---
title: Humana Healthy Horizons in Florida ABA / BA coverage (MMA plan).
url: "https://carelu.com/payers/humana-healthy-horizons-florida"
markdown_url: "https://carelu.com/payers/humana-healthy-horizons-florida.md"
state: FL (Florida)
payer: Humana Healthy Horizons in Florida
kind: Medicaid managed care plan (MCO)
parent_program: Florida Medicaid (AHCA)
description: "How Humana Healthy Horizons administers Florida Medicaid Behavior Analysis — Availity, 24/7 IVR and fax channels, the MCD 466 PA form, documentation requirements, named regional BA reps, and non-par payment tied to the state fee schedule."
last_reviewed: September 2026
vob_data_updated: 2026-07-23
---

# Humana Healthy Horizons in Florida ABA / BA coverage (MMA plan).

_Payer Guide · Humana Healthy Horizons (FL) · Last updated September 2026 · 4 primary sources_

> Widest channels of the nine (Availity, 24/7 IVR, fax), named BA reps, fee-schedule-linked non-par pay.

Humana Healthy Horizons administers Florida's Behavior Analysis benefit in-house on the AHCA criteria, and differentiates on access: the broadest channel set of the nine plans (Availity Essentials preferred, a 24/7 IVR line, and fax), a dedicated BA provider-relations mailbox with named regional reps, and an unusually explicit rate anchor — non-participating providers' claims for authorized codes default to a percentage of the Florida Medicaid allowable fee schedule. It was also among the most generous at the carve-in, honoring pre-existing authorizations for 120 days.

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 — via Availity Essentials (preferred), IVR 800-523-0023 (24/7), or fax 813-321-7220, with CDE, physician order, and BASC-3 PRQ attached [1][3]
- **Prior auth for treatment**: Required — same channels; PA list at Humana.com/PAL [1][3]
- **Autism diagnosis required?**: No — state BA policy applies: physician referral + order + CDE, no autism-diagnosis requirement [4]

## At a glance

- **Plan type:** SMMC MMA plan (Humana), in-house UM
- **Clinical rules:** AHCA BA Coverage Policy; PA form MCD 466
- **Prior auth:** Availity (preferred), IVR 800-523-0023 (24/7), or fax 813-321-7220
- **Documentation:** CDE, physician order, BASC-3 PRQ (initial + every 12 months), hours rationale, IEP/504 if school-based
- **Claims:** Availity payer ID 61101; clean claims in 20 days; non-par default = % of state fee schedule
- **BA support:** FLBA@humana.com + named regional reps; provider line 800-477-6931

## How Humana runs BA authorization

PA is required for all BA services and can be initiated three ways: Availity Essentials (Humana's preferred channel), the 24/7 IVR at 800-523-0023, or fax to 813-321-7220, using the Florida ABA PA form (MCD 466). The documentation list tracks the state policy closely: the Comprehensive Diagnostic Evaluation, the physician's order, the BASC-3 PRQ for ages 2–18 (at initial request and every 12 months), a rationale for the requested hours, and the IEP or 504 plan when services are school-based. The plan's full PA list lives at Humana.com/PAL. Uniquely among the nine, Humana publishes a dedicated BA provider-relations structure: the FLBA@humana.com mailbox plus named regional representatives covering Regions A–E and F–I — for an intake team, a saved contact sheet turns authorization questions into emails with a named owner. Non-par contracting starts at RequestToJoin@humana.com. [1][3]

## Rates and claims: the fee-schedule anchor

Participating providers bill at contracted rates (claims via Availity, payer ID 61101; paper to Humana's Lexington, KY claims office), with clean claims processed within 20 days. The notable rate fact: for codes inside an approved authorization, non-participating claims default-pay at a percentage of the Florida Medicaid allowable fee schedule — an explicit statutory-schedule linkage that makes the state's low BA rates (97153 at $12.26/unit) the reference point for any Humana negotiation. At the February 2025 carve-in, Humana honored and auto-extended pre-existing Acentra authorizations for 120 days and paid non-par providers at pre-transition rates through that window. [1]

## Intake gates

The questions that decide whether a family can start with Humana Healthy Horizons in Florida, and what they have to bring.

- **Age limit**: Follows the Florida Medicaid rule: BA is for recipients under the age of 21, with EPSDT available above the coverage-policy and fee-schedule limits. Humana’s BA informational flyer and ABA toolkit publish no plan-specific age limit, and the state policy forbids a plan from applying more stringent service coverage limits. [4][1]
- **Diagnosis recency**: No autism diagnosis is required. Humana’s own instrument clock tracks the state cycle: the BASC-3 PRQ is required for ages 2 through 18 at the initial request and every 12 months, on top of the state’s reassessment and updated behavior plan at least every six months. The Comprehensive Diagnostic Evaluation itself carries no published expiry. [1][4]
- **Who may diagnose**: The state rule, restated in Humana’s documentation list: the physician’s order and the Comprehensive Diagnostic Evaluation both attach to the request, with the referral coming from an independent physician or qualifying practitioner and the CDE led by a licensed practitioner working within their medical, developmental or psychological scope of practice. Humana publishes no narrower list of its own. [1][4]
- **Diagnostic tools required**: Humana names the BASC-3 PRQ explicitly — ages 2 through 18, at the initial request and every 12 months — as a required attachment alongside the CDE and the physician’s order. The state pair applies in full, so the Vineland-3 Comprehensive Parent Interview Form (plus the Maladaptive Behavior Domain for ages 3 and older) rides with it, complete scoring reports included. [1][4]
- **Referral required?**: Required, and Humana publishes the fullest documentation list of the nine plans: the Comprehensive Diagnostic Evaluation, the physician’s order, the BASC-3 PRQ, a rationale for the requested hours, and the IEP or 504 plan when services are school-based — submitted on the Florida ABA PA form (MCD 466) through Availity Essentials (preferred), the 24/7 IVR at 800-523-0023, or fax 813-321-7220. Humana’s current flyer adds that “the Behavior Analysis Authorization form should be completed and included with your authorization request” and that “a valid Medicaid ID is required for all providers, whether located in Florida or out of state, as a condition of payment.” [1][2][4]
- **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. Humana’s BA informational flyer and ABA toolkit publish no telehealth code list, modifier set or place-of-service rule for Florida BA. [4][1]
  - Ask the plan: Humana’s Florida BA mailbox (FLBA@humana.com) or the provider line 800-477-6931 before scheduling a remote session other than 97156 caregiver training.
- **Prior-auth decision time**: Humana’s 2026 Florida provider handbook publishes no decision timeframe for PA requests. Its PA page says only that requests “should be made as soon as possible.” The contract clock therefore applies. The AHCA contract every MMA plan signs sets the clock: plans “shall provide standard authorization decisions within no more than five (5) days following receipt of the request for service,” extendable by “up to four (4) additional days,” and expedited decisions “no later than two (2) days after receipt,” extendable by one day. The contract defines days as calendar days. That is stricter than the federal Medicaid managed-care cap (7 calendar days standard and 72 hours expedited for rating periods from 1/1/2026, 42 CFR 438.210(d)), so the state clock governs. Humana’s BA request must include a current assessment “from within the past 60 days,” so time the reassessment to the submission. No reauthorization lead time is published. [5][6][7]
- **Other insurance (who pays first)**: Humana’s handbook says only: “Humana Healthy Horizons assumes full responsibility for collections in the event of third-party liability.” It publishes no step-by-step rule on billing the other payer first. The state rule that binds every MMA plan still applies. 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. [5][8][7]
  - Ask the plan: Humana Provider Services (IVR 800-523-0023): whether Humana wants the commercial EOB before its claim, and whether its BA authorization is still required when a commercial plan pays first.

## Delivery and billing rules

Coverage decides whether Humana Healthy Horizons in Florida 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**: The state floor: supervision of BCaBAs and RBTs per the Council of Autism Service Providers practice standards, specified in the supervision plan inside the approved behavior plan, which names the authorized supervisors. Humana adds no ratio or caseload cap — but it does ask for a rationale for the requested hours with every authorization, which is where a supervision schedule has to be justified. [4][1]
- **Concurrent billing (97153 + 97155)**: The state rule governs and Humana publishes no variation: the supervisee is not reimbursed when the supervisor is reimbursed for the same time period, and simultaneous services by more than one BA provider are non-covered unless medically necessary, prior authorized and indicated in the approved behavior plan. [4]
  - Ask the plan: Humana’s Florida BA mailbox (FLBA@humana.com) or the named regional BA representative for whether an authorization may carry 97153 and 97155 on the same clock time.
- **Daily limits / MUEs**: The state weekly ceiling of up to 40 hours per week of BA intervention as prior-authorized in the behavior plan, with EPSDT available above it and group treatment capped at six participants. Humana bills “reimbursement for all services in 15-minute increments” and requires add-on codes to be billed with the corresponding base code. No per-day unit table is published. [4][1]
  - Ask the plan: Humana provider services (800-477-6931) for per-day claim edits; the AHCA fee schedule under Rule 59G-4.002 for per-assessment unit caps.
- **Session-note signature**: The state rule: session notes signed and dated by the rendering practitioner, carrying date, time, location, duration, behaviors observed, skills targeted, the recipient’s response, protocol modification or therapist direction, an explanation if the parent or guardian was absent, and the participants; the behavior assessment and behavior plan signed by the Lead Analyst and the parent or guardian. Humana publishes no additional signature rule for BA. [4][1]
- **Place of service**: Humana makes the state school rule an explicit line item on its documentation list — the IEP or 504 plan is required when services are school-based — and the state rule supplies the rest: in the absence of an IEP, documentation justifying the services plus an estimated IEP timeframe; 1:1 shadow, personal care, companion and chaperone services non-covered regardless of setting; travel time non-covered. [1][4]
- **Bill as provider**: Humana publishes the box-by-box rule: “use the CMS-1500 form to submit claims for behavioral analysis services”; if the rendering provider is in a group and the group is being paid, “the group will be captured in the billing provider section (Box 33), and then the rendering provider will be captured in the rendering provider section (Box 24)”; if the rendering provider is the one being reimbursed, they go in Box 33; and “enter the individual rendering (treating) provider’s number in Item 24 J… only when it is different from the pay-to provider number.” Claims go out under payer ID 61101 through Availity (paper to the Lexington, KY claims office), clean claims process within 20 days, and for codes inside an approved authorization non-participating providers default to the lesser of the amount Humana specified on the authorization form or 100% of the applicable Medicaid fee schedule. [1][4]

## What intake should collect for Humana Healthy Horizons in Florida

- **Referral + order + CDE:** The CDE and physician order attach to the Humana PA — collect them at intake.
- **BASC-3 PRQ scoring report:** Required at initial request and every 12 months for ages 2–18.
- **Hours rationale:** Humana asks for the rationale behind requested hours — align clinical planning with the ask.
- **School status + IEP/504:** Required with school-based requests.
- **Regional BA rep:** Identify the named Humana rep for your region and save the FLBA@humana.com contact.

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

## Verification of benefits (VOB) data

How Humana Healthy Horizons in Florida ABA benefits route and read on an eligibility check. Data last updated 2026-07-23.

### EDI routing

- **Payer ID (Availity):** 61101
- **Behavioral health administrator:** none
- **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 | 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. Humana's own materials explicitly defer coding mechanics to AHCA in writing: "Procedure codes and the latest published fee schedules can be found on the AHCA website... Rule 59G-4.002." Non-par providers are reimbursed at 80% of the Florida Medicaid fee schedule, absent a controlling legal requirement or Letter of Agreement (MCD 466 PA form, p.3) — a concrete figure, not the vague "a percentage of..." previously on file. These are the statewide AHCA BA Coverage Policy mechanics, binding on Humana Healthy Horizons in Florida per the policy's plan-compliance clause (§1.2); Humana Healthy Horizons in 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 Humana Healthy Horizons in Florida provider relations before quoting a family.
- **97152, 97156, 97158:** These are the statewide AHCA BA Coverage Policy mechanics, binding on Humana Healthy Horizons in Florida per the policy's plan-compliance clause (§1.2); Humana Healthy Horizons in 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 Humana Healthy Horizons in 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). These are the statewide AHCA BA Coverage Policy mechanics, binding on Humana Healthy Horizons in Florida per the policy's plan-compliance clause (§1.2); Humana Healthy Horizons in 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 Humana Healthy Horizons in Florida provider relations before quoting a family.
- **97154:** The modifier documents group size, not staff credential — rate scales DOWN as the group grows. These are the statewide AHCA BA Coverage Policy mechanics, binding on Humana Healthy Horizons in Florida per the policy's plan-compliance clause (§1.2); Humana Healthy Horizons in 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 Humana Healthy Horizons in 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 Humana Healthy Horizons in Florida per the policy's plan-compliance clause (§1.2); Humana Healthy Horizons in 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 Humana Healthy Horizons in 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. Independently cross-confirmed absent from the Humana FL PAL too — not just the AHCA fee schedule. These are the statewide AHCA BA Coverage Policy mechanics, binding on Humana Healthy Horizons in Florida per the policy's plan-compliance clause (§1.2); Humana Healthy Horizons in 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 Humana Healthy Horizons in 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 Humana Healthy Horizons in Florida per the policy's plan-compliance clause (§1.2); Humana Healthy Horizons in 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 Humana Healthy Horizons in 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 Humana Healthy Horizons in Florida per the policy's plan-compliance clause (§1.2); Humana Healthy Horizons in 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 Humana Healthy Horizons in Florida provider relations before quoting a family.

### Contacts

- **Provider services phone:** 800-477-6931
- **Phone menu path:** Prior-authorization IVR: 800-523-0023, available 24/7 (live representatives Monday–Friday, 8 a.m.–8 p.m. Eastern).
- **Hours:** Participating and nonparticipating providers: Monday–Friday, 8 a.m.–8 p.m. Eastern.
- **Portal:** [Availity Essentials](https://www.availity.com/)
- **Fax:** 813-321-7220

Questions to ask on a verification call:

- What payer ID should we use for pVerify and Change Healthcare eligibility checks, and do you support 270/271 real-time eligibility on Availity ID 61101, or is it batch only?
- 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://assets.humana.com/is/content/humana/ABA_Informational_Flyer_AHCApdf (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://assets.humana.com/is/content/humana/ABA_PA_Formpdf (accessed 2026-07-23)
- https://assets.humana.com/is/content/humana/FL%20MCD%20PAL%20Cpdf (accessed 2026-07-23)

## Common questions

### Does Humana Healthy Horizons cover ABA in Florida?

Yes — it administers the state Behavior Analysis benefit on AHCA criteria: no autism diagnosis required, physician referral + order + CDE, PA on all BA services via Availity, 24/7 IVR, or fax.

### What documents does a Humana Florida BA authorization need?

The CDE, the physician's order, the BASC-3 PRQ (ages 2–18, initial and every 12 months), a rationale for requested hours, and the IEP/504 for school-based services — submitted with the MCD 466 form.

### What does Humana pay non-par ABA providers in Florida?

For codes in an approved authorization, non-par claims default-pay at a percentage of the Florida Medicaid allowable fee schedule — so the state's BA rates are the explicit reference point.

## Primary sources

1. [Humana Healthy Horizons FL — BA Informational Flyer (675204FL0225)](https://assets.humana.com/is/content/humana/ABA_Informational_Flyer_AHCApdf)
2. [Humana FL — ABA PA Form (MCD 466)](https://assets.humana.com/is/content/humana/ABA_PA_Formpdf)
3. [Humana FL — ABA clinical toolkit](https://provider.humana.com/medicaid/florida-medicaid/aba-toolkit)
4. [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)
5. [Humana Healthy Horizons in Florida — 2026 Provider Handbook](https://assets.humana.com/is/content/humana/Provider_Handbookpdf)
6. [Humana Healthy Horizons in Florida — Prior Authorization page](https://provider.humana.com/medicaid/florida-medicaid/prior-authorization)
7. [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)
8. [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.