---
title: Arizona Complete Health ABA coverage (AHCCCS plan).
url: "https://carelu.com/payers/arizona-complete-health"
markdown_url: "https://carelu.com/payers/arizona-complete-health.md"
state: AZ (Arizona)
payer: Arizona Complete Health - Complete Care Plan
kind: Medicaid managed care plan (MCO)
parent_program: AHCCCS (Arizona Medicaid)
description: "How Arizona Complete Health (Centene) administers AHCCCS ABA — corporate clinical policy CP.BH.104, the confirmed-diagnosis and 5-year eval-recency rules, hour-band guidance, the Care1st merger, and the statewide footprint."
last_reviewed: September 2026
vob_data_updated: 2026-07-23
---

# Arizona Complete Health ABA coverage (AHCCCS plan).

_Payer Guide · Arizona Complete Health · Last updated September 2026 · 4 primary sources_

> Centene's CP.BH.104 overlay: dx confirmation, 5-year eval recency, hour bands; every county.

Arizona Complete Health - Complete Care Plan — Centene's Arizona vehicle — is the only ACC plan in every county, holds both the North and South GSA ACC-RBHA contracts, and absorbed Care1st's members in 2024. Unlike the plans that simply link AMPM 320-S, AzCH runs a genuinely distinct corporate clinical policy: CP.BH.104 "Applied Behavior Analysis" (last revised 12/24), which layers a confirmed-diagnosis expectation, a five-year evaluation-recency rule, and hour-band guidance on top of the state baseline. Knowing where the corporate policy yields to Arizona's rules is the intake skill for this plan.

This plan administers the **AHCCCS (Arizona Medicaid)** ABA benefit: the state rules are the floor, and this page covers what the plan layers on top. Read it together with the [AHCCCS (Arizona Medicaid) guide](https://carelu.com/payers/arizona-ahcccs).

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment:** Not published / unverified. Verify via: The AzCH prior-authorization code lookup on azcompletehealth.com — read the 97151 and 97152 rows. CP.BH.104 is a medical-necessity policy and states no standing assessment-PA rule. [1][2]
- **Prior auth for treatment**: Required per CP.BH.104 — BCBA behavioral assessment + FBA or skills assessment + individualized plan; updated assessment and plan every 6 months [1]
- **Autism diagnosis required?**: CP.BH.104 asks for a confirmed ASD dx — but defers to "state-defined ABA criteria," which in Arizona means non-ASD diagnoses qualify under AMPM 320-S; cite it [1][3]

## At a glance

- **Plan type:** ACC in all counties + ACC-RBHA North & South GSAs (Centene)
- **Clinical rules:** Centene CP.BH.104 (rev. 12/24) — a real overlay, deferring to state criteria where Arizona differs
- **Diagnosis recency:** Comprehensive diagnostic evaluation within the past 5 years (CP.BH.104 — not a state rule)
- **Hour guidance:** Focused ABA 10–25 hrs/wk; comprehensive 30–40; supervision 1–2 hrs per 10 direct
- **Reauth cadence:** Updated behavior assessment + treatment plan every 6 months
- **UM:** Centene Advanced Behavioral Health (in-house); azcompletehealth.com portal

## CP.BH.104: what the corporate policy requires

Initiation under CP.BH.104 requires medical stability, a behavioral assessment completed by a BCBA (or state-law equivalent) using record review, interviews, rating scales, and direct observation, plus an FBA — descriptive, traditional, or IISCA — or a skills assessment from a named list (VB-MAPP, ABLLS-R, AFLS, PEAK, SSIS, EFL, Socially Savvy), feeding an individualized treatment plan. Continuation requires an updated behavior assessment and updated treatment plan every 6 months (or more often if state-mandated), with progress data across settings. Intensity guidance comes as bands rather than hard caps: focused ABA at 10–25 hours/week, comprehensive ABA at 30–40 hours/week of direct treatment, and supervision at 1–2 hours per 10 direct hours (2 hours required below 10 hours/week). Whether AzCH operationally requires PA on the 97151 assessment for AHCCCS members isn't published as a single rule — the plan's prior-auth page works code-by-code, so run the lookup before promising an auth-free assessment. [1][2]

## Where the policy yields to Arizona — and the plan's footprint

CP.BH.104 asks for a confirmed ASD diagnosis (current DSM, confirmed via tools like the ADOS-2, ADI-R, or CARS-2) "or an appropriate diagnosis as otherwise specified according to state-defined ABA criteria" — and that escape clause is what reconciles the corporate policy with Arizona's no-ASD-required Medicaid rule. When the diagnosis is non-ASD, cite AMPM 320-S explicitly in the request rather than arguing the corporate criteria. Two more facts to hold: CP.BH.104's five-year evaluation-recency rule is a dx-recency gate the state policy does not impose, so check the evaluation date at intake; and the footprint is the state's largest — every county as an ACC plan, both ACC-RBHA GSAs, and the former Care1st membership (Apache, Coconino, Mohave, Navajo, Yavapai) transitioned in 2024. AzCH also terminated Action Behavior Centers in the March 2026 network purge, so displaced-family inbounds will carry this plan's card statewide. [1][4]

## Intake gates

The questions that decide whether a family can start with Arizona Complete Health - Complete Care Plan, and what they have to bring.

- **Age limit**: CP.BH.104 carries no age criterion. The policy frames ASD as "typically a lifelong diagnosis... requiring treatment at any point in time," and says of Focused ABA that "it is not restricted by age, cognitive level, or co-occurring conditions." Arizona adds none either — AMPM 320-S sets no age bound. [1][3]
- **Diagnosis recency**: Five years — and it is a plan rule, not a state one. CP.BH.104 requires that "a comprehensive diagnostic evaluation, as specified according to state-defined ABA criteria, has been conducted within the past five years," including a summary of how current symptoms affect functioning across settings (family, peer, school) in communication, socialization, restricted/repetitive behaviour and adaptive functioning. AMPM 320-S imposes no recency clock, so this is the gate that catches stale evaluations on this plan. [1][3]
- **Who may diagnose**: "ABA is recommended by a qualified licensed health care provider working within their scope of practice and who is qualified to diagnose ASD." The diagnosis itself must be "a confirmed autism spectrum disorder (ASD) diagnosis, according to the most current version of the [DSM] criteria or an appropriate diagnosis as otherwise specified according to state-defined ABA criteria" — that second clause is what lets a non-ASD Arizona diagnosis through under AMPM 320-S. [1][3]
- **Diagnostic tools required**: CP.BH.104 names its instruments explicitly. The ASD diagnosis and severity level must be confirmed by one of: CHAT; M-CHAT/M-CHAT-R/F; STAT; SCQ; ASSQ; CAST; ADOS/ADOS-2; ADI-R; CARS/CARS-2; GARS-3; EarliPoint; SWYC-POSI; RITA-T; CSBS-ITC; or another evidence-based assessment reviewed case by case. The behavioral assessment then needs record review, interviews, rating scales and direct observation using continuous or discontinuous measurement, plus either an FBA (descriptive, traditional functional analysis, or IISCA) or a skills assessment from a named list — VB-MAPP, ABLLS-R, AFLS, PEAK, SSIS, EFL or Socially Savvy. [1]
- **Referral required?**: No separate physician prescription is required — the recommendation from a qualified licensed health care provider qualified to diagnose ASD is the referral. What CP.BH.104 does demand up front is a completed behavioral assessment by a BCBA (or duly certified, licensed or registered equivalent under state law) feeding an individualized treatment plan, plus documented coordination of care with school, prescribers and any PT/OT/speech providers. Whether the plan requires PA on the 97151 assessment for AHCCCS members is not published as a standing rule — its prior-authorization page works code by code. [1][2]
- **Telehealth**: Permitted, without a code list. CP.BH.104 states that ABA "services may be provided in various settings (e.g., home, clinic, school, community) and modalities (e.g., in-person, telehealth)," and devotes a section to CASP's Practice Parameters for Telehealth-Implementation of Applied Behavior Analysis: telehealth "is not intended to replace in person service, as it is intended to supplement the traditional in person service delivery model," with modality selected on the member's needs, preference, caregiver availability and environmental support — and "providers should refer to respective state allowances for telehealth services." [1]
- **Prior-auth decision time**: AzCH’s provider manual (§4.3): standard requests decided "not later than fourteen (14) calendar days after the receipt of the authorization request" with a possible extension of up to 14 calendar days; expedited no later than 72 hours. Nothing ABA-specific beyond deferring to AMPM 320-S, and no reauth lead time. AHCCCS’s own CY2025 prior-authorization metrics report (March 2026) says that "Beginning January 1, 2026" the CMS rule requires Medicaid managed care plans to decide within "7 calendar days for standard requests (non-urgent)" and "72 hours for expedited requests (urgent)"; the federal regulation ties the 7-day ceiling to rating periods starting on or after January 1, 2026. Confirm with AzCH which clock it runs. [5][6][7][3]
- **Other insurance (who pays first)**: AzCH: "The Health Plan does not require prior authorization when the Health Plan is not the primary payer." Pursue the primary and submit its EOB before billing AzCH for copays and deductibles. When the member has exhausted the primary benefit, request AzCH prior authorization for primary coverage — "The provider MUST submit evidence of the member's primary benefits being exhausted." "Medicaid is the payer of last resort except under limited situations"; AzCH pays the difference up to the contracted rate (AHCCCS allowable if non-contracted). The manual gives conflicting secondary filing windows, so file as early as possible after the primary EOB. AHCCCS policy (ACOM 434) adds pay-and-recover for preventive pediatric/EPSDT services. Under federal rules TRICARE pays before Medicaid, and CHAMPVA pays first when the child is also Medicaid-eligible. [5][8][9][10][11]

## Delivery and billing rules

Coverage decides whether Arizona Complete Health - Complete Care Plan 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**: One to two hours of supervision per ten hours of direct treatment "is considered standard of care in most cases; two hours of supervision is required if direct treatment totals less than 10 hours per week." The policy also requires "a comprehensive infrastructure for case supervision by a behavior analyst of all assessments and treatment," and documentation at both initiation and every 6-month continuation that treatment "will be delivered or supervised by an ABA-credentialed professional." [1]
- **Daily limits / MUEs**: No per-day unit ceiling. CP.BH.104 works in weekly bands — focused ABA 10 to 25 hours per week of direct treatment, comprehensive ABA 30 to 40 — and requires the treatment plan to outline "hours of therapy per day... with the goal of increasing or decreasing the intensity of therapy as the member/enrollee's ability to tolerate and participate permits," justified by impairment level, symptom severity, treatment history and response, and taking account of the member's age, school attendance requirements and other daily activities. [1]
- **Place of service**: Settings are open, with two boundaries. ABA "services may be provided in various settings (e.g., home, clinic, school, community)," and data must be "collected in multiple settings, such as in a clinic, home, and school (as applicable)." The limits: ABA is not covered for services otherwise covered under IDEA — with the express carve-back that "unless restricted within a state Medicaid benefit, ABA services can occur in coordination with school services and transition plans" — and treatment is a discontinuation candidate when "services are in lieu of school, respite care, or other community-based settings of care." [1]
- **Concurrent billing (97153 + 97155)** _(ask the plan)_: Not addressed. CP.BH.104 is a medical-necessity policy; its CPT table is explicitly informational — "inclusion or exclusion of any codes does not guarantee coverage" — and it states no rule on billing 97153 and 97155 for the same clock time. [1]
  - Ask the plan: Centene Advanced Behavioral Health / AzCH provider services and the plan's payment policies on azcompletehealth.com.

## What intake should collect for Arizona Complete Health - Complete Care Plan

- **Evaluation date:** CP.BH.104 wants the comprehensive diagnostic evaluation within 5 years — flag stale evals for re-evaluation early.
- **Diagnosis + confirming tools:** ASD confirmed via ADOS-2/ADI-R/CARS-2-style tools — or a non-ASD dx framed under AMPM 320-S's state criteria.
- **Assessment inputs:** BCBA assessment with FBA or a named skills assessment (VB-MAPP, ABLLS-R, etc.) — the initiation package is prescriptive.
- **Requested intensity vs. bands:** Fit requests to the 10–25 (focused) / 30–40 (comprehensive) hour bands, with supervision ratios in the plan.

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

## Verification of benefits (VOB) data

How Arizona Complete Health - Complete Care Plan ABA benefits route and read on an eligibility check. Data last updated 2026-07-23.

### EDI routing

- **Payer ID (pVerify):** 01348
- **Payer ID (Change Healthcare / Optum):** 68069 — AzCH's own electronic-transactions page: Payer ID 68069 (Medicaid, Medicare and Exchange) across all clearinghouses. pVerify 01348 = "ARIZONA COMPLETE HEALTH" (predecessors 00356 Cenpatico-AZ, 00353 Bridgeway).
- **Supports 270/271 eligibility:** Yes
- **Real-time eligibility:** Yes
- **Behavioral health administrator:** none (integrated — Centene)
- **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 | Not published as a single rule — CP.BH.104 governs clinically; AzCH's PA page works code-by-code, so run the lookup before promising an auth-free 97151/97152. | — | office/clinic, home (POS 12 — pays a ~10–11.5% premium on the AHCCCS schedule), school, community, telehealth (modality allowed under AMPM 320-S; ABA-specific POS/modifier not itemized) | — | HM (below bachelor's / BT-RBT), HN (bachelor's / BCaBA), HO (master's / BCBA), HP (doctoral / BCBA-D) |
| 97152 | Yes | Not published as a single rule — CP.BH.104 governs clinically; AzCH's PA page works code-by-code, so run the lookup before promising an auth-free 97151/97152. | — | office/clinic, home (POS 12 — pays a ~10–11.5% premium on the AHCCCS schedule), school, community, telehealth (modality allowed under AMPM 320-S; ABA-specific POS/modifier not itemized) | — | HM (below bachelor's / BT-RBT), HN (bachelor's / BCaBA), HO (master's / BCBA), HP (doctoral / BCBA-D) |
| 97153 | Yes | Required per CP.BH.104 (BCBA assessment + FBA/skills assessment + individualized plan; updated assessment & plan every 6 months). | — | office/clinic, home (POS 12 — pays a ~10–11.5% premium on the AHCCCS schedule), school, community, telehealth (modality allowed under AMPM 320-S; ABA-specific POS/modifier not itemized) | — | HM (below bachelor's / BT-RBT), HN (bachelor's / BCaBA), HO (master's / BCBA), HP (doctoral / BCBA-D) |
| 97154 | Yes | Required per CP.BH.104 (BCBA assessment + FBA/skills assessment + individualized plan; updated assessment & plan every 6 months). | — | office/clinic, home (POS 12 — pays a ~10–11.5% premium on the AHCCCS schedule), school, community, telehealth (modality allowed under AMPM 320-S; ABA-specific POS/modifier not itemized) | — | HM (below bachelor's / BT-RBT), HN (bachelor's / BCaBA), HO (master's / BCBA), HP (doctoral / BCBA-D) |
| 97155 | Yes | Required per CP.BH.104 (BCBA assessment + FBA/skills assessment + individualized plan; updated assessment & plan every 6 months). | — | office/clinic, home (POS 12 — pays a ~10–11.5% premium on the AHCCCS schedule), school, community, telehealth (modality allowed under AMPM 320-S; ABA-specific POS/modifier not itemized) | — | HM (below bachelor's / BT-RBT), HN (bachelor's / BCaBA), HO (master's / BCBA), HP (doctoral / BCBA-D) |
| 97156 | Yes | Required per CP.BH.104 (BCBA assessment + FBA/skills assessment + individualized plan; updated assessment & plan every 6 months). | — | office/clinic, home (POS 12 — pays a ~10–11.5% premium on the AHCCCS schedule), school, community, telehealth (modality allowed under AMPM 320-S; ABA-specific POS/modifier not itemized) | — | HM (below bachelor's / BT-RBT), HN (bachelor's / BCaBA), HO (master's / BCBA), HP (doctoral / BCBA-D) |
| 97157 | Yes | Required per CP.BH.104 (BCBA assessment + FBA/skills assessment + individualized plan; updated assessment & plan every 6 months). | — | office/clinic, home (POS 12 — pays a ~10–11.5% premium on the AHCCCS schedule), school, community, telehealth (modality allowed under AMPM 320-S; ABA-specific POS/modifier not itemized) | — | HM (below bachelor's / BT-RBT), HN (bachelor's / BCaBA), HO (master's / BCBA), HP (doctoral / BCBA-D) |
| 97158 | Yes | Required per CP.BH.104 (BCBA assessment + FBA/skills assessment + individualized plan; updated assessment & plan every 6 months). | — | office/clinic, home (POS 12 — pays a ~10–11.5% premium on the AHCCCS schedule), school, community, telehealth (modality allowed under AMPM 320-S; ABA-specific POS/modifier not itemized) | — | HM (below bachelor's / BT-RBT), HN (bachelor's / BCaBA), HO (master's / BCBA), HP (doctoral / BCBA-D) |
| 0362T | Yes | Required per CP.BH.104 (BCBA assessment + FBA/skills assessment + individualized plan; updated assessment & plan every 6 months). | — | office/clinic, home (POS 12 — pays a ~10–11.5% premium on the AHCCCS schedule), school, community, telehealth (modality allowed under AMPM 320-S; ABA-specific POS/modifier not itemized) | — | HM (below bachelor's / BT-RBT), HN (bachelor's / BCaBA), HO (master's / BCBA), HP (doctoral / BCBA-D) |
| 0373T | Yes | Required per CP.BH.104 (BCBA assessment + FBA/skills assessment + individualized plan; updated assessment & plan every 6 months). | — | office/clinic, home (POS 12 — pays a ~10–11.5% premium on the AHCCCS schedule), school, community, telehealth (modality allowed under AMPM 320-S; ABA-specific POS/modifier not itemized) | — | HM (below bachelor's / BT-RBT), HN (bachelor's / BCaBA), HO (master's / BCBA), HP (doctoral / BCBA-D) |

Code notes:

- **97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, 0362T, 0373T:** Centene overlay CP.BH.104 (rev. 12/24), deferring to AMPM 320-S for non-ASD diagnoses. Hour bands: focused 10–25, comprehensive 30–40; supervision 1–2 hrs per 10 direct. 5-year eval-recency gate. AMPM 320-S covers ASD "and/or other diagnoses as justified by medical necessity" — no strict autism-dx requirement. Per-code daily unit caps are not published (AzCH uses hour bands, not caps).

### Medicaid rates

Source: Not separately published by Arizona Complete Health. AHCCCS ACC/DDD plans are capitated, but ABA tracks the AHCCCS physician fee schedule (see arizona-ahcccs rates) as the public benchmark — Arizona Complete Health's actual contracted rate is not published (and is NOT a statutory floor, unlike New Mexico). Effective 2023-11-01 (AHCCCS benchmark).

| Code | Rate | Unit | Modifier tiers |
| --- | --- | --- | --- |
| 97151 | Benchmark: $30.06 (HN) / $35.78 (HO) / $44.73 (HP) office — see arizona-ahcccs | 15min | — |
| 97152 | Benchmark: $21.49 (HM) / $25.58 (HN) / $28.43 (HO/HP) office — see arizona-ahcccs | 15min | — |
| 97153 | Benchmark: $17.91 (HM) / $21.32 (HN) / $23.69 (HO/HP) office — see arizona-ahcccs | 15min | — |
| 97154 | Benchmark: $4.48 (HM) / $5.33 (HN) / $5.92 (HO/HP) office — see arizona-ahcccs | 15min | — |
| 97155 | Benchmark: $25.05 (HN) / $29.82 (HO) / $37.28 (HP) office — see arizona-ahcccs | 15min | — |
| 97158 | Benchmark: $6.26 (HN) / $7.46 (HO) / $9.32 (HP) office — see arizona-ahcccs | 15min | — |

### Contacts

- **Provider services phone:** 1-866-796-0542 (Provider Customer Service)

Questions to ask on a verification call:

- Does 97151/97152 need prior auth for this member, or does that depend on the current PA lookup-tool row?
- Is there an hour-band cap (e.g., focused 10–25, comprehensive 30–40) that applies to this member specifically?
- Is telehealth allowed for ABA codes, and does it need a particular modifier?
- What POS codes (home, school, community) do you accept for ABA billing?

### VOB data sources

- https://www.azcompletehealth.com/providers/resources/electronic-transactions.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://essentials.availity.com/availity/documents/payer_list_wShortNames.pdf (accessed 2026-07-23; source document older than 18 months)
- https://www.azahcccs.gov/Resources/Downloads/EDIchanges/AZ270_271_CG.pdf (accessed 2026-07-23)
- https://www.azcompletehealth.com/content/dam/centene/policies/behavioral-policies/CP.BH.104.pdf (accessed 2026-07-23)
- https://www.azahcccs.gov/shared/Downloads/MedicalPolicyManual/300/320S.pdf (accessed 2026-07-23)
- https://www.azahcccs.gov/AHCCCS/Downloads/PublicNotices/rates/FinalPublicNotice_RateChanges_20231101_ABA.pdf (accessed 2026-07-23)
- https://azahcccs.gov/PlansProviders/Downloads/FFSrates/ABA/FY26_Final_ABA_FeeSchedule.xlsx (accessed 2026-07-23)
- https://www.azcompletehealth.com/contact-us.html (accessed 2026-07-23)

## Common questions

### Does Arizona Complete Health cover ABA?

Yes — under Centene's clinical policy CP.BH.104 layered on the AHCCCS baseline: a BCBA behavioral assessment, an FBA or skills assessment, and an individualized treatment plan at initiation, with updates every 6 months.

### Does Arizona Complete Health require an autism diagnosis?

CP.BH.104 asks for a confirmed ASD diagnosis, but its own text defers to "state-defined ABA criteria" — and Arizona's AMPM 320-S covers other diagnoses justified by medical necessity. For non-ASD cases, cite AMPM 320-S in the request.

### Does Arizona Complete Health cap ABA hours?

No hard caps — CP.BH.104 uses guideline bands: 10–25 hours/week for focused ABA, 30–40 for comprehensive, with supervision at 1–2 hours per 10 direct hours.

### What happened to Care1st?

Care1st no longer exists as a separate ACC plan — it merged into Arizona Complete Health, with northern-county members transitioned in 2024. Any "Care1st" card or listing is stale.

## Primary sources

1. [Centene/AzCH — Clinical Policy CP.BH.104, Applied Behavior Analysis (rev. 12/24)](https://www.azcompletehealth.com/content/dam/centene/policies/behavioral-policies/CP.BH.104.pdf)
2. [AzCH — prior authorization page](https://www.azcompletehealth.com/providers/resources/prior-authorization.html)
3. [AMPM 320-S — Behavior Analysis Services (AHCCCS)](https://www.azahcccs.gov/shared/Downloads/MedicalPolicyManual/300/320S.pdf)
4. [azfamily — Nearly 1K Arizona children lose in-network ABA (3/5/2026)](https://www.azfamily.com/2026/03/05/nearly-1k-arizona-children-with-autism-lose-aba-therapy-coverage/)
5. [Arizona Complete Health — Provider Manual Section 4, Medical/Utilization Management](https://www.azcompletehealth.com/providers/resources/provider-manual/pm_section_4.html)
6. [AHCCCS — Prior Authorization Metrics for Medical Items and Services, CY2025 (3/31/2026)](https://www.azahcccs.gov/Resources/Downloads/PriorAuthorizationMetricAnnualReports/CMS_PA_Mandate_Report_Final_033026.pdf)
7. [42 CFR 438.210(d) — Medicaid managed care authorization decision timeframes](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-438/subpart-D/section-438.210)
8. [Arizona Complete Health — Provider Manual Section 8, Claims (§8.22 COB)](https://www.azcompletehealth.com/providers/resources/provider-manual/pm_section_8.html)
9. [AHCCCS ACOM 434 — Coordination of Benefits and Third-Party Liability (eff. 5/2/2025)](https://www.azahcccs.gov/shared/Downloads/ACOM/PolicyFiles/400/434.pdf)
10. [32 CFR 199.8 — TRICARE double coverage (secondary to other plans, primary to Medicaid)](https://www.ecfr.gov/current/title-32/subtitle-A/chapter-VII/subchapter-M/part-199/section-199.8)
11. [VA — CHAMPVA Guidebook (updated 1/1/2025), CHAMPVA as secondary payer](https://www.va.gov/files/2025-12/CHAMPVA-Guidebook.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.