---
title: MetroPlusHealth ABA coverage (NY Medicaid Managed Care).
url: "https://carelu.com/payers/metroplus-health-new-york"
markdown_url: "https://carelu.com/payers/metroplus-health-new-york.md"
state: NY (New York)
payer: MetroPlusHealth (NY Medicaid)
kind: Medicaid managed care plan (MCO)
parent_program: New York Medicaid
description: "How MetroPlusHealth — the NYC Health + Hospitals plan — handles NY Medicaid ABA: email/fax authorization to CSS, the annual diagnosis-validation requirement that's stricter than the state's 2-year rule, and the NYC-only footprint."
last_reviewed: September 2026
vob_data_updated: 2026-07-23
---

# MetroPlusHealth ABA coverage (NY Medicaid Managed Care).

_Payer Guide · MetroPlusHealth (NY) · Last updated September 2026 · 3 primary sources_

> NYC H+H plan; auth via email/fax to CSS; unique quirk: diagnosis must be re-validated annually.

MetroPlusHealth, the NYC Health + Hospitals plan, carries the NY Medicaid ABA carve-in with two plan-specific wrinkles worth designing intake around. First, the mechanics are old-school: ABA authorization requests and clinical information go to MetroPlus CSS by email or fax, not a slick portal workflow. Second — and unique among the plans we profile — MetroPlus requires the autism diagnosis to be authenticated and re-validated annually by the member's treatment team, a stricter cadence than the state's 2-year referral rule, and it holds that LBAs don't meet the practitioner level to validate the diagnosis themselves.

This plan administers the **New York Medicaid** ABA benefit: the state rules are the floor, and this page covers what the plan layers on top. Read it together with the [New York Medicaid (NYS DOH / eMedNY) guide](https://carelu.com/payers/new-york-medicaid).

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment** _(ask the plan)_: Not published — assessment-PA specifics, authorization periods and hour caps aren’t in the materials we could verify; confirm with MetroPlus CSS per case [1][2]
  - Ask the plan: MetroPlus CSS — the email/fax authorization intake named in the 2023 ABA benefit notice — or the metroplus.org provider authorization page. Ask specifically whether 97151 needs its own authorization, and get the answer in writing per case.
- **Prior auth for treatment**: Required — authorization requests and clinical information go to MetroPlus CSS by email or fax (per the 2023 benefit notice) [1]
- **Autism diagnosis required?**: Yes — state baseline plus a MetroPlus quirk: a comprehensive autism evaluation by a NYS-licensed clinician, authenticated and re-validated annually (LBAs don't qualify to validate it) [1][3]

## At a glance

- **Plan type:** Mainstream MMC (Metroplus Health Plan, Inc. — NYC Health + Hospitals)
- **Footprint:** New York City only
- **Authorization channel:** Email or fax to MetroPlus CSS — requests + clinical information
- **Diagnosis recency:** Annual — diagnosis authenticated and re-validated every year (stricter than the state's 2-year referral)
- **Diagnostic evaluation:** Comprehensive autism evaluation by a NYS-licensed clinician; LBAs can't validate the dx
- **Clinical criteria:** State baseline (under 21, ASD/Rett) + MetroPlus overlays

## The annual diagnosis-validation quirk

MetroPlus states that LBAs do not meet the practitioner level to authenticate or validate an autism diagnosis — so ABA providers must coordinate with the member's treatment team (physician, psychologist, or other qualified NYS-licensed clinician) to have the diagnosis authenticated and validated annually. That's a materially tighter clock than the state's 2-year referral: for every MetroPlus family, intake should diary an annual diagnosis-revalidation task with the diagnosing or treating clinician, or reauthorization becomes an avoidable scramble. The underlying diagnostic requirement is a comprehensive autism evaluation by a NYS-licensed clinician accompanying or preceding the diagnosis. [1]

## Mechanics and what to verify

Per the plan's 2023 benefit notice, authorization requests and supporting clinical information are submitted to MetroPlus CSS by email or fax — build a submission template and a delivery-confirmation habit, since email/fax workflows lack a portal's status visibility. Assessment-PA specifics, authorization periods, hour caps, and rates aren't published in the materials we could verify; confirm current requirements with CSS or via the metroplus.org provider portal per case. The footprint is NYC-only, and the clinical baseline is the state's: under 21, ASD/Rett, practitioner referral. [1][3]

## Intake gates

The questions that decide whether a family can start with MetroPlusHealth (NY Medicaid), and what they have to bring.

- **Age limit**: Follows the New York Medicaid rule: ABA is covered for members “under 21 years of age with a diagnosis of Autism Spectrum Disorder (ASD) as defined by… (DSM-5) and/or Rett Syndrome.” No minimum age and no adult pathway — the 21st birthday is a hard cliff. MetroPlus publishes no age rule of its own; its footprint, not its age rule, is the plan-specific limit — New York City only. [3][1]
- **Diagnosis recency**: Stricter than the state, and this is the fact to design intake around. Where New York Medicaid runs a 2-year referral clock, MetroPlus requires the autism diagnosis to be “authenticated and validated annually” by the member’s treatment team. Diary a yearly diagnosis-revalidation task with the diagnosing or treating clinician for every MetroPlus family, or reauthorization becomes an avoidable scramble. [1][3]
- **Who may diagnose**: Follows the New York Medicaid referral rule, plus a MetroPlus exclusion that matters: LBAs “do not meet the practitioner level to authenticate or validate an autism diagnosis,” so ABA providers must coordinate with the member’s treatment team — physician, psychologist, or another qualified NYS-licensed clinician — to have the diagnosis authenticated and validated. The underlying requirement is a comprehensive autism evaluation by a NYS-licensed clinician accompanying or preceding the diagnosis. [1][3]
- **Diagnostic tools required**: No instrument is named. MetroPlus requires “a comprehensive autism evaluation by a NYS-licensed clinician” behind the diagnosis but does not specify which instruments must sit inside it; the state baseline requires only the DSM-5 Diagnostic Checklist with the referral and the standardized assessment used, identified as appropriate. [1][3]
- **Referral required?**: Follows the New York Medicaid rule: the member “must be referred for ABA services by a NYS-licensed and NYS Medicaid-enrolled physician, psychologist, psychiatric nurse practitioner, pediatric nurse practitioner, or physician assistant,” the referral is “valid for no more than two years,” and it must carry age, the ASD/Rett diagnosis, date of initial diagnosis, co-morbid diagnoses, symptom severity level, a statement the patient needs ABA, and the DSM-5 Diagnostic Checklist. MetroPlus’s own mechanics are old-school: authorization requests and supporting clinical information go to MetroPlus CSS by email or fax rather than through a portal workflow, so build a submission template and a delivery-confirmation habit. Assessment-PA specifics and authorization periods are not published. [3][1]
  - Ask the plan: MetroPlus CSS, or the metroplus.org provider portal, for assessment-PA specifics and authorization periods.
- **Prior-auth decision time**: MetroPlusHealth’s June 2026 manual tightened every Medicaid clock: a standard prior authorization is decided “within three (3) business days of the receipt of all necessary information, but no later than seven (7) days after the request is received”; a fast-track (urgent) request “within seventy-two (72) hours from the date that the request is received”; a continuing-care (concurrent) request within one business day of all necessary information, again no later than 7 days (72 hours if fast-track). Extensions shrank too: timeframes “may be extended seven (7) calendar days” at the member’s or provider’s request or when the plan needs information (the March 2025 manual allowed 14). ABA requests go to metroplusaba@metroplus.org or fax 212-908-5182. No ABA reauth lead time is published for Medicaid. [4][2]
- **Other insurance (who pays first)**: MetroPlusHealth’s June 2026 manual publishes no coordination-of-benefits procedure of its own (its only primary-insurer language covers no-fault and workers’ compensation denials), so the state rule governs. Medicaid is “the payer of last resort” and “Providers must bill all applicable insurance sources before submitting claims to Medicaid. Payment from those sources must be received before submitting a Medicaid claim”; under the state contract, when other coverage is known the plan must “alert the provider and ask them to bill the TPHI that should be primary to the Plan.” In practice: bill the commercial plan first, then MetroPlus with the primary’s EOB. Whether MetroPlus still requires its own ABA authorization when it is secondary is not published — ask Provider Services (800-303-9629). [5][6][4]
- **Telehealth** _(ask the plan)_: Not published. MetroPlus’s 2023 ABA benefit notice covers the submission channel and the annual diagnosis-validation rule and says nothing about which ABA codes may be delivered remotely; the state manual answers telehealth only for supervision. [1][3]
  - Ask the plan: MetroPlus CSS or the metroplus.org provider authorization page — confirm telehealth code eligibility and POS in writing before scheduling remote sessions.

## Delivery and billing rules

Coverage decides whether MetroPlusHealth (NY Medicaid) 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 New York Medicaid rule, which the state applies to FFS and managed care alike: “an LBA can supervise no more than six CBAAs/unlicensed individuals at a time,” “LBAs are required to supervise unlicensed individuals for a minimum of five percent of the hours the unlicensed individual spends providing behavior analysis services each calendar month,” and “supervision must include at least two face-to-face, real-time contacts per month” with the LBA observing service delivery in at least one. Supervision may run over synchronous audio-and-video where on-site is impractical. 97155 counts toward the 5% “only when the LBA joins the patient and the unlicensed individual during a treatment session to direct the unlicensed individual/technician in implementing a new or modified treatment protocol.” CBAAs need direct supervision, and the supervisor “should assess each patient’s/client’s progress at least every 6 months… and review and sign treatment notes and reports prepared by the CBAA supervisee.” MetroPlus publishes no supervision ratio of its own; its plan-specific credential rule runs in the other direction, holding that LBAs do not meet the practitioner level to authenticate or validate the autism diagnosis. [3][1]
- **Session-note signature**: Follows the New York Medicaid rule: the LBA supervisor must “review and sign treatment notes and reports prepared by the CBAA supervisee,” and documentation of supervision itself “should be recorded in the patient file.” Clinical documentation must carry the treatment plan with assessment and goals, the goal data, total hours of service per week by who delivered them, and the location(s) of services. Records are kept “for a minimum of six years and, for minors, until the patient turns 22 years of age.” MetroPlus publishes no additional session-note signature rule; its one documentation-cadence rule is the annual diagnosis authentication by the treatment team. [3][1]
- **Place of service**: Follows the New York Medicaid rule: “LBAs and CBAAs may work in any legally authorized setting. Examples of such settings include private practice, settings where patients/clients reside full-time or part-time, clinics, hospitals, residences, and community settings” — but “NYS Medicaid does not reimburse for ABA services in a school setting.” The treatment plan must record the location(s) of services. No MetroPlus-specific setting rule was located; the footprint is the plan-specific constraint — New York City only. [3]
  - Ask the plan: MetroPlus CSS for any plan-specific setting restriction.
- **Concurrent billing (97153 + 97155)** _(ask the plan)_: Not published. The 2023 benefit notice is a process document, not a reimbursement policy, and the state manual is silent on 97153 with 97155. [1][3]
  - Ask the plan: MetroPlus CSS or provider services via the metroplus.org provider authorization page.
- **Daily limits / MUEs** _(ask the plan)_: Not published — MetroPlus states no authorization periods, unit ceilings or hour caps in the materials that could be verified. Treat the authorized units as the ceiling and get the authorization period in writing with each approval, since the email/fax workflow gives no portal status visibility. [1][2]
  - Ask the plan: MetroPlus CSS or the metroplus.org provider authorization page — confirm authorization period, unit limits and rates per case.
- **Bill as provider** _(ask the plan)_: Not published. At the fee-for-service layer New York is explicit: LBAs bill “using the LBA’s National Provider Identification (NPI) number for the ‘Billing’ provider and/or ‘Supervising’ provider,” with “the NPI number of the CBAA that provided the ABA service… reported as the ‘Rendering’ provider on each claim”; for unlicensed aides and LBA limited-permit holders the supervising LBA’s NPI fills all three roles. CBAAs cannot bill directly and enroll as OPRA providers. MetroPlus states no managed-care claim convention of its own in the materials that could be verified, and the state manual directs MMC providers to their plan for billing guidance. [3][1]
  - Ask the plan: MetroPlus CSS or provider services — confirm the rendering/supervising NPI convention before billing CBAA- or technician-delivered units.

## What intake should collect for MetroPlusHealth (NY Medicaid)

- **Comprehensive autism evaluation:** By a NYS-licensed clinician — it must accompany or precede the diagnosis, and an LBA's attestation doesn't count.
- **Annual revalidation plan:** Diary a yearly diagnosis-authentication task with the treatment team — MetroPlus's cadence is annual, not the state's 2 years.
- **CSS submission package:** Auth request + clinical information by email or fax — use a template and confirm receipt.
- **Complete state referral packet:** The state baseline (under 21, ASD/Rett, referral with DSM-5 checklist) still applies.

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

## Verification of benefits (VOB) data

How MetroPlusHealth (NY Medicaid) ABA benefits route and read on an eligibility check. Data last updated 2026-07-23.

### EDI routing

- **Payer ID (pVerify):** 00659
- **Payer ID (Availity):** 13265
- **Payer ID (Change Healthcare / Optum):** 13265
- **Supports 270/271 eligibility:** Yes
- **Behavioral health administrator:** none — MetroPlus in-sourced BH from Beacon Health Options effective 10/1/2021 — This CORRECTS the build spec's assumption that MetroPlus delegates BH — MetroPlus's own press release confirms it in-sourced BH from Beacon Health Options effective 10/1/2021 ("Participating behavioral health providers now work directly with MetroPlusHealth"), corroborated by zero Beacon/Carelon hits across its 2025 Provider Manual and 2026 BH/HCBS PA grid.
- **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 — confirmed at the CATEGORY level ("CHILDREN Applied Behavior Analysis Treatment (ABA)", In-Network Prior Authorization = Yes) on the 2026 BH/HCBS Provider PA Request Guide, repeated across all lines of business (MMC/HARP, CHP, Essential Plan, QHP, Gold). This source does NOT break PA status out by individual CPT code — applying it to this specific code is inferred from the category-level finding, not a direct per-code statement. | Not stated for core Medicaid Managed Care. The Child Health Plus-specific benefit summary (Provider Manual Appendix XB) states an explicit "Applied Benefit Analysis (ABA) – limited to 680 hours/calendar year" — but the equivalent core-MMC appendix (XA) states no hour figure at all, so this cap likely does NOT apply to the mainstream Medicaid line. per calendar year (Child Health Plus line only, 680-hr cap); unverified for core Medicaid Managed Care | — | — | — |
| 97152 | Yes | Required — confirmed at the CATEGORY level ("CHILDREN Applied Behavior Analysis Treatment (ABA)", In-Network Prior Authorization = Yes) on the 2026 BH/HCBS Provider PA Request Guide, repeated across all lines of business (MMC/HARP, CHP, Essential Plan, QHP, Gold). This source does NOT break PA status out by individual CPT code — applying it to this specific code is inferred from the category-level finding, not a direct per-code statement. | Not stated for core Medicaid Managed Care. The Child Health Plus-specific benefit summary (Provider Manual Appendix XB) states an explicit "Applied Benefit Analysis (ABA) – limited to 680 hours/calendar year" — but the equivalent core-MMC appendix (XA) states no hour figure at all, so this cap likely does NOT apply to the mainstream Medicaid line. per calendar year (Child Health Plus line only, 680-hr cap); unverified for core Medicaid Managed Care | — | — | — |
| 97153 | Yes | Required — confirmed at the CATEGORY level ("CHILDREN Applied Behavior Analysis Treatment (ABA)", In-Network Prior Authorization = Yes) on the 2026 BH/HCBS Provider PA Request Guide, repeated across all lines of business (MMC/HARP, CHP, Essential Plan, QHP, Gold). This source does NOT break PA status out by individual CPT code — applying it to this specific code is inferred from the category-level finding, not a direct per-code statement. | Not stated for core Medicaid Managed Care. The Child Health Plus-specific benefit summary (Provider Manual Appendix XB) states an explicit "Applied Benefit Analysis (ABA) – limited to 680 hours/calendar year" — but the equivalent core-MMC appendix (XA) states no hour figure at all, so this cap likely does NOT apply to the mainstream Medicaid line. per calendar year (Child Health Plus line only, 680-hr cap); unverified for core Medicaid Managed Care | — | — | — |
| 97154 | Yes | Required — confirmed at the CATEGORY level ("CHILDREN Applied Behavior Analysis Treatment (ABA)", In-Network Prior Authorization = Yes) on the 2026 BH/HCBS Provider PA Request Guide, repeated across all lines of business (MMC/HARP, CHP, Essential Plan, QHP, Gold). This source does NOT break PA status out by individual CPT code — applying it to this specific code is inferred from the category-level finding, not a direct per-code statement. | Not stated for core Medicaid Managed Care. The Child Health Plus-specific benefit summary (Provider Manual Appendix XB) states an explicit "Applied Benefit Analysis (ABA) – limited to 680 hours/calendar year" — but the equivalent core-MMC appendix (XA) states no hour figure at all, so this cap likely does NOT apply to the mainstream Medicaid line. per calendar year (Child Health Plus line only, 680-hr cap); unverified for core Medicaid Managed Care | — | — | — |
| 97155 | Yes | Required — confirmed at the CATEGORY level ("CHILDREN Applied Behavior Analysis Treatment (ABA)", In-Network Prior Authorization = Yes) on the 2026 BH/HCBS Provider PA Request Guide, repeated across all lines of business (MMC/HARP, CHP, Essential Plan, QHP, Gold). This source does NOT break PA status out by individual CPT code — applying it to this specific code is inferred from the category-level finding, not a direct per-code statement. | Not stated for core Medicaid Managed Care. The Child Health Plus-specific benefit summary (Provider Manual Appendix XB) states an explicit "Applied Benefit Analysis (ABA) – limited to 680 hours/calendar year" — but the equivalent core-MMC appendix (XA) states no hour figure at all, so this cap likely does NOT apply to the mainstream Medicaid line. per calendar year (Child Health Plus line only, 680-hr cap); unverified for core Medicaid Managed Care | — | — | — |
| 97156 | Yes | Required — confirmed at the CATEGORY level ("CHILDREN Applied Behavior Analysis Treatment (ABA)", In-Network Prior Authorization = Yes) on the 2026 BH/HCBS Provider PA Request Guide, repeated across all lines of business (MMC/HARP, CHP, Essential Plan, QHP, Gold). This source does NOT break PA status out by individual CPT code — applying it to this specific code is inferred from the category-level finding, not a direct per-code statement. | Not stated for core Medicaid Managed Care. The Child Health Plus-specific benefit summary (Provider Manual Appendix XB) states an explicit "Applied Benefit Analysis (ABA) – limited to 680 hours/calendar year" — but the equivalent core-MMC appendix (XA) states no hour figure at all, so this cap likely does NOT apply to the mainstream Medicaid line. per calendar year (Child Health Plus line only, 680-hr cap); unverified for core Medicaid Managed Care | — | — | — |
| 97157 | Yes | Required — confirmed at the CATEGORY level ("CHILDREN Applied Behavior Analysis Treatment (ABA)", In-Network Prior Authorization = Yes) on the 2026 BH/HCBS Provider PA Request Guide, repeated across all lines of business (MMC/HARP, CHP, Essential Plan, QHP, Gold). This source does NOT break PA status out by individual CPT code — applying it to this specific code is inferred from the category-level finding, not a direct per-code statement. | Not stated for core Medicaid Managed Care. The Child Health Plus-specific benefit summary (Provider Manual Appendix XB) states an explicit "Applied Benefit Analysis (ABA) – limited to 680 hours/calendar year" — but the equivalent core-MMC appendix (XA) states no hour figure at all, so this cap likely does NOT apply to the mainstream Medicaid line. per calendar year (Child Health Plus line only, 680-hr cap); unverified for core Medicaid Managed Care | — | — | — |
| 97158 | Yes | Required — confirmed at the CATEGORY level ("CHILDREN Applied Behavior Analysis Treatment (ABA)", In-Network Prior Authorization = Yes) on the 2026 BH/HCBS Provider PA Request Guide, repeated across all lines of business (MMC/HARP, CHP, Essential Plan, QHP, Gold). This source does NOT break PA status out by individual CPT code — applying it to this specific code is inferred from the category-level finding, not a direct per-code statement. | Not stated for core Medicaid Managed Care. The Child Health Plus-specific benefit summary (Provider Manual Appendix XB) states an explicit "Applied Benefit Analysis (ABA) – limited to 680 hours/calendar year" — but the equivalent core-MMC appendix (XA) states no hour figure at all, so this cap likely does NOT apply to the mainstream Medicaid line. per calendar year (Child Health Plus line only, 680-hr cap); unverified for core Medicaid Managed Care | — | — | — |
| 0362T | — | — | — | — | — | — |
| 0373T | — | — | — | — | — | — |

Code notes:

- **97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158:** Authorization requests + clinical information submitted to MetroPlus CSS by email (metroplusaba@metroplus.org) or fax (212-908-5182), per the plan's 2023 benefit notice — not a portal workflow.

### Contacts

- **Provider services phone:** 1-800-303-9626
- **Hours:** Mon-Fri 8:00 a.m.-6:00 p.m. ET
- **Portal:** [MetroPlusHealth Provider Portal](https://providers.metroplus.org)

Questions to ask on a verification call:

- Does the 680-hour/calendar-year ABA cap (stated for Child Health Plus) also apply to core Medicaid Managed Care members, or is there no cap on that line?
- Is prior authorization required per individual ABA CPT code, or just at the category level?
- What POS settings are allowed for ABA, given the plan's coding crosswalk excludes ABA (APG-reimbursed) from its standard tables?
- Is ABA billable via telehealth, and if so what code/modifier applies?
- What billing modifiers does MetroPlus require for ABA claims?
- Which STC bucket does MetroPlus return ABA benefit detail under, and is the cost share a copay or coinsurance?
- Does MetroPlus support real-time 270/271 eligibility responses for payer ID 00659?

### VOB data sources

- https://pverify.com/wp-content/uploads/2026/06/pVeify-Payer-List-June-26.pdf (accessed 2026-07-23)
- https://essentials.availity.com/availity/documents/payer_list_wShortNames.pdf (accessed 2026-07-23)
- https://metroplus.org/wp-content/uploads/2025/04/PRV-25.047_MPH-2024-Provider-Manual-March-Updates_2025_FINAL.pdf (accessed 2026-07-23)
- https://www.caqh.org/sites/default/files/CAQH%20CORE%20Eligibility%20Benefits%20(270_271)%20Data%20Content%20Rule%20vEB2.0.pdf (accessed 2026-07-23)
- https://metroplus.org/wp-content/uploads/2026/05/2026_MH_BH_HCBS_Provider-PA-Request-Guide_-v1.2_C_FINAL.xlsx (accessed 2026-07-23)
- https://metroplus.org/wp-content/uploads/2024/08/PRV-24.075_MPH_2024-Provider-Manual_FINAL_081224.pdf (accessed 2026-07-23)
- https://metroplus.org/press/important-notice-to-our-applied-behavioral-analysis-aba-providers-regarding-2023-aba-benefit-changes/ (accessed 2026-07-23)
- https://metroplus.org/providers/join-our-network/contact-us/ (accessed 2026-07-23)

## Common questions

### Does MetroPlusHealth cover ABA therapy?

Yes — it carries the NY Medicaid ABA carve-in for NYC members under 21 with ASD/Rett, with authorization requests and clinical information submitted to MetroPlus CSS by email or fax.

### How often does the autism diagnosis need to be validated at MetroPlus?

Annually — MetroPlus requires the diagnosis be authenticated and re-validated every year by the member's treatment team, and holds that LBAs don't meet the practitioner level to do it. That's stricter than the state's 2-year referral rule.

### Is MetroPlus available outside New York City?

No — it's the NYC Health + Hospitals plan, with a New York City-only footprint.

## Primary sources

1. [MetroPlusHealth notice — 2023 ABA benefit changes](https://metroplus.org/press/important-notice-to-our-applied-behavioral-analysis-aba-providers-regarding-2023-aba-benefit-changes/)
2. [MetroPlus provider authorization page](https://metroplus.org/providers/provider-resources/provider-authorization/)
3. [eMedNY ABA Provider Policy Manual (state baseline)](https://www.emedny.org/ProviderManuals/ABA/PDFS/ABA_Policy.pdf)
4. [MetroPlusHealth Provider Manual (updated June 2026, PRV-26073), §7.12](https://metroplus.org/wp-content/uploads/2026/07/H0423_PRV26_3833_C-06162026-PRV-26073_Jun26-Provider-Manual_R8_UA.pdf)
5. [eMedNY Information for All Providers — General Policy (Version 2022-2)](https://www.emedny.org/ProviderManuals/AllProviders/PDFS/Information_for_All_Providers-General_Policy.pdf)
6. [NYS Medicaid Managed Care Model Contract (March 1, 2019), Appendix F §3 and §3.7](https://www.health.ny.gov/health_care/managed_care/docs/medicaid_managed_care_fhp_hiv-snp_model_contract.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.