verify) | 15min | suggestedDailyUnits: 32 |
| 97154 | $4.80 | 15min | suggestedDailyUnits: 12 |
| 97155 | $21.25 | 15min | suggestedDailyUnits: 24 |
| 97156 | $25.00 | 15min | suggestedDailyUnits: 16 |
| 97157 | $12.40 | 15min | suggestedDailyUnits: 16 |
| 97158 | $5.60 | 15min | suggestedDailyUnits: 16 |
| 0362T | $25.00 | 15min | suggestedDailyUnits: 8 |
| 0373T | $16.40 | 15min | suggestedDailyUnits: 32 |

### Contacts

- **Provider services phone:** 1-855-232-3596
- **Phone menu path:** Press * for healthcare provider. Also serves as Availity registration support routing.
- **Hours:** Mon-Fri 8am-5pm (general contact line also answers 24/7 per the Aetna Better Health NJ portal page)
- **Portal:** [Availity Essentials](https://www.aetnabetterhealth.com/newjersey/providers/portal.html)
- **Fax:** 844-404-3972

Questions to ask on a verification call:

- Can you confirm the current contracted rate for 97153 — our reference (Aetna's 2020 sheet) still shows $11.20, but the state raised the FFS rate to $15.00 in 2022?
- What are today's rates for 97151, 97152, 97154, 97157, 97158, 0362T, and 0373T?
- Which places of service are approved under this member's ABA authorization?

### VOB data sources

- https://www.aetnabetterhealth.com/content/dam/aetna/medicaid/newjersey/pdf/Applied%20behavioral%20analysis%20program.pdf (accessed 2026-07-23; source document older than 18 months)
- https://pverify.com/wp-content/uploads/2026/03/pVerifyPayers_All-Payers-List-3-2026.pdf (accessed 2026-07-23)
- https://www.optum.com/content/dam/o4-dam/resources/pdfs/guides/professional-claims-payer-list.pdf (accessed 2026-07-23)
- https://test.njmmis.com/downloadDocuments/5010_270-271_HIPAACompanionGuide.pdf (accessed 2026-07-23)
- https://www.nj.gov/humanservices/dmhas/documents/pdf/resources/providers/DMAHS-BH-Integration-Points-of-Contact.pdf (accessed 2026-07-23)
- https://web.archive.org/web/2023/https://www.nj.gov/humanservices/dmahs/news/Provider_Newsletter_for_Applied_Behavior_Analysis_Therapy.pdf (accessed 2026-07-23)
- https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/guidelines/scc/ABA_SCC_SM.pdf (accessed 2026-07-23)
- https://autismnj.org/news/autism-new-jerseys-advocacy-leads-to-medicaid-rate-increase-for-aba-services/ (accessed 2026-07-23)
- https://www.aetnabetterhealth.com/newjersey/providers/portal.html (accessed 2026-07-23)

## Common questions

### Does Aetna Better Health of New Jersey cover ABA?

Yes — it administers the NJ FamilyCare ABA benefit closest to the state baseline of all five MCOs, with a published rate sheet and unit limits copied from the DMAHS schedule. PA is required, via Availity or the BH prior auth form.

### What does Aetna Better Health NJ pay for ABA?

Its published 2020 sheet mirrors the state FFS schedule: $25.00 for 97151/97156, $21.25 for 97155, and $11.20 for 97153. The state raised 97153 to $15.00 in February 2022 — whether Aetna followed is unverified, so confirm in your contract.

### How fast does Aetna Better Health NJ decide ABA authorizations?

Urgent requests within 24 hours; routine requests within 7 days. Progress reports go via Availity or fax (844) 404-3972.

## Primary sources

1. [Aetna Better Health NJ — ABA Program rates (eff. 4/1/2020)](https://www.aetnabetterhealth.com/content/dam/aetna/medicaid/newjersey/pdf/Applied%20behavioral%20analysis%20program.pdf)
2. [DMAHS BH Integration Points of Contact V3.1 — Aetna ABA contacts](https://www.nj.gov/humanservices/dmhas/documents/pdf/resources/providers/DMAHS-BH-Integration-Points-of-Contact.pdf)
3. [Aetna Better Health NJ — BH prior authorization request form](https://www.aetnabetterhealth.com/content/dam/aetna/medicaid/new-jersey-medicaid/provider/pdf/aetna_bh_prior_auth_form.pdf)
4. [DMAHS Provider Newsletter Vol 30 No 06 — Provision of ABA services (4/1/2020)](https://web.archive.org/web/2023/https://www.nj.gov/humanservices/dmahs/news/Provider_Newsletter_for_Applied_Behavior_Analysis_Therapy.pdf)
5. [Optum ABA State Mandates BH803ABASTM12026 — NJ Medicaid entry](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/guidelines/scc/ABA_SCC_SM.pdf)
6. [Autism NJ — Medicaid rate increase for ABA services](https://autismnj.org/news/autism-new-jerseys-advocacy-leads-to-medicaid-rate-increase-for-aba-services/)
7. [Optum/UHC Community Plan — NJ FamilyCare ABA Provider Orientation (2022)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/autismABA/njaba/NJ.FamilyCare.Medicaid.ABA.pdf)
8. [Aetna Better Health of New Jersey — Provider Manual (Decision/notification requirements)](https://www.aetnabetterhealth.com/content/dam/aetna/medicaid/new-jersey-medicaid/provider/pdf/aetna_provider_manual.pdf)
9. [42 CFR 438.210(d) — Medicaid managed care authorization timeframes (eCFR)](https://www.ecfr.gov/current/title-42/section-438.210)
10. [N.J.A.C. 10:49-7.3 — Third-party liability (TPL) benefits (LII)](https://www.law.cornell.edu/regulations/new-jersey/N-J-A-C-10-49-7-3)
11. [32 CFR 199.8 — TRICARE double coverage (eCFR)](https://www.ecfr.gov/current/title-32/section-199.8)
12. [38 CFR 17.272 — CHAMPVA benefit limitations; Medicaid exception (eCFR)](https://www.ecfr.gov/current/title-38/section-17.272)

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.