---
title: Banner-University Family Care ABA coverage (AHCCCS plan).
url: "https://carelu.com/payers/banner-university-family-care"
markdown_url: "https://carelu.com/payers/banner-university-family-care.md"
state: AZ (Arizona)
payer: Banner-University Family Care
kind: Medicaid managed care plan (MCO)
parent_program: AHCCCS (Arizona Medicaid)
description: "How Banner-University Family Care handles Arizona AHCCCS ABA — the AMPM 320-S state baseline, the plan's ABA Prior Authorization Form, the 10-county ACC + ALTCS footprint, and the specifics you'll need to verify in the Banner portal."
last_reviewed: September 2026
vob_data_updated: 2026-07-23
---

# Banner-University Family Care ABA coverage (AHCCCS plan).

_Payer Guide · Banner-University Family Care · Last updated September 2026 · 6 primary sources_

> State baseline + its own ABA PA form; specifics unpublished — verify in the Banner portal.

Banner-University Family Care — the Banner Health / University of Arizona Health Plans entry — carries the second-largest ACC footprint (ten counties, including Maricopa and Pima) plus ALTCS contracts. Unlike Mercy Care, UHC, or Arizona Complete Health, Banner publishes no distinct ABA clinical policy: everything we can verify points to the AMPM 320-S state baseline plus the plan's own ABA Prior Authorization Form. That makes this a verify-in-the-portal plan — the state guide tells you the clinical rules; Banner's portal tells you the paperwork.

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** _(ask the plan)_: Not published — unlike Mercy Care and UHC/Optum, Banner states no assessment-PA position publicly; confirm whether 97151/97152 need PA before booking [1][2]
  - Ask the plan: Banner Health Plans (bannerhealth.com/bhpprovider) — ask the plan directly whether 97151/97152 need PA. Banner publishes no assessment-PA position at all, so do not assume the Mercy Care / UHC pattern.
- **Prior auth for treatment**: Required — the plan publishes an ABA Prior Authorization Form; durations and specifics unpublished, verify in the portal [1]
- **Autism diagnosis required?**: No distinct plan policy published — AMPM 320-S baseline applies (autism dx not strictly required) [2][1]

## At a glance

- **Plan type:** ACC in 10 counties + ALTCS (Banner Health / UA Health Plans)
- **Clinical rules:** No distinct published ABA policy — AMPM 320-S baseline
- **Treatment PA:** Required — via Banner's ABA Prior Authorization Form
- **Assessment PA:** Not published — verify whether 97151/97152 need PA before booking
- **Portal:** bannerhealth.com/bhpprovider (Banner Health Plans provider portal)
- **Rates:** Not published — AHCCCS physician fee schedule is the benchmark

## What's verified — and what to pull from the portal

Banner lists an "Applied Behavior Analysis (ABA) Prior Authorization Form" among its behavioral-health materials, which confirms treatment PA exists — but the plan publishes no ABA clinical policy, no assessment-PA rule, no authorization durations, and no hour guidance that we could verify. The honest operating assumption is the state baseline: AMPM 320-S clinical criteria (including the no-autism-dx-required rule and 6-month progress reports), with Banner's own form as the PA vehicle. Before quoting a family a start date, pull the current ABA PA form from the behavioral-health materials page at bannerhealth.com/bhpprovider and confirm directly with the plan whether assessment codes 97151/97152 require PA — the two largest Arizona plans skip it, but Banner's position isn't published. [1][2]

## Footprint

Banner-University Family Care operates as an ACC plan in Maricopa, Pinal, Cochise, Gila, Graham, Greenlee, La Paz, Pima, Santa Cruz, and Yuma counties, plus ALTCS in ten counties — the second-largest geographic reach after Arizona Complete Health. For intake, that means Banner cards show up across both metro Phoenix and southern Arizona; treat every one as an AMPM 320-S case with Banner-specific paperwork to confirm. [3]

## Intake gates

The questions that decide whether a family can start with Banner-University Family Care, and what they have to bring.

- **Age limit**: Follows the AHCCCS rule — Banner publishes no distinct ABA clinical policy, only its own ABA Prior Authorization Form: AMPM 320-S sets no age bound of its own. Behavior Analysis Services are covered "for individuals with Autism Spectrum Disorder (ASD) and/or other diagnoses as justified by medical necessity," and the policy applies across ACC, ALTCS E/PD, DCS/CMDP, DES/DDD, the RBHA contracts and fee-for-service programs without an age criterion. In practice children reach the benefit through EPSDT, and nothing in the policy text excludes adults — screen on medical necessity, not birthday. [2][1]
- **Diagnosis recency**: Follows the AHCCCS rule — Banner publishes no distinct ABA clinical policy, only its own ABA Prior Authorization Form: None at the state level. AMPM 320-S imposes no recency clock on the diagnostic evaluation — and no autism diagnosis at all is strictly required. What must be current is the assessment: services are "prescribed or recommended in specific dosages, frequency, intensity, and duration by a qualified BHP as the result of an assessment of the member." Plan-level overlays can be stricter, so check the per-plan guide before telling a family an old evaluation still counts. [2][1]
- **Who may diagnose**: Follows the AHCCCS rule — Banner publishes no distinct ABA clinical policy, only its own ABA Prior Authorization Form: AMPM 320-S gates on who recommends ABA, not on who diagnoses: services must be "prescribed or recommended... by a qualified BHP." A Behavioral Health Professional is defined as an individual licensed under A.R.S. Title 32, Chapter 33 whose scope allows independent behavioral health practice (or practice under direct supervision, except a licensed substance abuse technician); a psychiatrist (A.R.S. § 36-501); a psychologist (A.R.S. § 32-2061); a physician; a Behavior Analyst (A.R.S. § 32-2091); a registered nurse practitioner licensed as an adult psychiatric and mental health nurse; or a registered nurse with psychiatric-mental health certification or one year of behavioral health experience. [2][1]
- **Diagnostic tools required**: Follows the AHCCCS rule — Banner publishes no distinct ABA clinical policy, only its own ABA Prior Authorization Form: No single instrument is mandated. "Behavior Analysis Services shall be based upon assessment(s) that include Standardized and/or Non-standardized instruments through both direct and indirect methods." Standardized examples named in the policy: the Pervasive Developmental Disabilities Behavior Inventory, the Brigance Inventory of Early Development and the Vineland Adaptive Behavior Scales. Non-standardized examples: curriculum-referenced assessments and stimulus preference assessment procedures. [2][1]
- **Referral required?**: Follows the AHCCCS rule — Banner publishes no distinct ABA clinical policy, only its own ABA Prior Authorization Form: A prescription or recommendation from a qualified Behavioral Health Professional, based on an assessment of the member, is the referral — AMPM 320-S requires nothing else and sets no prior-authorization rules of its own, leaving PA to the Contractors. The two largest plans both skip PA on the assessment codes: Mercy Care states no PA is needed for 97151 and 97152, and Optum's Arizona orientation states "All ABA services require prior authorization except 97151 and 97152." [2][4][5][1]
- **Prior-auth decision time**: Banner – UFC’s 2026 manual: "Medical Standard requests will be reviewed within 14 days. Medical Expedited requests will be reviewed within 72 hours of receipt," and "Extensions on expedited and standard requests can be provided if more time is needed to obtain records." ABA PA is required before services begin, faxed on Banner’s ABA PA form; no reauth lead time is published. 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 Banner which clock it runs. [7][8][9]
- **Other insurance (who pays first)**: Banner – UFC pays last: it "will require an Evidence of Benefit (EOB) or Remit Advice (RA) from a primary payer to coordinate benefits once the primary payer has adjudicated the claim" and "may further review the claim for medical necessity" on its own criteria; "If primary payor does not cover the service, B – UFC may waive the need for an EOB or RA." Cost sharing is paid up to the lesser of its fee schedule or the other payer’s allowed amount, and secondary claims are due within 60 days of the primary RA. The manual does not say whether Banner requires its own PA when secondary; AHCCCS policy (ACOM 434) bars a secondary PA only when the other insurer approved the service as medically necessary, so where the commercial plan has not approved ABA, get Banner’s PA. Under federal rules TRICARE pays before Medicaid, and CHAMPVA pays first when the child is also Medicaid-eligible. [7][10][11][12]

## Delivery and billing rules

Coverage decides whether Banner-University Family Care 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**: Follows the AHCCCS rule — Banner publishes no distinct ABA clinical policy, only its own ABA Prior Authorization Form: A duty with no number attached. "Behavior Analysis Services shall be directed and overseen by Behavior Analysts and supported, where applicable, by Behavior Analysis Trainees and/or Behavior Technicians." The Behavior Analyst "is responsible for all aspects of clinical direction, supervision, and provider-level case management," for training Trainees and Technicians, for ensuring that "the extent, kind, and quality" of what they deliver matches their training and experience, and for their compliance with the policy and A.R.S. § 32-2091. A Behavior Analysis Trainee needs "direct and ongoing supervision consistent with the standards set by a nationally recognized Behavior Analyst certification board." AMPM 320-S publishes no supervision percentage and no caseload cap, so for RBT-credentialed staff the BACB floor is the operative number. [2][1]
- **Bill as provider**: Follows the AHCCCS rule — Banner publishes no distinct ABA clinical policy, only its own ABA Prior Authorization Form: The claim line has to say who actually delivered the service. AHCCCS pays credential-tiered rates through modifiers — HM below bachelor's (technician level), HN bachelor's, HO master's, HP doctoral — and AMPM 320-S points to the Behavioral Health Services Billing Matrix for "modifiers for Behavior Analysis Trainee billing." Whose NPI goes in the rendering field is set per Contractor: UnitedHealthcare Community Plan, for instance, requires the rendering provider's 10-digit NPI in box 24J, "must be an active AHCCCS registered provider (The rendering provider is the BCBA/Licensed Clinician)." [2][6][5][1]
- **Concurrent billing (97153 + 97155):** Not published / unverified. Verify via: Banner Health Plans at bannerhealth.com/bhpprovider — pull the current ABA Prior Authorization Form and ask the plan directly; none of this is published at plan level. [2][1]
- **Session-note signature** _(ask the plan)_: Follows the AHCCCS rule — Banner publishes no distinct ABA clinical policy, only its own ABA Prior Authorization Form: AMPM 320-S sets a reporting cadence, not a signature rule. Progress reports are required "at minimum, every six months" and must include member identification; background information (family dynamics, school placement, cultural considerations, prenatal and/or developmental history, medical history, sensory, dietary and adaptive needs, sleep patterns, medications); assessment findings; outcomes (measurable objectives, progress toward goals, clinical recommendations, treatment dosage, family role and outcomes); and care coordination (transition statement and individualized discharge criteria). Who signs a session note, and within what window, is not stated. [2][1]
  - Ask the plan: Banner Health Plans at bannerhealth.com/bhpprovider — pull the current ABA Prior Authorization Form and ask the plan directly; none of this is published at plan level.

## What intake should collect for Banner-University Family Care

- **Diagnosis (any qualifying):** AMPM 320-S baseline — ASD or another diagnosis justified by medical necessity, with a BHP recommendation.
- **Current Banner ABA PA form:** Pull it from bannerhealth.com/bhpprovider before submitting — the specifics aren't published anywhere else.
- **Assessment-PA answer:** Confirm with the plan whether 97151/97152 need PA — unpublished, so don't assume the Mercy Care/UHC pattern.
- **County + plan line:** ACC vs. ALTCS membership — Banner holds both, on different rules.

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

## Verification of benefits (VOB) data

How Banner-University Family Care ABA benefits route and read on an eligibility check. Data last updated 2026-07-23.

### EDI routing

- **Payer ID (pVerify):** 01013
- **Payer ID (Change Healthcare / Optum):** 66901 — Optum RTE 66901 = "Banner University Family Care" is the ELIGIBILITY (270/271) ID (verified). The CLAIMS payer ID appears as 09830 in clearinghouse directories but Banner's own submissions page could not be fetched (header-overflow) — treat claims 09830 as unverified-from-primary; confirm via bannerhealth.com/bhpprovider/resources/claims/submissions.
- **Supports 270/271 eligibility:** Yes
- **Real-time eligibility:** Yes
- **Behavioral health administrator:** none (integrated — Banner / UA Health Plans)
- **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 | — | — | 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 | — | — | 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 | — | — | 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 | — | — | 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 | — | — | 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 | — | — | 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 | — | — | 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 | — | — | 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 | — | — | 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 | — | — | 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:** Banner publishes an ABA Prior Authorization Form (treatment PA exists) but no clinical policy, assessment-PA rule, or durations — pull the current form from bannerhealth.com/bhpprovider. 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 Banner-University Family Care. AHCCCS ACC/DDD plans are capitated, but ABA tracks the AHCCCS physician fee schedule (see arizona-ahcccs rates) as the public benchmark — Banner-University Family Care'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:** 800-582-8686 (TTY 711)
- **Hours:** Monday–Friday, 7:30 a.m.–5:00 p.m. (after hours route to an answering service)
- **Fax:** 866-465-8340 (Grievance & Appeals fax)

Questions to ask on a verification call:

- Does 97151/97152 require prior authorization for this member, since Banner hasn’t published a standing PA rule?
- What’s the current PA requirement and turnaround for 97153–97158, 0362T, and 0373T?
- Is there a unit or hour cap per day or week for ABA treatment codes?
- Is telehealth allowed for ABA, and does it require a specific POS or modifier?

### VOB data sources

- https://www.optum.com/ (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.bannerhealth.com/bhpprovider/resources/bh/materials (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.bannerhealth.com/bhpprovider/about/contact (accessed 2026-07-23)

## Common questions

### Does Banner-University Family Care cover ABA?

Yes — as an AHCCCS ACC plan it covers Behavior Analysis Services under AMPM 320-S. Treatment requires PA via Banner's ABA Prior Authorization Form; the plan publishes no distinct clinical policy beyond the state baseline.

### Does Banner require PA for the ABA assessment?

Not published — unlike Mercy Care and UHC, Banner's assessment-PA position isn't stated publicly. Verify with the plan or the current PA form before booking an assessment as auth-free.

### What does Banner pay for ABA?

Not published. Benchmark against the AHCCCS physician fee schedule (97153 at $17.91–$23.69 per 15-minute unit by credential tier); your contract is the source of truth.

## Primary sources

1. [Banner Health Plans — behavioral health materials and forms](https://www.bannerhealth.com/bhpprovider/resources/bh/materials)
2. [AMPM 320-S — Behavior Analysis Services (AHCCCS)](https://www.azahcccs.gov/shared/Downloads/MedicalPolicyManual/300/320S.pdf)
3. [AHCCCS — Available Health Plans list](https://www.azahcccs.gov/Members/Downloads/Resources/ENGLISH_HealthPlanList.pdf)
4. [Mercy Care — Applied Behavior Analysis provider page](https://www.mercycareaz.org/providers/applied-behavior-analysis.html)
5. [Optum — Arizona AHCCCS Autism/ABA Program provider orientation (BH4129)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/autismABA/azaba/azABA_Provider_Orient.pdf)
6. [AHCCCS — Final Public Notice, FFS rate changes 11/1/2023 (ABA codes)](https://www.azahcccs.gov/AHCCCS/Downloads/PublicNotices/rates/FinalPublicNotice_RateChanges_20231101_ABA.pdf)
7. [Banner – University Family Care — 2026 Provider Manual (eff. 7/9/2026)](https://www.bannerhealth.com/bhpprovider/-/media/files/project/bhpprovider/manuals-and-directories/manuals/prov-bufc-prov-manual_eff07092026_en.pdf)
8. [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)
9. [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)
10. [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)
11. [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)
12. [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.