---
title: Molina Healthcare of Arizona ABA coverage (AHCCCS plan).
url: "https://carelu.com/payers/molina-healthcare-arizona"
markdown_url: "https://carelu.com/payers/molina-healthcare-arizona.md"
state: AZ (Arizona)
payer: Molina Healthcare of Arizona
kind: Medicaid managed care plan (MCO)
parent_program: AHCCCS (Arizona Medicaid)
description: "How Molina Healthcare of Arizona handles AHCCCS ABA — the AMPM 320-S state baseline, the Prior Auth and Pre-Service Review Guide, Availity Essentials submission, and the three-county Phoenix-metro footprint."
last_reviewed: September 2026
vob_data_updated: 2026-07-23
---

# Molina Healthcare of Arizona ABA coverage (AHCCCS plan).

_Payer Guide · Molina Healthcare (AZ) · Last updated September 2026 · 6 primary sources_

> Smallest ACC footprint (3 Phoenix-metro counties); no published ABA policy — verify by phone.

Molina Healthcare of Arizona is the newest and smallest ACC plan — it entered with the 2022 ACC awards and covers three counties (Maricopa, Gila, Pinal), making it Phoenix-metro-centric. Like Banner and Health Choice, it publishes no distinct ABA clinical policy: the honest picture is the AMPM 320-S state baseline, with Molina's Prior Auth and Pre-Service Review Guide and its Healthcare Services line as the operational front door. Every ABA specific for this plan should be verified directly before quoting it to a family.

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

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment:** Not published / unverified. Verify via: The current Molina Prior Auth and Pre-Service Review Guide — read the 97151/97152 rows — or Healthcare Services at (844) 782-2678. [1][2]
- **Prior auth for treatment:** Not published / unverified. Verify via: The current Molina Prior Auth and Pre-Service Review Guide — read the 97153-97158 rows — or Healthcare Services at (844) 782-2678 / fax (833) 832-1015. [1]
- **Autism diagnosis required?**: No distinct plan policy published — AMPM 320-S baseline applies (autism dx not strictly required) [2][1]

## At a glance

- **Plan type:** ACC in Maricopa, Gila, Pinal (entered with the 2022 awards)
- **Clinical rules:** No distinct published ABA policy — AMPM 320-S baseline
- **PA initiation:** Healthcare Services (844) 782-2678 or fax (833) 832-1015
- **Portal:** Availity Essentials (encouraged for submissions)
- **Assessment/treatment PA:** Not published — verify against the current Prior Auth Guide
- **Rates:** Not published — AHCCCS physician fee schedule is the benchmark

## The state baseline, with plan mechanics to verify

Nothing we could verify shows Molina layering clinical criteria beyond AMPM 320-S — so the coverage conversation follows the state guide: no strict autism-diagnosis requirement, BHP-recommended services based on assessment, 6-month progress reports. The mechanics run through Molina's Prior Auth and Pre-Service Review Guide, with PA initiated via Healthcare Services at (844) 782-2678 or fax (833) 832-1015, and Availity Essentials as the encouraged submission portal. The guide's current ABA rows — including whether 97151/97152 need PA — are the thing to check on first contact, because none of it is published as a standing ABA rule. [1][2]

## Intake gates

The questions that decide whether a family can start with Molina Healthcare of Arizona, and what they have to bring.

- **Age limit**: Follows the AHCCCS rule — Molina publishes no distinct ABA clinical policy, only its Prior Auth and Pre-Service Review Guide: AMPM 320-S sets no age bound of its own. Behavior Analysis Services are covered "for individuals with Autism Spectrum Disorder (ASD) and/or other diagnoses as justified by medical necessity," and the policy applies across ACC, ALTCS E/PD, DCS/CMDP, DES/DDD, the RBHA contracts and fee-for-service programs without an age criterion. In practice children reach the benefit through EPSDT, and nothing in the policy text excludes adults — screen on medical necessity, not birthday. [2][1]
- **Diagnosis recency**: Follows the AHCCCS rule — Molina publishes no distinct ABA clinical policy, only its Prior Auth and Pre-Service Review Guide: None at the state level. AMPM 320-S imposes no recency clock on the diagnostic evaluation — and no autism diagnosis at all is strictly required. What must be current is the assessment: services are "prescribed or recommended in specific dosages, frequency, intensity, and duration by a qualified BHP as the result of an assessment of the member." Plan-level overlays can be stricter, so check the per-plan guide before telling a family an old evaluation still counts. [2][1]
- **Who may diagnose**: Follows the AHCCCS rule — Molina publishes no distinct ABA clinical policy, only its Prior Auth and Pre-Service Review Guide: AMPM 320-S gates on who recommends ABA, not on who diagnoses: services must be "prescribed or recommended... by a qualified BHP." A Behavioral Health Professional is defined as an individual licensed under A.R.S. Title 32, Chapter 33 whose scope allows independent behavioral health practice (or practice under direct supervision, except a licensed substance abuse technician); a psychiatrist (A.R.S. § 36-501); a psychologist (A.R.S. § 32-2061); a physician; a Behavior Analyst (A.R.S. § 32-2091); a registered nurse practitioner licensed as an adult psychiatric and mental health nurse; or a registered nurse with psychiatric-mental health certification or one year of behavioral health experience. [2][1]
- **Diagnostic tools required**: Follows the AHCCCS rule — Molina publishes no distinct ABA clinical policy, only its Prior Auth and Pre-Service Review Guide: No single instrument is mandated. "Behavior Analysis Services shall be based upon assessment(s) that include Standardized and/or Non-standardized instruments through both direct and indirect methods." Standardized examples named in the policy: the Pervasive Developmental Disabilities Behavior Inventory, the Brigance Inventory of Early Development and the Vineland Adaptive Behavior Scales. Non-standardized examples: curriculum-referenced assessments and stimulus preference assessment procedures. [2][1]
- **Referral required?**: Follows the AHCCCS rule — Molina publishes no distinct ABA clinical policy, only its Prior Auth and Pre-Service Review Guide: A prescription or recommendation from a qualified Behavioral Health Professional, based on an assessment of the member, is the referral — AMPM 320-S requires nothing else and sets no prior-authorization rules of its own, leaving PA to the Contractors. The two largest plans both skip PA on the assessment codes: Mercy Care states no PA is needed for 97151 and 97152, and Optum's Arizona orientation states "All ABA services require prior authorization except 97151 and 97152." [2][6][5][1]
- **Prior-auth decision time**: Molina’s April 2026 manual already runs the 7-day clock: "For a standard authorization request, Molina makes the determination and provides notification within seven (7) calendar days," outpatient standard pre-service "No later than 7 Calendar Days from the date the request was received", and expedited no later than 72 hours; behavioral health outpatient extensions add up to 14 calendar days from the extension notice. ABA is on Molina’s PA list; no reauth lead time is published. [7][1]
- **Other insurance (who pays first)**: "Medicaid is always the payer of last resort": bill the primary payer and submit its EOB to Molina for secondary processing, reimbursed under the state COB methodology. "Molina will pay claims for prenatal care and preventive pediatric care (EPSDT) and then seek reimbursement from third parties." The manual does not say whether Molina’s own PA is needed when it is secondary; AHCCCS policy (ACOM 434) bars a secondary PA only when the other insurer approved the service as medically necessary. Under federal rules TRICARE pays before Medicaid, and CHAMPVA pays first when the child is also Medicaid-eligible. [7][8][9][10]

## Delivery and billing rules

Coverage decides whether Molina Healthcare of Arizona pays. These decide whether the claim survives: staffing and supervision, concurrent billing, per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.

- **Supervision**: Follows the AHCCCS rule — Molina publishes no distinct ABA clinical policy, only its Prior Auth and Pre-Service Review Guide: A duty with no number attached. "Behavior Analysis Services shall be directed and overseen by Behavior Analysts and supported, where applicable, by Behavior Analysis Trainees and/or Behavior Technicians." The Behavior Analyst "is responsible for all aspects of clinical direction, supervision, and provider-level case management," for training Trainees and Technicians, for ensuring that "the extent, kind, and quality" of what they deliver matches their training and experience, and for their compliance with the policy and A.R.S. § 32-2091. A Behavior Analysis Trainee needs "direct and ongoing supervision consistent with the standards set by a nationally recognized Behavior Analyst certification board." AMPM 320-S publishes no supervision percentage and no caseload cap, so for RBT-credentialed staff the BACB floor is the operative number. [2][1]
- **Bill as provider**: Follows the AHCCCS rule — Molina publishes no distinct ABA clinical policy, only its Prior Auth and Pre-Service Review Guide: The claim line has to say who actually delivered the service. AHCCCS pays credential-tiered rates through modifiers — HM below bachelor's (technician level), HN bachelor's, HO master's, HP doctoral — and AMPM 320-S points to the Behavioral Health Services Billing Matrix for "modifiers for Behavior Analysis Trainee billing." Whose NPI goes in the rendering field is set per Contractor: UnitedHealthcare Community Plan, for instance, requires the rendering provider's 10-digit NPI in box 24J, "must be an active AHCCCS registered provider (The rendering provider is the BCBA/Licensed Clinician)." [2][4][5][1]
- **Concurrent billing (97153 + 97155):** Not published / unverified. Verify via: Molina Healthcare Services at (844) 782-2678 or fax (833) 832-1015, and the current Prior Auth and Pre-Service Review Guide. [2][1]

## What intake should collect for Molina Healthcare of Arizona

- **Diagnosis (any qualifying):** AMPM 320-S baseline — ASD or another diagnosis justified by medical necessity.
- **Current Prior Auth Guide rows:** Verify the ABA code rows (97151–97158) in the live guide, or via (844) 782-2678, before promising timelines.
- **County:** Molina only operates in Maricopa, Gila, and Pinal — outside those, the card is another plan's.
- **Availity access:** Molina encourages Availity Essentials — have the workflow ready rather than defaulting to fax.

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

## Verification of benefits (VOB) data

How Molina Healthcare of Arizona ABA benefits route and read on an eligibility check. Data last updated 2026-07-23.

### EDI routing

- **Payer ID (pVerify):** 00847 — pVerify 00847 = "MOLINA COMPLETE CARE OF ARIZONA MEDICAID" (Elig Y).
- **Supports 270/271 eligibility:** Yes
- **Behavioral health administrator:** none (integrated — Molina Complete Care of AZ)
- **ABA rides on:** medical benefit
- **Two-hop verification required:** No

### Code-level coverage

| Code | Covered | Prior auth | Unit cap | Place of service | Telehealth | Modifiers |
| --- | --- | --- | --- | --- | --- | --- |
| 97151 | Yes | — | — | office/clinic, home (POS 12 — pays a ~10–11.5% premium on the AHCCCS schedule), school, community, telehealth (modality allowed under AMPM 320-S; ABA-specific POS/modifier not itemized) | — | HM (below bachelor's / BT-RBT), HN (bachelor's / BCaBA), HO (master's / BCBA), HP (doctoral / BCBA-D) |
| 97152 | Yes | — | — | office/clinic, home (POS 12 — pays a ~10–11.5% premium on the AHCCCS schedule), school, community, telehealth (modality allowed under AMPM 320-S; ABA-specific POS/modifier not itemized) | — | HM (below bachelor's / BT-RBT), HN (bachelor's / BCaBA), HO (master's / BCBA), HP (doctoral / BCBA-D) |
| 97153 | Yes | — | — | office/clinic, home (POS 12 — pays a ~10–11.5% premium on the AHCCCS schedule), school, community, telehealth (modality allowed under AMPM 320-S; ABA-specific POS/modifier not itemized) | — | HM (below bachelor's / BT-RBT), HN (bachelor's / BCaBA), HO (master's / BCBA), HP (doctoral / BCBA-D) |
| 97154 | Yes | — | — | office/clinic, home (POS 12 — pays a ~10–11.5% premium on the AHCCCS schedule), school, community, telehealth (modality allowed under AMPM 320-S; ABA-specific POS/modifier not itemized) | — | HM (below bachelor's / BT-RBT), HN (bachelor's / BCaBA), HO (master's / BCBA), HP (doctoral / BCBA-D) |
| 97155 | Yes | — | — | office/clinic, home (POS 12 — pays a ~10–11.5% premium on the AHCCCS schedule), school, community, telehealth (modality allowed under AMPM 320-S; ABA-specific POS/modifier not itemized) | — | HM (below bachelor's / BT-RBT), HN (bachelor's / BCaBA), HO (master's / BCBA), HP (doctoral / BCBA-D) |
| 97156 | Yes | — | — | office/clinic, home (POS 12 — pays a ~10–11.5% premium on the AHCCCS schedule), school, community, telehealth (modality allowed under AMPM 320-S; ABA-specific POS/modifier not itemized) | — | HM (below bachelor's / BT-RBT), HN (bachelor's / BCaBA), HO (master's / BCBA), HP (doctoral / BCBA-D) |
| 97157 | Yes | — | — | office/clinic, home (POS 12 — pays a ~10–11.5% premium on the AHCCCS schedule), school, community, telehealth (modality allowed under AMPM 320-S; ABA-specific POS/modifier not itemized) | — | HM (below bachelor's / BT-RBT), HN (bachelor's / BCaBA), HO (master's / BCBA), HP (doctoral / BCBA-D) |
| 97158 | Yes | — | — | office/clinic, home (POS 12 — pays a ~10–11.5% premium on the AHCCCS schedule), school, community, telehealth (modality allowed under AMPM 320-S; ABA-specific POS/modifier not itemized) | — | HM (below bachelor's / BT-RBT), HN (bachelor's / BCaBA), HO (master's / BCBA), HP (doctoral / BCBA-D) |
| 0362T | Yes | — | — | office/clinic, home (POS 12 — pays a ~10–11.5% premium on the AHCCCS schedule), school, community, telehealth (modality allowed under AMPM 320-S; ABA-specific POS/modifier not itemized) | — | HM (below bachelor's / BT-RBT), HN (bachelor's / BCaBA), HO (master's / BCBA), HP (doctoral / BCBA-D) |
| 0373T | Yes | — | — | office/clinic, home (POS 12 — pays a ~10–11.5% premium on the AHCCCS schedule), school, community, telehealth (modality allowed under AMPM 320-S; ABA-specific POS/modifier not itemized) | — | HM (below bachelor's / BT-RBT), HN (bachelor's / BCaBA), HO (master's / BCBA), HP (doctoral / BCBA-D) |

Code notes:

- **97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, 0362T, 0373T:** Molina publishes no distinct AZ ABA policy — its Prior Auth and Pre-Service Review Guide (Healthcare Services (844) 782-2678 / fax (833) 832-1015; Availity Essentials) is the operational front door; verify the ABA code rows before booking. AMPM 320-S covers ASD "and/or other diagnoses as justified by medical necessity" — no strict autism-dx requirement. Per-code daily unit caps are not published (AzCH uses hour bands, not caps).

### Medicaid rates

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

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

### Contacts

- **Provider services phone:** (800) 424-5891 (Provider Customer Service; also prior authorizations incl. behavioral health)
- **Portal:** [Availity (Molina Complete Care of AZ Provider Portal)](https://www.availity.com/molinacompletecare)
- **Fax:** (888) 656-7501 outpatient / (888) 656-2201 inpatient

Questions to ask on a verification call:

- Does 97151/97152 need prior authorization for this member, since Molina hasn’t published a standing ABA rule?
- What’s the current unit/hour cap for 97153–97158, 0362T, and 0373T?
- Is telehealth allowed for ABA codes, and what modifier is required?
- What POS codes do you accept for ABA billing?

### VOB data sources

- https://pverify.com/wp-content/uploads/2026/03/pVerifyPayers_All-Payers-List-3-2026.pdf (accessed 2026-07-23)
- https://www.molinahealthcare.com/providers/az/medicaid/resource/edi.aspx (accessed 2026-07-23)
- https://essentials.availity.com/availity/documents/payer_list_wShortNames.pdf (accessed 2026-07-23; source document older than 18 months)
- https://www.azahcccs.gov/Resources/Downloads/EDIchanges/AZ270_271_CG.pdf (accessed 2026-07-23)
- https://www.molinahealthcare.com/-/media/Molina/PublicWebsite/PDF/Providers/az/Forms/MHAZ-Prior-Auth-and-Pre-Service-Review-Guide-508.pdf (accessed 2026-07-23)
- https://www.azahcccs.gov/shared/Downloads/MedicalPolicyManual/300/320S.pdf (accessed 2026-07-23)
- https://www.azahcccs.gov/AHCCCS/Downloads/PublicNotices/rates/FinalPublicNotice_RateChanges_20231101_ABA.pdf (accessed 2026-07-23)
- https://azahcccs.gov/PlansProviders/Downloads/FFSrates/ABA/FY26_Final_ABA_FeeSchedule.xlsx (accessed 2026-07-23)

## Common questions

### Does Molina Healthcare of Arizona cover ABA?

Yes — as an AHCCCS ACC plan on the AMPM 320-S baseline. Molina publishes no distinct ABA clinical policy; PA mechanics run through its Prior Auth and Pre-Service Review Guide and Availity Essentials.

### Does Molina require PA for ABA in Arizona?

Its code-level ABA PA rules aren't published as a standing rule — verify against the current Prior Auth Guide or call Healthcare Services at (844) 782-2678 before booking.

### Where does Molina operate in Arizona?

Three counties: Maricopa, Gila, and Pinal — the smallest ACC footprint, centered on Phoenix metro.

## Primary sources

1. [Molina Healthcare of Arizona — Prior Auth and Pre-Service Review Guide](https://www.molinahealthcare.com/-/media/Molina/PublicWebsite/PDF/Providers/az/Forms/MHAZ-Prior-Auth-and-Pre-Service-Review-Guide-508.pdf)
2. [AMPM 320-S — Behavior Analysis Services (AHCCCS)](https://www.azahcccs.gov/shared/Downloads/MedicalPolicyManual/300/320S.pdf)
3. [AHCCCS — Available Health Plans list](https://www.azahcccs.gov/Members/Downloads/Resources/ENGLISH_HealthPlanList.pdf)
4. [AHCCCS — Final Public Notice, FFS rate changes 11/1/2023 (ABA codes)](https://www.azahcccs.gov/AHCCCS/Downloads/PublicNotices/rates/FinalPublicNotice_RateChanges_20231101_ABA.pdf)
5. [Optum — Arizona AHCCCS Autism/ABA Program provider orientation (BH4129)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/autismABA/azaba/azABA_Provider_Orient.pdf)
6. [Mercy Care — Applied Behavior Analysis provider page](https://www.mercycareaz.org/providers/applied-behavior-analysis.html)
7. [Molina Healthcare of Arizona — Medicaid 2026 Provider Manual (updated April 2026)](https://www.molinahealthcare.com/-/media/Molina/PublicWebsite/MHAZ-Medicaid-2026%20Provider-Manual-508.pdf)
8. [AHCCCS ACOM 434 — Coordination of Benefits and Third-Party Liability (eff. 5/2/2025)](https://www.azahcccs.gov/shared/Downloads/ACOM/PolicyFiles/400/434.pdf)
9. [32 CFR 199.8 — TRICARE double coverage (secondary to other plans, primary to Medicaid)](https://www.ecfr.gov/current/title-32/subtitle-A/chapter-VII/subchapter-M/part-199/section-199.8)
10. [VA — CHAMPVA Guidebook (updated 1/1/2025), CHAMPVA as secondary payer](https://www.va.gov/files/2025-12/CHAMPVA-Guidebook.pdf)

Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed September 2026; it is general information, not billing, legal, or clinical advice. Always verify current requirements against the payer's live policy and a benefits check for the specific member.

Source: Carelu ABA Payer Directory — https://carelu.com/payers. Free to cite with attribution.