---
title: "Aetna ABA coverage in New Jersey: the intake guide."
url: "https://carelu.com/payers/aetna-new-jersey"
markdown_url: "https://carelu.com/payers/aetna-new-jersey.md"
state: NJ (New Jersey)
payer: Aetna in New Jersey
kind: Commercial insurance
description: "How Aetna covers ABA for New Jersey families — the national clinical policy, prior authorization, the P.L. 2009, c.115 mandate (ages, the parity-voided $36k cap, exemptions), New Jersey behavior-analyst licensure, and what intake should verify."
last_reviewed: September 2026
vob_data_updated: 2026-07-23
---

# Aetna ABA coverage in New Jersey: the intake guide.

_Payer Guide · Aetna · New Jersey · Last updated September 2026 · 7 primary sources_

> CPB 0554 (ABA) + CPB 0648 (ASD) + the P.L. 2009, c.115 mandate layer.

For an intake team in New Jersey, an Aetna card means three layers at once: the carrier's national clinical policy, New Jersey's autism insurance mandate (P.L. 2009, c.115), 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 [1]
- **Prior auth for treatment**: Required — precertification; reauthorization commonly ~6 months (verify per plan) [1][7]
- **Autism diagnosis required?**: Yes — ASD only (F84.0–F84.9); ABA for other diagnoses considered experimental [2]

## At a glance

- **Covers ABA?:** Yes — for ASD, per the national Aetna policy
- **State mandate:** P.L. 2009, c.115 (N.J.S.A. 17:48-6ii and parallel sections)
- **Mandate age:** Under 21 in statute; IHC/SEH markets extended to adults 21+ (Jan 2015)
- **Mandate caps:** $36,000/yr in statute — voided for MHPAEA group plans (DOBI Bulletin 10-02)
- **Exempt from mandate:** Self-funded ERISA plans (may exclude ABA entirely)
- **Licensure:** NJ Licensed Applied Behavior Analyst (Consumer Affairs board)

## The national policy, applied in New Jersey

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 New Jersey is the legal floor underneath it: the state mandate below governs what fully-insured plans must cover (Aetna's CPBs state that applicable state mandates take precedence for fully insured plans), 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 New Jersey. [2][3]

## The New Jersey mandate: strong, and stronger than it reads

P.L. 2009, c.115 (effective February 9, 2010, codified across N.J.S.A. 17:48-6ii and parallel sections for insurers, HMOs, individual and small-employer plans, plus the SHBP and SEHBP) requires state-regulated plans to cover autism screening and diagnosis, medically necessary PT/OT/ST for autism or other developmental disabilities, and medically necessary ABA-based behavioral interventions for autism in individuals under 21 — coverage owed even when services aren't restorative. The statute's headline limitation, a $36,000/year ABA cap, is largely dead: DOBI Bulletin 10-02 held the cap cannot be applied to group health plans subject to MHPAEA, because New Jersey classifies autism as a biologically-based mental illness and dollar limits conflict with federal parity — leaving it live mainly in nongroup policies. The IHC and SEH program boards went further in amendments effective January 2015, extending ABA to adults 21+ and removing therapy visit limits in the individual and small-employer markets. Practical current state: state-regulated plans cover medically necessary ABA without dollar caps. Self-funded ERISA plans remain exempt and may exclude ABA entirely. [4][5]

## Aetna Medicaid in New Jersey

A family saying "we have Aetna" in New Jersey may actually be on the carrier's Medicaid plan — Aetna Better Health of New Jersey, an NJ FamilyCare MCO — which follows the state Medicaid rules (and publishes a rate sheet mirroring the state FFS schedule), not this commercial policy. Verify which line of business the card belongs to, and use the dedicated guide for the Medicaid plan.

## Licensure & rates in New Jersey

New Jersey licenses behavior analysts through the State Board of Applied Behavior Analyst Examiners at the Division of Consumer Affairs: the Licensed Applied Behavior Analyst (LBA — master's or doctorate, current BCBA/BCBA-D, and the NJ jurisprudence exam) and the assistant-level LaBA, under N.J.S.A. 45:8B-91 et seq. and N.J.A.C. 13:42B. The board's position is that supervision in all its forms constitutes practicing behavior analysis and requires a license; RBTs are unlicensed and work under a licensee. On rates: Aetna does not publish commercial ABA fee schedules for New Jersey (none of the national carriers do) — rates are contract-negotiated and live in your participating-provider agreement. Benchmark against NJ FamilyCare's published FFS schedule ($15.00/unit for 97153, $21.25 for 97155, $25.00 for 97151/97156) and treat rate-setting as a contracting conversation, not a lookup. [6]

## Intake gates

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

- **Diagnosis recency**: Twelve months, and it attaches to the functional measure rather than to the diagnosis. Aetna's medical-necessity criteria require that "There is demonstration of functional impairment on a standardized scale of functioning in the past 12 months," with the impairment at least one standard deviation below the population mean or representing a significant risk of harm to self or others. The ASD diagnosis itself carries no stated shelf life — so a family with an older diagnostic report is not blocked, but a stale adaptive score is. [7]
- **Who may diagnose**: A scope-of-practice test rather than a specialty list. Aetna requires "a DSM-V diagnosis of Autism Spectrum Disorder (ICD-10: F84.0; F84.3 - F84.9) obtained by an appropriate provider," and defines that as a "licensed psychologist/psychiatrist, physician or other health care professional qualified to diagnose mental health conditions within their scope of practice." Note the code range: F84.2 (Rett syndrome) sits outside the listed set, and ABA for diagnoses other than ASD is treated as experimental. One New Jersey wrinkle on the code range: DOBI's implementing bulletin notes carriers may exclude clear Rett and childhood disintegrative disorder diagnoses from the mandate's autism definition, but must still consider them under the mandate's developmental-disability therapy prongs — so a Rett exclusion in the carrier policy is not the end of the coverage conversation on a state-regulated plan. [7][4]
- **Diagnostic tools required**: Aetna names adaptive-functioning instruments, not autism diagnostic instruments. The medical-necessity criteria require demonstrated functional impairment "on a standardized scale of functioning in the past 12 months. For instance, the Vineland Adaptive Behavior Scales 3 (VABS-3), the Adaptive Behavior Assessment Scale (ABAS), VB-MAPP or ABLLS," and quality-of-care elements add "Repeated measurement with standardized measures to assess progress." No ADOS-2 or ADI-R requirement appears anywhere — the instrument Aetna asks for is the one that sizes the hours, and the level-of-impairment calculation is what justifies the number requested. [7]
- **Age limit** _(plan-dependent)_: Aetna sets no upper age limit in its national medical-necessity criteria. The ABA Medical Necessity Guide gives age only as clinical shape, not as a gate: comprehensive ABA carries a "typical age range" of 0-7 years at 10-25 hours a week for 1-2 years, while focused ABA is listed for "All ages" at 1-20 hours a week. The binding age question is the legal layer underneath: New Jersey's mandate (P.L. 2009, c.115) reaches individuals under 21 on state-regulated plans, with the IHC and SEH program boards extending ABA to adults 21+ in the individual and small-employer markets from January 2015; a self-funded ERISA plan answers to its own plan document. Establish funding type before quoting an age answer. So a 21-plus New Jersey inquiry is a market-analysis question, not an automatic turn-away. [7][4]
  - Ask the plan: The member's benefit document and Aetna precertification — funding type decides whether the state mandate or the plan document sets the age boundary.
- **Prior-auth decision time** _(plan-dependent)_: Depends on how the plan is funded. Fully insured New Jersey plans follow the Ensuring Transparency in Prior Authorization Act (in force January 1, 2025): for outpatient services such as ABA, a denial must be communicated "no later than 12 days if the request is submitted in paper, or nine days if submitted through an electronic portal provided by the payer," and urgent-care determinations no later than 72 hours after receipt; if the payer asks for more information and the provider does not respond within 72 hours, the request is deemed withdrawn. Useful for reauthorizations: a prior authorization for a chronic or long-term condition "shall remain in effect for 180 days" unless a shorter period is needed with notice to the provider. Self-funded (ERISA) plans follow the federal claims rule instead: pre-service decisions within 15 days of receipt (one 15-day extension), urgent within 72 hours. Aetna's office manual and ABA medical-necessity guide publish no ABA-specific decision clock. [8][9][10]
  - Ask the plan: Benefits verification: fully insured NJ policy (ETPAA 9/12-day clock, 180-day authorizations) vs. self-funded ERISA plan (15 days / 72 hours), plus the carrier's behavioral health reviewer turnaround.
- **Other insurance (who pays first)** _(plan-dependent)_: For a child on two parents' plans, New Jersey's group coordination-of-benefits rule (fully insured group contracts) puts the plan of "the parent whose birthday falls earlier in a year" first — month and day only; same birthday → the plan that covered the parent longer. Divorced or separated parents: the custodial parent's plan pays first, then the custodial parent's spouse's plan, then the non-custodial parent's plan, unless a court decree makes one parent responsible for the child's health care. Self-funded plans set their own order in the plan document. Aetna says it follows the NAIC order-of-benefit rules, "as allowed by state or federal law," including the birthday rule, and that many self-funded plans use maintenance of benefits. If the child also has TRICARE, this plan pays first — TRICARE is the secondary payer to other health insurance under its double-coverage rule (Medicaid is the only coverage it pays ahead of). CHAMPVA likewise pays last: "In double coverage situations, CHAMPVA would be the last payer." If the child also has Medicaid, this plan is primary and Medicaid pays last. [11][12][13][14][15]
  - Ask the plan: Benefits verification with both plans: funding type, which is primary for the child, and whether the secondary plan requires its own authorization.
- **Referral required?** _(ask the plan)_: Not published. Aetna's ABA Medical Necessity Guide and its ABA clinical policy bulletin set a diagnosis requirement, a precertification requirement and a provider-licensure requirement, but state no referral or physician order as a condition of coverage. The gate that does exist is precertification itself — required for both the assessment and treatment. [7]
  - Ask the plan: Aetna precertification/provider services at the number on the member's ID card, and the member's benefit document — ask whether the plan layers a referral requirement on behavioral health.
- **Telehealth** _(ask the plan)_: Not published. Aetna's ABA materials set medical-necessity criteria and precertification requirements for 97151-97158, 0362T and 0373T but say nothing about remote delivery, telehealth modifiers or place-of-service codes. Nothing in the New Jersey mandate or DOBI Bulletin 10-02 addresses telehealth delivery of ABA, so there is no state floor to fall back on here — unlike Nebraska, whose statute names telehealth expressly. [7]
  - Ask the plan: Aetna provider services and the member's benefit document — confirm which ABA codes pay by telehealth and with which POS code before scheduling remote supervision or caregiver training.

## Delivery and billing rules

Coverage decides whether Aetna in 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.

- **Supervision**: Aetna sets a duty, not a number. Where a state mandate, plan document or contract allows services from someone neither state-licensed nor BACB-certified, “there must be supervision and direction of the unlicensed or non-certified providers in line with practice standards.” The ABA Medical Necessity Guide publishes no supervision percentage, ratio or caseload cap — the operative standard is professional practice plus whatever the contract adds. [7]
- **Bill as provider**: The claim carries the analyst, not the technician. “Services must be provided directly or billed by licensed behavior analysts (in states with behavior analyst licensure laws), board-certified behavior analysts, or licensed psychologists where behavior analysis is within their scope of practice definition, unless state mandates, plan documents or contracts require otherwise.” The escape clause matters: a state mandate or your contract can move the line, so confirm before enrolling technicians. [7]
- **Place of service** _(plan-dependent)_: Aetna does not publish a POS code list for ABA. The one place-of-service boundary it does state is the schools carve-out: pursuant to applicable law Aetna “is not required [to] provide services to a child under an individualized education program or any obligation imposed on a public school by the Individuals with Disabilities Education Act.” That is a limit on paying for what the IEP owes, not a blanket ban on the school setting — and it yields to a stronger state mandate. Where ABA is payable in a school, in the community or in a group home is a benefit-document question on Aetna plans. New Jersey adds a wrinkle worth checking separately: state Medicaid policy on school-setting ABA has moved since 2020, and a fully insured NJ commercial plan is bound by the state mandate rather than by Aetna’s national default. [7]
  - Ask the plan: The member’s benefit document, and Aetna provider services for whether school-setting ABA is payable on that plan.
- **Concurrent billing (97153 + 97155)** _(ask the plan)_: Not published. Neither the ABA Medical Necessity Guide nor Aetna’s clinical policy bulletin on ABA addresses whether 97153 and 97155 may be billed for the same clock time; Aetna carries the concurrency question in its claim editing rather than in a public policy.
  - Ask the plan: Aetna precertification/provider services at the number on the member’s ID card, and the plan’s own reimbursement schedule — ask specifically whether 97155 pays alongside 97153 when analyst, technician and member are all face-to-face.
- **Daily limits / MUEs** _(ask the plan)_: Not published. Aetna’s ABA documents set medical-necessity criteria and precertification requirements for 97151–97158, 0362T and 0373T, but no per-day unit ceiling and no statement of which MUE table applies.
  - Ask the plan: Aetna provider services; confirm before promising a family more than four hours a day of 97153.
- **Session-note signature** _(ask the plan)_: Not published in Aetna’s ABA materials — no rule on who signs a session note or within what window.
  - Ask the plan: The Aetna provider manual and your participation agreement’s documentation clause.

## What intake should collect for Aetna in New Jersey

- **Plan funding type:** Fully insured (mandate applies, no dollar cap in practice) vs. self-funded ERISA (exempt) — it decides which rulebook governs. Ask for the employer and check the card.
- **Line of business:** Commercial vs. Aetna Better Health of New Jersey (NJ FamilyCare Medicaid) — different rules, different guide.
- **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:** Under 21 for the statutory ABA prong — but IHC/SEH-market plans extend ABA to adults, so flag 21+ cases for market analysis rather than turning them away.

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

## Verification of benefits (VOB) data

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

### EDI routing

- **Payer ID (pVerify):** 00001 — pVerify 00001 = "Aetna" (Medical, Eligibility=Yes).
- **Payer ID (Availity):** 60054 — Availity 60054 = AETNA appears in the stale 2012 snapshot and matches the current national Aetna commercial ID — inferred pending a current export.
- **Payer ID (Change Healthcare / Optum):** 60054 — Change Healthcare/Optum lists 60054 = "Aetna Health Plan - PPO" (supports 270/271).
- **Supports 270/271 eligibility:** Yes
- **Behavioral health administrator:** Aetna Behavioral Health (same-payer-ID pass-through) — Aetna Behavioral Health rides the same medical payer ID (no second hop); confirm the ABA precertification path via Aetna provider services.
- **BH administrator payer ID:** 60054
- **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 — precertification via Availity or phone (both assessment and treatment) per Aetna's national CPB 0554/0648; reauthorization commonly ~6 months. For fully-insured NJ plans the P.L. 2009, c.115 mandate is the legal floor (dollar caps voided for MHPAEA group plans per DOBI Bulletin 10-02); self-funded ERISA plans are exempt. | — | — | — | — |
| 97152 | Yes | Required — precertification via Availity or phone (both assessment and treatment) per Aetna's national CPB 0554/0648; reauthorization commonly ~6 months. For fully-insured NJ plans the P.L. 2009, c.115 mandate is the legal floor (dollar caps voided for MHPAEA group plans per DOBI Bulletin 10-02); self-funded ERISA plans are exempt. | — | — | — | — |
| 97153 | Yes | Required — precertification via Availity or phone (both assessment and treatment) per Aetna's national CPB 0554/0648; reauthorization commonly ~6 months. For fully-insured NJ plans the P.L. 2009, c.115 mandate is the legal floor (dollar caps voided for MHPAEA group plans per DOBI Bulletin 10-02); self-funded ERISA plans are exempt. | — | — | — | — |
| 97154 | Yes | Required — precertification via Availity or phone (both assessment and treatment) per Aetna's national CPB 0554/0648; reauthorization commonly ~6 months. For fully-insured NJ plans the P.L. 2009, c.115 mandate is the legal floor (dollar caps voided for MHPAEA group plans per DOBI Bulletin 10-02); self-funded ERISA plans are exempt. | — | — | — | — |
| 97155 | Yes | Required — precertification via Availity or phone (both assessment and treatment) per Aetna's national CPB 0554/0648; reauthorization commonly ~6 months. For fully-insured NJ plans the P.L. 2009, c.115 mandate is the legal floor (dollar caps voided for MHPAEA group plans per DOBI Bulletin 10-02); self-funded ERISA plans are exempt. | — | — | — | — |
| 97156 | Yes | Required — precertification via Availity or phone (both assessment and treatment) per Aetna's national CPB 0554/0648; reauthorization commonly ~6 months. For fully-insured NJ plans the P.L. 2009, c.115 mandate is the legal floor (dollar caps voided for MHPAEA group plans per DOBI Bulletin 10-02); self-funded ERISA plans are exempt. | — | — | — | — |
| 97157 | Yes | Required — precertification via Availity or phone (both assessment and treatment) per Aetna's national CPB 0554/0648; reauthorization commonly ~6 months. For fully-insured NJ plans the P.L. 2009, c.115 mandate is the legal floor (dollar caps voided for MHPAEA group plans per DOBI Bulletin 10-02); self-funded ERISA plans are exempt. | — | — | — | — |
| 97158 | Yes | Required — precertification via Availity or phone (both assessment and treatment) per Aetna's national CPB 0554/0648; reauthorization commonly ~6 months. For fully-insured NJ plans the P.L. 2009, c.115 mandate is the legal floor (dollar caps voided for MHPAEA group plans per DOBI Bulletin 10-02); self-funded ERISA plans are exempt. | — | — | — | — |
| 0362T | Yes | Required — precertification via Availity or phone (both assessment and treatment) per Aetna's national CPB 0554/0648; reauthorization commonly ~6 months. For fully-insured NJ plans the P.L. 2009, c.115 mandate is the legal floor (dollar caps voided for MHPAEA group plans per DOBI Bulletin 10-02); self-funded ERISA plans are exempt. | — | — | — | — |
| 0373T | Yes | Required — precertification via Availity or phone (both assessment and treatment) per Aetna's national CPB 0554/0648; reauthorization commonly ~6 months. For fully-insured NJ plans the P.L. 2009, c.115 mandate is the legal floor (dollar caps voided for MHPAEA group plans per DOBI Bulletin 10-02); self-funded ERISA plans are exempt. | — | — | — | — |

Code notes:

- **97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, 0362T, 0373T:** Verify via: Aetna provider services / precertification and a live benefits check (plan funding type first) — CPB 0554 & 0648 are medical-necessity policies with no unit caps, POS codes, or modifiers. Commercial ABA rates are contract-specific (out of Layer 4 scope).

### Contacts

- **Portal:** [Availity Essentials](https://www.availity.com)

Questions to ask on a verification call:

- What is the member's plan funding type — fully-insured (P.L. 2009, c.115 mandate applies) or self-funded (ERISA, mandate-exempt)?
- Are there unit or hour caps on ABA codes for this member's specific plan?
- Which places of service (home/office/school/telehealth) are approved for this member's authorization?
- Are there modifier requirements (licensure tier, telehealth) for billing?
- Is eligibility checking real-time or batch?

### VOB data sources

- 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://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://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)

## Common questions

### Does Aetna cover ABA therapy in New Jersey?

Yes — under the carrier's national policy for ASD, layered on New Jersey's mandate (P.L. 2009, c.115) for fully-insured plans. Self-funded employer plans are exempt from the mandate, so always verify plan funding type first.

### Does the $36,000 ABA cap in New Jersey's mandate still apply?

Mostly not — DOBI Bulletin 10-02 held the cap cannot be applied to group plans subject to federal parity (MHPAEA), since New Jersey treats autism as a biologically-based mental illness. In practice, state-regulated plans cover medically necessary ABA without dollar caps; the cap survives mainly in nongroup policies.

### What does Aetna pay for ABA in New Jersey?

Commercial ABA rates are not published — they are negotiated in your participating-provider agreement. Benchmark against NJ FamilyCare's FFS schedule ($15.00 for 97153, $25.00 for 97151/97156 per 15-minute unit) and treat rate-setting as part of contracting.

## Primary sources

1. [Aetna — Participating provider behavioral health precertification list (ABA: 97151–97158, 0362T, 0373T)](https://www.aetna.com/content/dam/aetna/pdfs/aetnacom/healthcare-professionals/documents-forms/bh_precert_list.pdf)
2. [Aetna CPB 0554 — Applied Behavior Analysis](https://www.aetna.com/cpb/medical/data/500_599/0554.html)
3. [Aetna CPB 0648 — Autism Spectrum Disorders](https://www.aetna.com/cpb/medical/data/600_699/0648.html)
4. [NJ DOBI Bulletin 10-02 — Implementation of P.L. 2009, c.115](https://www.nj.gov/dobi/bulletins/blt10_02.pdf)
5. [Autism NJ — Amendments to Insurance Mandate Expand Coverage](https://autismnj.org/news/amendments-to-insurance-mandate-expand-coverage/)
6. [NJ Board of Applied Behavior Analyst Examiners — FAQ](https://www.njconsumeraffairs.gov/abae/Pages/FAQ.aspx)
7. [Aetna — Applied Behavior Analysis Medical Necessity Guide (©2026)](https://www.aetna.com/content/dam/aetna/pdfs/health-care-professionals/applied-behavioral-analysis-necessity-guide.pdf)
8. [P.L. 2023, c.296 — Ensuring Transparency in Prior Authorization Act (N.J.S.A. 17B:30-55.1 et seq.)](https://www.nj.gov/treasury/pensions/documents/laws/ch296-2023.pdf)
9. [NJ DOBI Bulletin 24-17 — Ensuring Transparency in Prior Authorization Act](https://nj.gov/dobi/bulletins/blt24_17.pdf)
10. [29 CFR 2560.503-1 — ERISA claims procedure (eCFR)](https://www.ecfr.gov/current/title-29/section-2560.503-1)
11. [N.J.A.C. 11:4-28.6 — Rules for coordination of benefits (LII)](https://www.law.cornell.edu/regulations/new-jersey/N-J-A-C-11-4-28-6)
12. [Aetna — Office manual for health care professionals (coordination of benefits)](https://www.aetna.com/content/dam/aetna/pdfs/aetnacom/health-care-professionals/office_manual_hcp.pdf)
13. [32 CFR 199.8 — TRICARE double coverage (eCFR)](https://www.ecfr.gov/current/title-32/section-199.8)
14. [38 CFR 17.270 — CHAMPVA definitions, double coverage (eCFR)](https://www.ecfr.gov/current/title-38/section-17.270)
15. [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)

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.