---
title: Community Care Plan ABA / BA coverage (Florida MMA plan).
url: "https://carelu.com/payers/community-care-plan-florida"
markdown_url: "https://carelu.com/payers/community-care-plan-florida.md"
state: FL (Florida)
payer: Community Care Plan (FL)
kind: Medicaid managed care plan (MCO)
parent_program: Florida Medicaid (AHCA)
description: "How Community Care Plan — the provider-owned South Florida MMA plan — administers Behavior Analysis: full delegation of authorizations and claims to Therapy Network of Florida, 5-day standard / 2-day expedited turnarounds, and the state criteria underneath."
last_reviewed: September 2026
vob_data_updated: 2026-07-23
---

# Community Care Plan ABA / BA coverage (Florida MMA plan).

_Payer Guide · Community Care Plan · Last updated September 2026 · 2 primary sources_

> BA fully delegated to Therapy Network of FL — auths AND claims; fastest published turnarounds.

Community Care Plan (CCP) — the provider-owned plan of Broward Health and Memorial Healthcare System, with a South Florida footprint — delegates its entire Behavior Analysis function to Therapy Network of Florida (TNFL): prior authorizations AND claims. Day to day, a practice serving CCP members works with TNFL, not CCP. The plan's BA provider manual copies the AHCA coverage criteria nearly verbatim, and its published turnarounds are the fastest of the nine plans: 5 calendar days standard, 2 expedited.

This plan administers the **Florida Medicaid (AHCA)** ABA benefit: the state rules are the floor, and this page covers what the plan layers on top. Read it together with the [Florida Medicaid — Behavior Analysis Services (AHCA) guide](https://carelu.com/payers/florida-medicaid).

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Required — all codes on the FL BA fee schedule need PA from Therapy Network of Florida (portal at asp.healthsystemone.com/hs1providers; fax backup) [1]
- **Prior auth for treatment**: Required — via TNFL; standard approvals within 5 calendar days, expedited within 2 [1]
- **Autism diagnosis required?**: No — state BA policy applies: physician referral + order + CDE, no autism-diagnosis requirement [1][2]

## At a glance

- **Plan type:** SMMC MMA plan — provider-owned (Broward Health + Memorial), South FL
- **Clinical rules:** AHCA BA Coverage Policy, near-verbatim in the CCP BA manual
- **Prior auth:** Required for every code on the FL BA fee schedule — via Therapy Network of FL
- **Turnarounds:** 5 calendar days standard / 2 expedited — fastest published of the nine
- **Claims:** Also to TNFL — portal at therapynetwork.com; paper to Therapy Network of Florida
- **Age scope:** Members 21 and over excluded (per the state benefit)

## The TNFL delegation: one counterparty for everything

CCP's BA manual is direct: behavior assessments, reassessments, and all codes on the Florida BA Fee Schedule require prior authorization by Therapy Network. Requests go through the Provider Web Portal at asp.healthsystemone.com/hs1providers (fax available as backup), and approvals and claims status run 24/7 on therapynetwork.com — claims themselves also go to TNFL, with paper claims addressed to Therapy Network of Florida. Standard/routine approvals come within 5 calendar days and expedited/urgent within 2; when a TNFL clinician recommends denial, the recommendation completes within 4 calendar days with referral to the plan's Medical Director if the reviewing clinician and provider disagree. Services not on the Florida BA fee schedule are non-covered, and members 21 and over are excluded — consistent with the state benefit's under-21 scope. [1]

## The state criteria, unchanged underneath

CCP's coverage criteria and exclusions track the AHCA policy nearly verbatim: the referral + order + CDE gate with no autism-diagnosis requirement, Vineland-3/BASC-3 documentation, up-to-6-month authorizations, and the 40-hour weekly ceiling as prior-authorized. The operative difference is purely who you talk to — for intake, that means TNFL portal credentials are the day-one setup task, and the 2-day expedited pathway is worth knowing when a family's clinical urgency justifies it. [1][2]

## Intake gates

The questions that decide whether a family can start with Community Care Plan (FL), and what they have to bring.

- **Age limit**: Under 21, and CCP states it from both directions: its BA provider manual authorizes services for “Medicaid Ages 0-21,” and its service exclusions open with “any Medicaid member 21 years old and over.” That tracks the state benefit exactly — Florida Medicaid BA is for recipients under the age of 21, with EPSDT available above the coverage-policy and fee-schedule limits. [1][2]
- **Diagnosis recency**: No autism diagnosis is required. CCP publishes the cycle precisely: “the behavior reassessment is required every 6 months”; “the core standardized behavior instruments are only required on an annual basis unless a new behavior emerges or additional hours are requested”; and the reassessment must “be submitted at least 10 days but not more than 30 days prior to the last day of the previously certified service” — so a renewal filed too early is as much a problem as one filed too late. Modifications are never authorized retrospectively. [1][2]
- **Who may diagnose**: CCP requires a “prescription or referral form” issued “by an independent physician or practitioner qualified to assess and diagnose disorders related to functional impairments,” including the diagnosis and an order for BA services, plus the Comprehensive Diagnostic Evaluation. It then adds a signature-block rule that intake should treat as a document check: “all practitioner’s signature must include their NPI, credentials and date of signature as defined in Chapter 668, Part I, F.S. Please ensure that the referring provider’s (physician/ARNP/P.A.) LMN, prescription or referral form includes their NPI, credentials and date of signature” — note that CCP names ARNPs and PAs, which the state referral list does not. [1][2]
- **Diagnostic tools required**: “2 core standardized behavior instruments required (required once a year)”: the Vineland-3 Comprehensive Parent Interview Form for all recipients plus the Maladaptive Behavior Domain for ages 3 and older, and the BASC-3 PRQ for recipients ages 2 through 18 — with “additional assessment tools… at the lead analyst’s discretion,” and administration, scoring and reporting all documented in the behavior assessment. The behavior plan must also identify the functions of behavior “based on a Functional Analysis (FA), brief FA, precursor FA or conditional probability.” [1][2]
- **Referral required?**: Required, and it is the first item on CCP’s own checklist for authorizing the behavior assessment: the prescription or referral form from an independent physician or qualified practitioner, carrying the diagnosis and an order for BA services, plus the CDE. Everything on the Florida BA fee schedule needs prior authorization from Therapy Network of Florida — “behavior assessments, behavior reassessments, behavior intervention/treatment, modification request and all codes on the Florida BA Fee Schedule require prior authorization by Therapy Network” — via the portal at asp.healthsystemone.com/hs1providers, with fax as an emergency backup. Standard approvals land within 5 calendar days, expedited within 2. [1][2]
- **Telehealth**: Follows the Florida Medicaid rule: the only telemedicine provision is up to two hours per week of Lead Analyst caregiver training (97156) under Rule 59G-1.057, F.A.C. CCP’s BA provider manual publishes no telehealth section, and “any services not included on the Florida Behavior Analysis Fee Schedule” are non-covered — so a telehealth line that is not on that schedule will not pay. [2][1]
  - Ask the plan: Therapy Network of Florida provider relations (1-888-550-8800, option 2) before scheduling any remote session other than 97156 caregiver training.
- **Prior-auth decision time**: Therapy Network of Florida decides CCP’s BA requests. For approvals: “Standard/Routine requests are completed within 5 calendar days. Expedited/Urgent requests are completed within 2 calendar days.” Expedited means waiting “could place the member’s life, health, or ability to regain maximum function in serious jeopardy.” Reassessment (reauthorization) requests must “be submitted at least 10 days but not more than 30 days prior to the last day of the previously certified service”; for an authorization ending 4/30, submit no earlier than 4/1. CCP’s own MMA manual says standard requests “will not exceed 5 calendar days” and expedited “will not exceed 2 business days.” The AHCA contract sets 2 days for expedited. [1][3][4]
- **Other insurance (who pays first)**: CCP’s MMA manual: “Claims with primary and secondary coverage cannot be processed simultaneously. Medicaid is the payer of last resort. Submit claims to the primary payer first.” BA claims go to Therapy Network of Florida, not CCP, and TNFL allows “ninety (90) days from the date of final determination of the primary payer” for a claims complaint. Neither manual says whether a TNFL BA authorization is still needed when a commercial plan is primary. Florida Medicaid pays last. Rule 59G-1.052 says: “Florida Medicaid is the payer of last resort. Providers must exhaust all TPL sources of payment, such as Medicare, TRICARE, private health insurance … prior to submitting or resubmitting a claim.” The AHCA contract binds every MMA plan to that rule. Two consequences for intake: Medicaid pays only “the difference between the Florida Medicaid rate and the third-party payment,” and it pays nothing when “the provider’s TPL claim is denied for failing to obtain the appropriate authorization from the third-party.” So get the commercial plan’s own ABA authorization first. [3][1][5]
  - Ask the plan: Therapy Network of Florida: whether a TNFL BA authorization is required when a commercial plan pays first.

## Delivery and billing rules

Coverage decides whether Community Care Plan (FL) 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**: CCP makes supervision visible on the schedule rather than as a ratio. The behavior plan must carry a “supervision plan, including name(s) of authorized supervisor(s), and list this in the schedule,” and the requested weekly schedule must show “days of the week, hours of the day, service codes for those hours, to include supervision” — CCP’s own worked example pairs 97153 blocks with 97155 and 97156 blocks by day. The state standard sits underneath: supervision of BCaBAs and RBTs per the Council of Autism Service Providers practice standards, as specified in the approved behavior plan. [1][2]
- **Concurrent billing (97153 + 97155)**: CCP restates the state exclusion verbatim in its own exclusion list: “services by more than one BA provider unless determined to be medically necessary, prior authorized and indicated in the approved behavior plan.” The reimbursement half of the state rule applies too — the supervisee is not reimbursed when the supervisor is reimbursed for the same time period. So concurrency is something the approved plan and the TNFL authorization have to carry explicitly; the requested schedule is where it gets declared. [1][2]
- **Daily limits / MUEs**: By the week, with a documentation trigger. The state ceiling of up to 40 hours per week as prior-authorized in the behavior plan applies, and CCP’s documentation tips flag “any requests for more than 40 hours” as needing support. “Services not on the Florida BA fee schedule are non-covered,” and members 21 and over are excluded outright. No per-code per-day unit ceiling is published. [1][2]
  - Ask the plan: Therapy Network of Florida for any per-day claim edit, and the current AHCA BA fee schedule for per-assessment unit caps.
- **Session-note signature**: CCP publishes three signature rules, and this is the tightest-documented set among Florida’s nine plans. Session notes: “the notes must be signed and dated by the rendering practitioner,” carrying date, time, location and duration, maladaptive behaviors observed, replacement/compensatory skills targeted, the recipient’s response, protocol modification or therapist direction, an explanation if the parent or guardian was not present, and the participants. Plan: “the behavior assessment and behavior plan must be signed by the Lead Analyst and the recipient’s parent or caregiver.” And every signature on the treatment-plan document “must include their NPI, credentials and date of signature as defined in Chapter 668, Part I, F.S.” [1][2]
- **Place of service**: School is gated, and CCP asks for the detail up front: the full behavior assessment must include “detailed information about the school name, time frame, classroom type, IEP recommendation, 504 plan and services,” and an authorization request for services delivered in a school must include the IEP — failing which, documentation justifying the services plus an estimated IEP timeframe, a 504 plan if the school does not conduct IEPs, or the school’s name with an explanation if it conducts neither. The behavior plan must also name the treatment setting. CCP’s exclusion list goes one item beyond the state’s: personal care assistance, companion, chaperone or shadow; caregiver or childcare; travel time; and “services in PPEC.” [1][2]
- **Bill as provider**: Everything goes to Therapy Network of Florida, not to Community Care Plan — “do not send any claims to the health plans,” and a payment made in error by the plan is an overpayment to be returned. TNFL’s payer ID is 65062 for professional claims and 12k89 for institutional; paper claims go on an original CMS-1500 (or UB-04 for institutionally billed claims) to the TNFL claims processing centre in Ft. Lauderdale. A claim submitted before the authorization is approved “will deny for no authorization.” Adjustment requests run 365 days from the EOP/EOB date. Underneath, the state enrollment structure still decides whose NPI may render: Lead Analyst 392, BCaBA 391, RBT 390, inside an enrolled BA group (393). [1][2]

## What intake should collect for Community Care Plan (FL)

- **TNFL portal access:** Auths at asp.healthsystemone.com/hs1providers, status and claims at therapynetwork.com — set both up first.
- **Referral + order + CDE:** The state eligibility gate applies; no autism diagnosis required.
- **Vineland-3 & BASC-3 scoring reports:** The state documentation stack rides with every TNFL request.
- **Urgency assessment:** The 2-calendar-day expedited pathway exists — flag clinically urgent cases at intake.

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

## Verification of benefits (VOB) data

How Community Care Plan (FL) ABA benefits route and read on an eligibility check. Data last updated 2026-07-23.

### EDI routing

- **Payer ID (Availity):** 65062 (professional) / 12k89 (institutional) — Therapy Network of Florida, not Community Care Plan directly
- **Behavioral health administrator:** Therapy Network of Florida (TNFL) — full delegation of BOTH authorizations and claims for BA
- **BH administrator payer ID:** 65062 (professional) / 12k89 (institutional)
- **ABA rides on:** medical benefit — TNFL's manual treats BA claims as standard professional/institutional (837P/837I) claims, not a distinct behavioral-health service-type bucket — inferred as 'medical' rather than confirmed verbatim.
- **Two-hop verification required:** Yes

### Code-level coverage

| Code | Covered | Prior auth | Unit cap | Place of service | Telehealth | Modifiers |
| --- | --- | --- | --- | --- | --- | --- |
| 97151 | Yes | Required | 24 units per initial behavior assessment (max); the reassessment variant, billed with modifier TS, caps at 18 units — same $19.05/unit rate either way. per per assessment/reassessment (not daily) — a new authorization is required each time, not a recurring daily allotment. | home (categorical — no CMS POS-code number published anywhere in FL BA documentation, state or plan level), office/clinic (categorical), school (categorical — IEP/504 plan, or a documented explanation, required with the PA request per the coverage policy §7.2), community/other (categorical, per plan PA-form checkboxes) | No — not authorized for this code under the AHCA BA Coverage Policy. Only 97156 (family/caregiver training) has a stated telehealth allowance in Florida Medicaid BA; every other code is telehealth:'No' by policy design, not by omission. | TS — reassessment variant, same $19.05 rate, separate 18-unit cap (vs. 24 for the initial assessment) |
| 97152 | Yes | Required | 8 units per assessment (max). per per assessment (not daily). | home (categorical — no CMS POS-code number published anywhere in FL BA documentation, state or plan level), office/clinic (categorical), school (categorical — IEP/504 plan, or a documented explanation, required with the PA request per the coverage policy §7.2), community/other (categorical, per plan PA-form checkboxes) | No — not authorized for this code under the AHCA BA Coverage Policy. Only 97156 (family/caregiver training) has a stated telehealth allowance in Florida Medicaid BA; every other code is telehealth:'No' by policy design, not by omission. | — |
| 97153 | Yes | Required | No code-specific unit cap on the fee schedule; counts toward the aggregate 40 hrs/week (≈160 units/week) BA-intervention cap set by the coverage policy §4.2.2. per week (aggregate across all treatment codes together, not per-code). | home (categorical — no CMS POS-code number published anywhere in FL BA documentation, state or plan level), office/clinic (categorical), school (categorical — IEP/504 plan, or a documented explanation, required with the PA request per the coverage policy §7.2), community/other (categorical, per plan PA-form checkboxes) | No — not authorized for this code under the AHCA BA Coverage Policy. Only 97156 (family/caregiver training) has a stated telehealth allowance in Florida Medicaid BA; every other code is telehealth:'No' by policy design, not by omission. | XP — concurrent-supervision supervisee line, not separately reimbursed (the supervisor bills 97153/97155/97155-HN instead) |
| 97154 | Yes | Required | Max 6 participants per group (coverage policy §4.2.2); the group also counts toward the aggregate 40 hrs/week cap. Rendered by Lead Analyst, BCaBA, or RBT. per week (aggregate) plus a 6-participant group-size ceiling. | home (categorical — no CMS POS-code number published anywhere in FL BA documentation, state or plan level), office/clinic (categorical), school (categorical — IEP/504 plan, or a documented explanation, required with the PA request per the coverage policy §7.2), community/other (categorical, per plan PA-form checkboxes) | No — not authorized for this code under the AHCA BA Coverage Policy. Only 97156 (family/caregiver training) has a stated telehealth allowance in Florida Medicaid BA; every other code is telehealth:'No' by policy design, not by omission. | UN (2 clients, $7.58/unit), UP (3 clients, $7.08/unit), UQ (4 clients, $6.58/unit), UR (5 clients, $6.08/unit), US (6 clients, $5.58/unit) |
| 97155 | Yes | Required | No code-specific unit cap on the fee schedule; counts toward the aggregate 40 hrs/week cap. per week (aggregate across all treatment codes). | home (categorical — no CMS POS-code number published anywhere in FL BA documentation, state or plan level), office/clinic (categorical), school (categorical — IEP/504 plan, or a documented explanation, required with the PA request per the coverage policy §7.2), community/other (categorical, per plan PA-form checkboxes) | No — not authorized for this code under the AHCA BA Coverage Policy. Only 97156 (family/caregiver training) has a stated telehealth allowance in Florida Medicaid BA; every other code is telehealth:'No' by policy design, not by omission. | HN — BCaBA tier, $15.37/unit (vs. $19.17 Lead Analyst base rate), XP — concurrent-supervision supervisee line, not separately reimbursed |
| 97156 | Yes | Required | No code-specific cap on direct/in-person units; the TELEHEALTH variant (GT modifier) is separately capped at 2 hrs/week (8 units/week). per week (telehealth portion); aggregate 40 hrs/week cap governs the rest. | home (categorical — no CMS POS-code number published anywhere in FL BA documentation, state or plan level), office/clinic (categorical), school (categorical — IEP/504 plan, or a documented explanation, required with the PA request per the coverage policy §7.2), community/other (categorical, per plan PA-form checkboxes) | Yes — the ONLY Florida Medicaid BA code with a confirmed telehealth allowance. GT modifier, up to 2 hrs/week, per Rule 59G-1.057, F.A.C. (coverage policy §4.2.2, FL.CP.BH.500). Not confirmed whether the telehealth allowance extends to BCaBA-rendered (HN-modifier) training — both the coverage policy and Sunshine's clinical policy name the "Lead Analyst" specifically. Separately: Sunshine's general (non-BA) telehealth billing notice instructs POS 02 with NO GT/95/CR modifier appended, which appears to conflict with the BA-specific GT-modifier requirement — an unresolved discrepancy, flagged rather than guessed at; confirm the correct billing combination with each plan before submitting a 97156 telehealth claim. | GT — telemedicine delivery, same $19.05 rate, capped at 2 hrs/wk, HN — BCaBA tier, $15.24/unit (vs. $19.05 Lead Analyst base rate) |
| 97157 | No — absent from both the 2025 and 2026 AHCA Behavior Analysis fee schedules and not listed among the covered service categories in the Dec 2024 coverage policy §4.2.2. Cross-confirmed absent from Sunshine Health's own coding table (FL.CP.BH.500) and Humana's Florida Medicaid PA list too — three independent primary sources agree on the omission. This is NOT a formal written exclusion statement (no document states "97157 is excluded"), so treat this as verified-absent-from-the-billable-set rather than a proven-impossible claim. | N/A — not on the state's billable BA code set per the fee schedule and PA lists reviewed. | N/A per N/A | — | N/A | — |
| 97158 | Yes | Required | Max 6 participants per group; rendered by Lead Analyst or BCaBA only (NOT RBT, per the coverage policy — contrast 97154, which RBTs can render). per week (aggregate) plus a 6-participant group-size ceiling. | home (categorical — no CMS POS-code number published anywhere in FL BA documentation, state or plan level), office/clinic (categorical), school (categorical — IEP/504 plan, or a documented explanation, required with the PA request per the coverage policy §7.2), community/other (categorical, per plan PA-form checkboxes) | No — not authorized for this code under the AHCA BA Coverage Policy. Only 97156 (family/caregiver training) has a stated telehealth allowance in Florida Medicaid BA; every other code is telehealth:'No' by policy design, not by omission. | UN (2 clients, $9.58/unit), UP (3 clients, $9.08/unit), UQ (4 clients, $8.58/unit), UR (5 clients, $8.08/unit), US (6 clients, $7.58/unit) |
| 0362T | Yes | Required, and conditioned on medical necessity for the extra-technician protocol per the coverage policy. | 16 units per initial assessment or reassessment (max). per per assessment/reassessment. | home (categorical — no CMS POS-code number published anywhere in FL BA documentation, state or plan level), office/clinic (categorical), school (categorical — IEP/504 plan, or a documented explanation, required with the PA request per the coverage policy §7.2), community/other (categorical, per plan PA-form checkboxes) | No — not authorized for this code under the AHCA BA Coverage Policy. Only 97156 (family/caregiver training) has a stated telehealth allowance in Florida Medicaid BA; every other code is telehealth:'No' by policy design, not by omission. | — |
| 0373T | Yes | Required, and conditioned on medical necessity for the extra-technician protocol. | No distinct unit cap beyond the underlying code's session limits — the fee schedule doesn't publish one separately for this add-on. | home (categorical — no CMS POS-code number published anywhere in FL BA documentation, state or plan level), office/clinic (categorical), school (categorical — IEP/504 plan, or a documented explanation, required with the PA request per the coverage policy §7.2), community/other (categorical, per plan PA-form checkboxes) | No — not authorized for this code under the AHCA BA Coverage Policy. Only 97156 (family/caregiver training) has a stated telehealth allowance in Florida Medicaid BA; every other code is telehealth:'No' by policy design, not by omission. | — |

Code notes:

- **97151:** Physician referral + order + Comprehensive Diagnostic Evaluation gate the very first assessment request (no autism-diagnosis requirement) — see the guide's prose for the intake sequence. TNFL's own BA Provider Manual confirms every code on the FL BA fee schedule requires TN prior authorization directly, not just by state-pattern inference. These are the statewide AHCA BA Coverage Policy mechanics, binding on Community Care Plan (via Therapy Network of Florida) per the policy's plan-compliance clause (§1.2); Community Care Plan (via Therapy Network of Florida)'s own documents don't restate full code-level unit-cap/POS detail beyond what's marked 'verified' above — confirm any 'inferred' field with Community Care Plan (via Therapy Network of Florida) provider relations before quoting a family.
- **97152, 97156:** These are the statewide AHCA BA Coverage Policy mechanics, binding on Community Care Plan (via Therapy Network of Florida) per the policy's plan-compliance clause (§1.2); Community Care Plan (via Therapy Network of Florida)'s own documents don't restate full code-level unit-cap/POS detail beyond what's marked 'verified' above — confirm any 'inferred' field with Community Care Plan (via Therapy Network of Florida) provider relations before quoting a family.
- **97153:** Billed at the SAME $12.26/unit rate whether rendered by an RBT, BCaBA, or Lead Analyst — Florida does not tier 97153 by staff credential (contrast 97155/97156, which do via the HN modifier). TNFL's manual restates the 40-hrs/week aggregate threshold as a documentation trigger ("Any requests for more than 40 hours" need extra justification) directly, not just by state-pattern inference. These are the statewide AHCA BA Coverage Policy mechanics, binding on Community Care Plan (via Therapy Network of Florida) per the policy's plan-compliance clause (§1.2); Community Care Plan (via Therapy Network of Florida)'s own documents don't restate full code-level unit-cap/POS detail beyond what's marked 'verified' above — confirm any 'inferred' field with Community Care Plan (via Therapy Network of Florida) provider relations before quoting a family.
- **97154:** The modifier documents group size, not staff credential — rate scales DOWN as the group grows. TNFL's manual restates the 6-participant group-size cap directly. These are the statewide AHCA BA Coverage Policy mechanics, binding on Community Care Plan (via Therapy Network of Florida) per the policy's plan-compliance clause (§1.2); Community Care Plan (via Therapy Network of Florida)'s own documents don't restate full code-level unit-cap/POS detail beyond what's marked 'verified' above — confirm any 'inferred' field with Community Care Plan (via Therapy Network of Florida) provider relations before quoting a family.
- **97155:** Rendered by Lead Analyst or BCaBA only — RBTs do not bill 97155 in Florida. These are the statewide AHCA BA Coverage Policy mechanics, binding on Community Care Plan (via Therapy Network of Florida) per the policy's plan-compliance clause (§1.2); Community Care Plan (via Therapy Network of Florida)'s own documents don't restate full code-level unit-cap/POS detail beyond what's marked 'verified' above — confirm any 'inferred' field with Community Care Plan (via Therapy Network of Florida) provider relations before quoting a family.
- **97157:** If a family reports a Florida plan authorizing/paying 97157, verify directly with that plan — it would be an accommodation outside the state fee schedule, not the documented default. TNFL's manual does not separately confirm this absence — inherits the statewide finding (absent from both AHCA fee schedules and the coverage policy). These are the statewide AHCA BA Coverage Policy mechanics, binding on Community Care Plan (via Therapy Network of Florida) per the policy's plan-compliance clause (§1.2); Community Care Plan (via Therapy Network of Florida)'s own documents don't restate full code-level unit-cap/POS detail beyond what's marked 'verified' above — confirm any 'inferred' field with Community Care Plan (via Therapy Network of Florida) provider relations before quoting a family.
- **97158:** TNFL's manual restates the 6-participant group-size cap directly. These are the statewide AHCA BA Coverage Policy mechanics, binding on Community Care Plan (via Therapy Network of Florida) per the policy's plan-compliance clause (§1.2); Community Care Plan (via Therapy Network of Florida)'s own documents don't restate full code-level unit-cap/POS detail beyond what's marked 'verified' above — confirm any 'inferred' field with Community Care Plan (via Therapy Network of Florida) provider relations before quoting a family.
- **0362T:** Requires an on-site physician/QHP plus 2+ technicians for severe/destructive-behavior assessment support; billed alongside 97151/97151-TS, not standalone. These are the statewide AHCA BA Coverage Policy mechanics, binding on Community Care Plan (via Therapy Network of Florida) per the policy's plan-compliance clause (§1.2); Community Care Plan (via Therapy Network of Florida)'s own documents don't restate full code-level unit-cap/POS detail beyond what's marked 'verified' above — confirm any 'inferred' field with Community Care Plan (via Therapy Network of Florida) provider relations before quoting a family.
- **0373T:** Requires an on-site physician/QHP plus 2+ technicians for severe/destructive-behavior exposure treatment; billed alongside 97153/97155. These are the statewide AHCA BA Coverage Policy mechanics, binding on Community Care Plan (via Therapy Network of Florida) per the policy's plan-compliance clause (§1.2); Community Care Plan (via Therapy Network of Florida)'s own documents don't restate full code-level unit-cap/POS detail beyond what's marked 'verified' above — confirm any 'inferred' field with Community Care Plan (via Therapy Network of Florida) provider relations before quoting a family.

### Medicaid rates

Source: AHCA Behavior Analysis Fee Schedule (2025 and 2026 — rates identical across both years). TNFL's own BA manual defers explicitly to "the Florida BA Fee Schedule" without restating rates — this table is that state schedule, used as the reference baseline. Effective 2025-01-01.

| Code | Rate | Unit | Modifier tiers |
| --- | --- | --- | --- |
| 97151 | $19.05 | 15min | TS: $19.05 (reassessment; same rate, 18-unit cap vs. 24 for the initial assessment) |
| 97152 | $12.19 | 15min | — |
| 97153 | $12.26 | 15min | XP: Not reimbursed (concurrent-supervision supervisee line) |
| 97154 | $7.58 (2 clients, UN) | 15min | UN: $7.58 (2 clients); UP: $7.08 (3); UQ: $6.58 (4); UR: $6.08 (5); US: $5.58 (6) |
| 97155 | $19.17 (Lead Analyst) | 15min | HN: $15.37 (BCaBA); XP: Not reimbursed (concurrent-supervision supervisee line) |
| 97156 | $19.05 (Lead Analyst) | 15min | GT: $19.05 (telemedicine — same rate, capped at 2 hrs/week); HN: $15.24 (BCaBA) |
| 97157 | Not on the AHCA fee schedule (2025 or 2026) — not confirmed reimbursable under Florida Medicaid BA. | 15min | — |
| 97158 | $9.58 (2 clients, UN) | 15min | UN: $9.58 (2 clients); UP: $9.08 (3); UQ: $8.58 (4); UR: $8.08 (5); US: $7.58 (6) |
| 0362T | $12.19 | 15min | — |
| 0373T | $12.19 | 15min | — |

### Contacts

- **Provider services phone:** 1-888-550-8800
- **Phone menu path:** Provider Relations: 1-888-550-8800, option 2. Claims status/customer service (live interaction): 877-372-1273 — listen carefully to the voice prompts, which may answer the inquiry without needing a representative.
- **Portal:** [Therapy Network of Florida Provider Web Portal (HS1)](https://asp.healthsystemone.com/hs1providers)
- **Fax:** 1-855-470-4490

Questions to ask on a verification call:

- Does Community Care Plan/TNFL support 270/271 eligibility checks, and what pVerify payer ID should we use (professional claims route to 65062 via Availity)?
- Does ABA claims/eligibility route as a standard medical claim, or under a distinct behavioral-health bucket for TNFL?
- Which service-type code do you return ABA benefit details under?
- Does the deductible apply to ABA, and is the cost share a copay or coinsurance?
- Is any copay charged per visit or per day, and does the out-of-pocket max apply to ABA?
- What’s the cap period for 0373T?

### VOB data sources

- https://www.therapynetwork.com/state_links/ba/manuals/Community-Care-Plan-Behavior-Analysis-Provider-Manual.pdf (accessed 2026-07-23)
- https://portal.flmmis.com/FLPublic/Portals/0/StaticContent/Public/COMPANION%20GUIDES/FMMIS_5010_270_271_Companion%20Guide_v4_0_04272023.pdf (accessed 2026-07-23; source document older than 18 months)
- https://www.flrules.org/gateway/readRefFile.asp?refId=17525&filename=Florida%20Medicaid%20Behavior%20Analysis%20Services%20Coverage%20Policy.pdf (accessed 2026-07-23)
- https://ahca.myflorida.com/content/download/26138/file/2025%20Behavior%20Analysis%20Fee%20Schedule.pdf (accessed 2026-07-23)
- https://ahca.myflorida.com/content/download/28096/file/2026%20BA%20Fee%20Schedule.pdf (accessed 2026-07-23)

## Common questions

### Does Community Care Plan cover ABA?

Yes — the state Behavior Analysis benefit on AHCA criteria (no autism diagnosis required), with the entire BA function — authorizations and claims — delegated to Therapy Network of Florida.

### How fast does CCP approve BA authorizations?

The fastest published turnarounds of Florida's nine plans: 5 calendar days standard, 2 calendar days expedited, via Therapy Network of Florida.

### Where do CCP ABA claims go?

To Therapy Network of Florida, not CCP — electronically via the TNFL portal, or on paper addressed to Therapy Network of Florida.

## Primary sources

1. [Community Care Plan — Behavior Analysis Provider Manual (2025-01-29)](https://www.therapynetwork.com/state_links/ba/manuals/Community-Care-Plan-Behavior-Analysis-Provider-Manual.pdf)
2. [Florida Medicaid BA Services Coverage Policy (Dec 2024)](https://www.flrules.org/gateway/readRefFile.asp?refId=17525&filename=Florida%20Medicaid%20Behavior%20Analysis%20Services%20Coverage%20Policy.pdf)
3. [Community Care Plan — MMA Provider Manual (3/11/2026)](https://ccpcares.org/wp-content/uploads/CCP-MMA-Provider-Manual_03.11.26.pdf)
4. [AHCA SMMC Model Health Plan Contract — Attachment II Core Provisions (update 10/1/2025), §V.6 and §XI.D](https://ahca.myflorida.com/content/download/27248/file/Attachment%20II-%20-%20Core%20Contract%20Provisions%20Oct%202025.pdf)
5. [Rule 59G-1.052, F.A.C. — Third-Party Liability Requirements (AHCA)](https://ahca.myflorida.com/content/download/5929/file/59G_1052_TPL_Requirements.pdf?version=1)

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.