---
title: "Aetna ABA coverage in Indiana: the intake guide."
url: "https://carelu.com/payers/aetna-indiana"
markdown_url: "https://carelu.com/payers/aetna-indiana.md"
state: IN (Indiana)
payer: Aetna in Indiana
kind: Commercial insurance
description: "How Aetna covers ABA for Indiana families — the national clinical policy, prior authorization, the Ind. Code 27-8-14.2 mandate (ages, caps, exemptions), Indiana behavior-analyst licensure, and what intake should verify."
last_reviewed: September 2026
vob_data_updated: 2026-07-23
---

# Aetna ABA coverage in Indiana: the intake guide.

_Payer Guide · Aetna · Indiana · Last updated September 2026 · 9 primary sources_

> CPB 0554 (ABA) + CPB 0648 (ASD) + the Ind. Code 27-8-14.2 mandate layer.

For an intake team in Indiana, a Aetna card means three layers at once: the carrier's national clinical policy, Indiana's autism insurance mandate (Ind. Code 27-8-14.2), and the plan's funding type deciding which of the two actually binds. This guide stacks them in order.

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Required — precertification (form GR-69017-4), per Aetna's behavioral health precertification list (eff. 8/1/2024) — CPB 0554 itself sets no precertification rule [7][8]
- **Prior auth for treatment**: Required — precertification; reauthorization commonly ~6 months (verify per plan) [7][8]

## At a glance

- **Covers ABA?:** Yes — for ASD, per the national Aetna policy
- **State mandate:** Ind. Code 27-8-14.2
- **Mandate age:** No age limit in the mandate
- **Mandate caps:** No dollar, visit, or hour caps
- **Exempt from mandate:** Individual policies are offer-only; self-funded ERISA
- **Licensure:** IN Licensed Behavior Analyst (PLA, applications live since 5/2025)

## The national policy, applied in Indiana

Aetna covers ABA for autism spectrum disorder under its national clinical policy CPB 0554 (paired with CPB 0648 for ASD), and considers ABA experimental for anything else. Precertification is required for both the assessment and treatment — form GR-69017-4, submitted via Availity or phone — with reauthorization commonly on a roughly 6-month cadence. That clinical policy is national — what changes in Indiana is the legal floor underneath it: the state mandate below governs what fully-insured plans must cover, while self-funded employer plans answer to ERISA and federal parity instead. Plan funding type is therefore the first fact to establish on every benefits check. The full national policy breakdown lives in our Aetna guide; this page covers what changes in Indiana. [1][2]

## The Indiana mandate: what it guarantees (and doesn't)

Indiana’s mandate (2001) was the first autism insurance mandate in the country, and it remains one of the strongest: group accident and sickness policies must cover ASD treatment prescribed by the treating physician under a treatment plan, with no age limits and no dollar, visit, or hour caps — and cost-sharing no less favorable than for physical illness generally. Individual-policy insurers must offer (not automatically include) the coverage, and self-funded ERISA plans are exempt by preemption. There’s little parity tension here because the statute imposes no quantitative limits of its own. [3][4]

## No Indiana-specific Aetna policy exists

We checked: Aetna publishes no Indiana-specific ABA policy, form, or supplement — the national policy plus the state mandate is the whole picture. That’s worth knowing in itself: it means benefits verification (plan funding type, mandate applicability, benefit limits) is where Indiana-specific answers come from, not a carrier document. [1]

## Licensure & rates in Indiana

Indiana began licensing behavior analysts in May 2025 (IC 25-8.5, via the Professional Licensing Agency’s Behavior Analyst Committee), built on current BCBA/BCaBA certification with biennial renewal. Expect commercial payers to fold the LBA license into credentialing requirements as it phases in. On rates: Aetna does not publish commercial ABA fee schedules for Indiana (none of the national carriers do) — rates are contract-negotiated and live in your participating-provider agreement, so treat rate expectations as a contracting conversation, not a lookup. [5]

## Intake gates

The questions that decide whether a family can start with Aetna in Indiana, and what they have to bring.

- **Who may diagnose**: The diagnosis must come from a provider qualified to diagnose within their scope — a licensed psychologist, psychiatrist or physician. Aetna's precertification form (GR-69017-4, effective 1/1/2026) asks for the DSM-5 diagnosis code, the diagnosing provider and their credentials. Indiana's mandate adds no diagnosing-credential requirement of its own; its only gate is that the treatment be prescribed by the insured's treating physician. [1][2][3]
- **Telehealth**: Aetna covers telehealth for 97151, 97153, 97155, 97156 and 97157 — 97152 is excluded — billed with GT, 95 or FR modifiers per its telemedicine payment policy. Treat the answer as perishable: Aetna announced it would end ABA telehealth coverage in late 2023 and rescinded the change within weeks. Indiana's April 2026 ban on modifier 95 for 97151/97152/97153/97154/0373T is a Medicaid rule and does not reach a commercial Aetna plan. [1]
- **Age limit** _(plan-dependent)_: None from either direction, which is unusual. The carrier's national ABA policy states no age limit, and Indiana's mandate — the first autism insurance mandate in the country — imposes none either: group accident and sickness policies must cover treatment of an autism spectrum disorder prescribed by the insured's treating physician under a treatment plan, with no age limit and no dollar, visit or hour cap anywhere in IC 27-8-14.2. Individual-policy insurers must only offer the coverage, and self-funded ERISA plans are outside the chapter entirely — so an individual or self-funded plan may lawfully lack the benefit. [3]
  - Ask the plan: Benefits verification on the specific plan, via the payer portal or the number on the member’s card — ask three things: is this a fully-insured Indiana group policy (the mandate reaches it), an individual policy (IC 27-8-14.2-5 requires only that the coverage be offered, so ask whether this policy took it up), or a self-funded ERISA plan (outside the chapter entirely); and if the plan is outside the mandate, what age or hour limit the plan document itself imposes on ABA.
- **Referral required?** _(plan-dependent)_: Yes on a fully-insured Indiana group plan, and it is the statute that requires it: coverage is “limited to treatment that is prescribed by the insured's treating physician in accordance with a treatment plan.” The mandate names no credential for the person delivering the service — that comes from the carrier and from Indiana's separate licensure chapter — but the treating physician's prescription is a coverage condition. Capture the prescribing physician and the plan they signed off on. Individual policies (offer-only) and self-funded ERISA plans are outside the chapter. [3]
  - Ask the plan: Benefits verification on the specific plan, via the payer portal or the number on the member’s card — confirm the funding type first, because the statutory prescription requirement only reaches fully-insured Indiana group policies. On an individual or self-funded ERISA plan, ask the carrier directly whether it requires a treating-physician prescription and a treatment plan, and get the answer with the authorization.
- **Prior-auth decision time** _(plan-dependent)_: Depends on how the plan is funded. A fully insured plan issued in Indiana (group, individual or HMO) falls under IC 27-1-37.5-23, in force since July 1, 2025: urgent PA answered “not later than twenty-four (24) hours after receiving the request,” every other PA “not later than forty-eight (48) hours,” with weekends and state and federal holidays excluded; a missed deadline means the service “shall be automatically deemed authorized” (IC 27-1-37.5-28). A self-funded private-employer plan follows the federal ERISA claims rule instead: urgent within 72 hours; pre-service within a reasonable time “but not later than 15 days after receipt of the claim,” with one 15-day extension; and a request to extend an ongoing course of treatment that involves urgent care must be decided within 24 hours if made at least 24 hours before the authorization expires. Aetna publishes no ABA-specific reauthorization lead time in the precertification materials cited in this guide. [10][11][12]
  - Ask the plan: Benefits verification call or the Aetna (Availity) provider portal: ask whether the plan is fully insured and issued in Indiana (state 24/48-business-hour clock) or self-funded ERISA (federal 72-hour / 15-day clock), and what turnaround the plan quotes for ABA.
- **Other insurance (who pays first)** _(plan-dependent)_: Depends on the family and on plan funding. For a fully insured Indiana group plan, 760 IAC 1-38.1 sets the order: the plan covering the person as employee or subscriber pays before one covering them as a dependent; for a child whose parents are married or living together, “the plan of the parent whose birthday falls earlier in a calendar year” is primary (same birthday: the plan that has covered that parent longest); for parents who are divorced, separated or do not live together, with no court decree, the order is custodial parent, custodial parent's spouse, noncustodial parent, noncustodial parent's spouse — and a decree that makes one parent responsible for health coverage overrides it. A self-funded ERISA plan sets its COB rules in its plan document instead. TRICARE is always “last pay” behind other health coverage (32 CFR 199.8), so this plan pays before TRICARE. If the child also has Indiana Medicaid, this plan pays first and IHCP pays last — but IHCP still requires its own PA (“must also obtain PA from the appropriate IHCP PA contractor”) and will not pay for services this plan denied as out-of-network, so be in this plan's network and get both authorizations. [13][14][15][16][17][18]
  - Ask the plan: At intake, collect every coverage the child has, both parents' birthdays and any custody or court-decree terms; then ask Aetna (and the other carrier) on the benefits call whether each plan is fully insured or self-funded and which one they show as primary.
- **Diagnosis recency** _(ask the plan)_: Aetna publishes no recency rule for the ASD diagnostic evaluation, and Indiana's mandate sets none for commercial plans — the one-year CDE rule in this state belongs to Indiana Medicaid, not to IC 27-8-14.2. Capture the evaluation date anyway: the precertification package asks for it. [1][3]
  - Ask the plan: The precertification call or Availity, when submitting form GR-69017-4 — ask whether an evaluation of this age will be accepted for this plan.
- **Diagnostic tools required** _(ask the plan)_: No instrument is named. CPB 0554 does not require or reference a specific diagnostic tool, and the precertification form asks for the DSM-5 diagnosis code, the diagnosing provider and their credentials rather than for an instrument and score. Indiana's mandate names none either, and defines autism spectrum disorder only by reference to the DSM. [1][3]
  - Ask the plan: Aetna precertification (Availity or the number on the card) — ask whether a specific instrument is expected for this plan before scheduling testing.

## Delivery and billing rules

Coverage decides whether Aetna in Indiana 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**: Practitioners delivering ABA under CPB 0554 need BACB national certification or state behavior-analyst licensure, with unlicensed staff working under supervision per practice standards; Aetna publishes no numeric ratio. Indiana now supplies the licensure half: LBA and LABA applications went live May 13, 2025 and practising applied behavior analysis without the licence is prohibited, with direct-contact technicians exempt only while acting under the extended authority and direction of a licensed analyst. [1][2][5][6]
- **Concurrent billing (97153 + 97155)** _(ask the plan)_: Not published. Neither CPB 0554 nor CPB 0648 states whether 97155 and 97153 may be billed for the same clock time, and Aetna publishes no Indiana-specific ABA policy, form or supplement. [1]
  - Ask the plan: Availity Essentials for the plan's reimbursement and claim-editing policies, or the provider-services number on the member's card.
- **Daily limits / MUEs** _(ask the plan)_: Not published. CPB 0554 lists the covered ABA codes but sets no per-day unit ceiling, and Aetna publishes no ABA-specific MUE table. The operative ceiling is the precertification itself, which requires requested hours to be listed code by code — so the authorization, not a policy, is what bounds the day. CPB 0648 references intensive-intervention research norms of 25 hours a week, 12 months a year as clinical context rather than as a limit. [1]
  - Ask the plan: The authorization letter itself, plus Availity Essentials for the plan's claim-editing and reimbursement policies. Ask whether CMS MUE limits are applied to ABA codes on this plan.
- **Session-note signature** _(ask the plan)_: Not published. CPB 0554 and CPB 0648 set coverage criteria and precertification content; neither states what a session note must contain, who signs it, or by when. [1]
  - Ask the plan: Aetna provider services or Availity — ask for the documentation standard applied at audit, and keep to the precertification form's own data elements in the meantime.
- **Place of service** _(ask the plan)_: Not published as a payable-settings list. What CPB 0554 does make a submission requirement is adjacent and useful: the precertification form asks for concurrent services — PT, OT, speech and school services — plus how care is coordinated across them, so the school picture is data Aetna collects even though it publishes no school-versus-home rule. [1]
  - Ask the plan: Benefits verification on the specific plan — ask which places of service are payable for ABA and whether school-based delivery is excluded.
- **Bill as provider** _(ask the plan)_: Not published for ABA. CPB 0554 sets who may deliver the service — BACB-certified or state-licensed behavior analysts, with unlicensed staff supervised — but does not state whose NPI carries a technician-delivered 97153 claim, or which degree-level modifiers apply, and Aetna publishes no Indiana-specific ABA supplement. Indiana supplies the licensure half: the supervising analyst must hold the state LBA (or LABA) licence, and direct-contact technicians are exempt from licensure only while acting under the extended authority and direction of a licensed behavior analyst. [1][6]
  - Ask the plan: Aetna provider services or Availity — confirm the rendering-versus-billing NPI convention and any required degree-level modifiers before the first claim.

## What intake should collect for Aetna in Indiana

- **Plan funding type:** Fully insured (mandate applies) vs. self-funded ERISA (exempt) — it decides which rulebook governs. Ask for the employer and check the card.
- **Member ID + card photo:** Enough to run a live benefits verification — the only reliable answer on limits and cost-sharing.
- **Diagnosis report:** DSM-5 ASD diagnosis, diagnosing provider and credentials, evaluation date.
- **Age:** Where the mandate carries age terms, flag edge cases for the parity analysis rather than turning families away.

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

## Verification of benefits (VOB) data

How Aetna in Indiana ABA benefits route and read on an eligibility check. Data last updated 2026-07-23.

### EDI routing

- **Payer ID (pVerify):** 00001
- **Payer ID (Availity):** 60054 — Same 2012-vintage Availity list staleness finding as georgia.ts/aetna-florida — downgraded to inferred pending a current Availity export.
- **Payer ID (Change Healthcare / Optum):** 60054 — Same staleness finding as payerId.availity.
- **Supports 270/271 eligibility:** Yes

### Code-level coverage

| Code | Covered | Prior auth | Unit cap | Place of service | Telehealth | Modifiers |
| --- | --- | --- | --- | --- | --- | --- |
| 97151 | Yes | Required — precertification (form GR-69017-4), per national CPB 0554 | — | — | — | — |
| 97152 | Yes | Required — precertification (form GR-69017-4), per national CPB 0554 | — | — | — | — |
| 97153 | Yes | Required — precertification (form GR-69017-4), per national CPB 0554 | — | — | — | — |
| 97154 | Yes | Required — precertification (form GR-69017-4), per national CPB 0554 | — | — | — | — |
| 97155 | Yes | Required — precertification (form GR-69017-4), per national CPB 0554 | — | — | — | — |
| 97156 | Yes | Required — precertification (form GR-69017-4), per national CPB 0554 | — | — | — | — |
| 97157 | Yes | Required — precertification (form GR-69017-4), per national CPB 0554 | — | — | — | — |
| 97158 | Yes | Required — precertification (form GR-69017-4), per national CPB 0554 | — | — | — | — |
| 0362T | Yes | Required — precertification (form GR-69017-4), per national CPB 0554 | — | — | — | — |
| 0373T | Yes | Required — precertification (form GR-69017-4), per national CPB 0554 | — | — | — | — |

Code notes:

- **97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, 0362T, 0373T:** Verify via: Aetna provider services / precertification — CPB 0554 & 0648 are national medical-necessity policies only; no Indiana-specific or ABA-specific coding/reimbursement policy located.

### Contacts

- **Provider services phone:** 1-888-632-3862 (Aetna commercial precertification / Provider Services, TTY 711)
- **Portal:** [Availity Essentials](https://Availity.com)

Questions to ask on a verification call:

- Does Aetna administer ABA in-house or via a behavioral-health carve-out for this member's Indiana commercial plan?
- What are the per-code unit caps, POS, telehealth allowance, and licensure-tier modifiers for ABA codes? (No Indiana-specific coding table is published.)
- Is precertification actually required for this member? Aetna's national BH precertification list states its precertification programs don't apply to fully insured members in Indiana — confirm the member's funding type (fully insured vs. self-funded) before assuming PA applies.

### VOB data sources

- https://pverify.com/wp-content/uploads/2026/03/pVerifyPayers_All-Payers-List-3-2026.pdf (accessed 2026-07-23)
- https://essentials.availity.com/availity/documents/payer_list_wShortNames.pdf (accessed 2026-07-23; source document older than 18 months)
- https://www.caqh.org/sites/default/files/CAQH%20CORE%20Eligibility%20Benefits%20(270_271)%20Data%20Content%20Rule%20vEB2.0.pdf (accessed 2026-07-23)
- https://www.aetnaseniorproducts.com/ssi/assets/pdf/Aetna%20SSI%20EDI%20270-271%20Companion%20guide.pdf (accessed 2026-07-23)
- https://www.aetna.com/cpb/medical/data/500_599/0554.html (accessed 2026-07-23)
- https://www.aetna.com/cpb/medical/data/600_699/0648.html (accessed 2026-07-23)
- https://www.aetna.com/document-library/healthcare-professionals/documents-forms/bh_precert_list.pdf (accessed 2026-07-23; source document older than 18 months)

## Common questions

### Does Aetna cover ABA therapy in Indiana?

Yes — under the carrier's national policy for ASD, layered on Indiana's mandate (Ind. Code 27-8-14.2) for fully-insured plans. Self-funded employer plans are exempt from the mandate, so always verify plan funding type first.

### What does the Indiana autism mandate require?

Indiana’s mandate (2001) was the first autism insurance mandate in the country, and it remains one of the strongest: group accident and sickness policies must cover ASD treatment prescribed by the treating physician under a treatment plan, with no age limits and no dollar, visit, or hour caps — and cost-sharing no less favorable than for physical illness generally. See the mandate section above for ages, caps, and exemptions — and remember federal parity limits how hard the numeric caps can be enforced against group plans.

### What does Aetna pay for ABA in Indiana?

Commercial ABA rates are not published — they are negotiated in your participating-provider agreement. Benchmark against the Indiana Medicaid fee schedule where one exists, and treat rate-setting as part of contracting.

## Primary sources

1. [Aetna CPB 0554 — Applied Behavior Analysis](https://www.aetna.com/cpb/medical/data/500_599/0554.html)
2. [Aetna CPB 0648 — Autism Spectrum Disorders](https://www.aetna.com/cpb/medical/data/600_699/0648.html)
3. [Ind. Code § 27-8-14.2-4 (group mandate)](https://codes.findlaw.com/in/title-27-insurance/in-code-sect-27-8-14-2-4/)
4. [Ind. Code § 27-8-14.2-5 (individual offer)](https://codes.findlaw.com/in/title-27-insurance/in-code-sect-27-8-14-2-5/)
5. [Indiana PLA — Behavior Analyst licensure](https://www.in.gov/pla/professions/behavior-analyst/)
6. [Ind. Code § 25-8.5-3-6 — practice restriction and exceptions](https://law.justia.com/codes/indiana/title-25/article-8-5/chapter-3/section-25-8-5-3-6/)
7. [Aetna — Participating provider behavioral health precertification list (eff. Aug. 1, 2024) (PDF)](https://www.aetna.com/content/dam/aetna/pdfs/aetnacom/healthcare-professionals/documents-forms/bh_precert_list.pdf)
8. [Aetna — Outpatient BH ABA Treatment Request: Required Information for Precertification, form GR-69017-4 (PDF)](https://www.aetna.com/content/dam/aetna/pdfs/aetnacom/pharmacy-insurance/healthcare-professional/documents/outpatient-behavioral-health-BH-ABA-assessment-precert.pdf)
9. [Aetna — Applied behavior analysis medical necessity guide (PDF)](https://www.aetna.com/content/dam/aetna/pdfs/health-care-professionals/applied-behavioral-analysis-necessity-guide.pdf)
10. [Ind. Code 27-1-37.5-23 — prior authorization response deadlines](https://codes.findlaw.com/in/title-27-insurance/in-code-sect-27-1-37-5-23/)
11. [Indiana SEA 480 (P.L.144-2025) — enrolled act adding IC 27-1-37.5-23 and -28, eff. July 1, 2025](https://iga.in.gov/pdf-documents/124/2025/senate/bills/SB0480/SB0480.06.ENRH.pdf)
12. [29 CFR 2560.503-1(f)(2) — ERISA group health plan claims procedure (eCFR)](https://www.ecfr.gov/current/title-29/section-2560.503-1)
13. [760 IAC 1-38.1-12 — order of benefits, nondependent before dependent](https://www.law.cornell.edu/regulations/indiana/760-IAC-1-38.1-12)
14. [760 IAC 1-38.1-13 — dependent child, birthday rule](https://www.law.cornell.edu/regulations/indiana/760-IAC-1-38.1-13)
15. [760 IAC 1-38.1-14 — dependent child, separated or divorced parents](https://www.law.cornell.edu/regulations/indiana/760-IAC-1-38.1-14)
16. [32 CFR 199.8 — TRICARE double coverage (eCFR)](https://www.ecfr.gov/current/title-32/section-199.8)
17. [IHCP — Prior Authorization module (PROMOD00012, v7.2, publ. Nov. 20, 2025)](https://www.in.gov/medicaid/providers/files/modules/prior-authorization.pdf)
18. [IHCP — Third-Party Liability module (PROMOD00017, v7.2, publ. Oct. 9, 2025)](https://www.in.gov/medicaid/providers/files/modules/third-party-liability.pdf)

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.