---
title: Molina Healthcare of Florida ABA / BA coverage (MMA plan).
url: "https://carelu.com/payers/molina-healthcare-florida"
markdown_url: "https://carelu.com/payers/molina-healthcare-florida.md"
state: FL (Florida)
payer: Molina Healthcare of Florida
kind: Medicaid managed care plan (MCO)
parent_program: Florida Medicaid (AHCA)
description: "How Molina Healthcare of Florida administers the Medicaid Behavior Analysis benefit since the February 2025 carve-in — in-house UM on state criteria, the BA Quick Reference Guide, and which process specifics remain publicly unverifiable."
last_reviewed: September 2026
vob_data_updated: 2026-07-23
---

# Molina Healthcare of Florida ABA / BA coverage (MMA plan).

_Payer Guide · Molina Healthcare (FL) · Last updated September 2026 · 2 primary sources_

> Administers BA in-house on state criteria; a BA QRG exists, but specifics aren't publicly verifiable.

Molina Healthcare of Florida administers the Behavior Analysis benefit in-house — it published a carve-in notice ("Molina Healthcare Will Provide Behavior Analysis (BA) Services") and maintains a BA Quick Reference Guide with October 2025 and 2026 editions. Honesty about the limits of this guide: Molina's site blocks automated access, so it is the weakest-verified of Florida's nine plans here. No evidence of distinct clinical criteria surfaced, which means the reliable playbook is the state one — the AHCA policy binds Molina like every MMA plan, and plan-specific submission mechanics should be confirmed in the portal.

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 — the state BA policy requires PA on all BA services (CDE + documentation with requests); Molina-specific submission details are not publicly verifiable — use the plan's PA Code Lookup Tool and portal [2]
- **Prior auth for treatment**: Required — per the state policy; check Molina's Prior Authorization Code Lookup Tool for current specifics [2]
- **Autism diagnosis required?**: No — state BA policy applies: physician referral + order + CDE, no autism-diagnosis requirement [2]

## At a glance

- **Plan type:** SMMC MMA plan (Molina), in-house UM
- **Clinical rules:** AHCA BA Coverage Policy — no distinct Molina clinical criteria found
- **Prior auth:** Required for all BA per state policy; check Molina's PA Code Lookup Tool
- **Plan resources:** BA Quick Reference Guide (10/2025 and 2026 editions) — access-restricted
- **Verification note:** Molina blocks automated access — confirm specifics in the provider portal
- **Rates:** Contracted; state fee schedule baseline

## What's verified, and what to confirm in the portal

Verified: Molina administers BA in-house since the February 1, 2025 carve-in, maintains a BA Quick Reference Guide (updated October 2025, with a 2026 edition), and — like every MMA plan — must comply with the AHCA coverage policy without imposing more stringent limits. That gives you the dependable core: PA on all BA services with the CDE and required documentation, the referral + order gate with no autism-diagnosis requirement, Vineland-3/BASC-3 scoring reports, and up-to-6-month authorization periods. Not publicly verifiable (the plan's site blocks automated retrieval): the exact submission channel and forms. Molina's Prior Authorization Code Lookup Tool and provider portal are the authoritative sources for those — build the first Molina submission around a portal session, not this page. Turnaround is published in Molina’s 3/18/2026 Florida Medicaid manual: a standard determination “no later than contractual requirements or seven (7) calendar days after we receive the initial request for service,” and an expedited one “no later than contractual requirements or two (2) calendar days” (the AHCA contract sets 5 days standard, 2 expedited). [1][3][2]

## Intake gates

The questions that decide whether a family can start with Molina Healthcare of 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. The coverage policy binds every MMA plan and forbids more stringent service coverage limits than state policy, so Molina cannot narrow the window — which matters here because molinahealthcare.com returns HTTP 403 to automated retrieval and the plan’s BA Quick Reference Guide could not be read. [2]
- **Who may diagnose**: The state rule, which Molina cannot narrow: the referral comes from an independent physician or qualifying practitioner (PCP in family practice, internal medicine or pediatrics; a developmental-behavioral, neurodevelopmental, pediatric-neurology or adult/child-psychiatry specialist; or a child psychologist), and the CDE must be led by a licensed practitioner working within their medical, developmental or psychological scope of practice. [2]
- **Diagnostic tools required**: The state pair: 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 ages 2 through 18, with complete scoring reports attached to every prior-authorization request and re-administration every 12 months. [2]
- **Referral required?**: Required — the state gate applies: an independent physician referral, a physician’s order for BA services, and a Comprehensive Diagnostic Evaluation performed to national evidence-based practice standards, with prior authorization on all BA services. The submission channel and any Molina-specific form are not publicly verifiable; Molina’s Prior Authorization Code Lookup Tool and provider portal are the authoritative sources. Turnaround is published in Molina’s 3/18/2026 Florida Medicaid manual: a standard determination “no later than contractual requirements or seven (7) calendar days after we receive the initial request for service,” and an expedited one “no later than contractual requirements or two (2) calendar days” (the AHCA contract sets 5 days standard, 2 expedited). [2][1][3]
  - Ask the plan: Molina’s BA Quick Reference Guide and PA Code Lookup Tool in the provider portal — build the first Molina submission around a portal session.
- **Prior-auth decision time**: Molina’s March 2026 Florida manual: “For a standard authorization request, Molina makes the determination and provides notification no later than contractual requirements or seven (7) calendar days after we receive the initial request for service.” Expedited requests are decided “no later than contractual requirements or two (2) calendar days.” The contractual requirement is the AHCA clock of 5 days standard and 2 days expedited. Molina does not retroactively authorize services that need PA. No BA reauthorization lead time is published. [3][4]
- **Other insurance (who pays first)**: Molina’s manual: “Medicaid is always the payer of last resort … If third party liability can be established, Providers must bill the primary payer and submit a primary explanation of benefits (EOB) to Molina for secondary Claim processing.” Primary carrier payment information must be on the claim. Pay-and-chase exception: “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 ABA claims count as EPSDT preventive care for this purpose. 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][5]
  - Ask the plan: Molina Provider Services: whether an ABA claim for a child with commercial coverage can be paid first under the EPSDT exception, and whether Molina’s BA authorization is required when the commercial plan pays first.

## Delivery and billing rules

Coverage decides whether Molina Healthcare of 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, as specified in the supervision plan inside the approved behavior plan, which must name the authorized supervisors; Lead Analyst is a BCBA, FL-CBA or Ch. 490/491 licensee, a BCaBA works under a BCBA, and an RBT under a BCBA or BCaBA. No Molina supervision ratio is publicly verifiable. [2]
  - Ask the plan: Molina provider services / the BA Quick Reference Guide for anything the plan layers on top of the state standard.
- **Session-note signature**: The state rule: “session notes must be 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 are signed by the Lead Analyst and the parent or guardian. [2]
- **Place of service**: The state rule: a school-based request must include the IEP, or a 504 plan, or documentation naming the school and explaining that neither exists; 1:1 shadow, personal care assistance, companion and chaperone services are non-covered “regardless of activity or setting,” as are caregiver/childcare services and travel time; BA is non-covered on the same day as behavioral health overlay, therapeutic behavioral on-site, or therapeutic group care services. [2]
- **Bill as provider**: The state enrollment structure governs: a professional claim (837P / CMS-1500) under an individually enrolled rendering practitioner — Lead Analyst 392, BCaBA 391, RBT 390 — with 390s and 391s enrollable only as members of an enrolled BA group (393). Molina publishes no retrievable BA-specific billing-provider rule. [2]
  - Ask the plan: Molina’s BA Quick Reference Guide for any plan-specific claim-form or modifier instruction.
- **Concurrent billing (97153 + 97155)** _(ask the plan)_: The state rule is the floor: 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. No retrievable Molina BA reimbursement policy addresses the same-clock-time question. [2]
  - Ask the plan: Molina provider services — ask whether 97155 pays alongside 97153 when analyst, technician and member are all face-to-face.

## What intake should collect for Molina Healthcare of Florida

- **Referral + order + CDE:** The state eligibility gate applies; no autism diagnosis required.
- **Vineland-3 & BASC-3 scoring reports:** The state documentation stack applies to Molina requests.
- **Current QRG + PA lookup:** Pull the latest BA Quick Reference Guide and run the codes through Molina's PA lookup tool in the portal.
- **Submission channel:** Confirm portal vs. fax and any Molina-specific form directly with the plan — not publicly verifiable.

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

## Verification of benefits (VOB) data

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

### EDI routing

- **Payer ID (pVerify):** 00300
- **Payer ID (Availity):** 51062
- **Supports 270/271 eligibility:** Yes
- **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. These are the statewide AHCA BA Coverage Policy mechanics, binding on Molina Healthcare of Florida per the policy's plan-compliance clause (§1.2); Molina Healthcare 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 Molina Healthcare of Florida provider relations before quoting a family.
- **97152, 97156, 97158:** These are the statewide AHCA BA Coverage Policy mechanics, binding on Molina Healthcare of Florida per the policy's plan-compliance clause (§1.2); Molina Healthcare 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 Molina Healthcare 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). These are the statewide AHCA BA Coverage Policy mechanics, binding on Molina Healthcare of Florida per the policy's plan-compliance clause (§1.2); Molina Healthcare 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 Molina Healthcare of 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 Molina Healthcare of Florida per the policy's plan-compliance clause (§1.2); Molina Healthcare 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 Molina Healthcare 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 Molina Healthcare of Florida per the policy's plan-compliance clause (§1.2); Molina Healthcare 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 Molina Healthcare 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. Molina's own 213-page Medicaid Provider Handbook contains zero mentions of Behavior Analysis or any BA code — BA-specific rules live only in Molina's separate, access-restricted BA Quick Reference Guide, not reviewed this pass. These are the statewide AHCA BA Coverage Policy mechanics, binding on Molina Healthcare of Florida per the policy's plan-compliance clause (§1.2); Molina Healthcare 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 Molina Healthcare 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 Molina Healthcare of Florida per the policy's plan-compliance clause (§1.2); Molina Healthcare 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 Molina Healthcare 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 Molina Healthcare of Florida per the policy's plan-compliance clause (§1.2); Molina Healthcare 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 Molina Healthcare of Florida provider relations before quoting a family.

### Medicaid rates

Source: AHCA Behavior Analysis Fee Schedule (2025 and 2026 — rates identical across both years). No Molina-specific rate schedule is publicly posted — MCOs must not impose limits more stringent than this state schedule, which serves as the reference baseline (AHCA BA Coverage Policy §1.2). 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:** (855) 322-4076
- **Hours:** Monday–Friday, 8:00 a.m.–7:00 p.m.
- **Portal:** [Molina Healthcare of Florida Provider Portal](https://provider.molinahealthcare.com/provider/login)

Questions to ask on a verification call:

- What payer ID should we use for Change Healthcare eligibility checks, and do you support real-time 270/271 on Availity ID 51062?
- 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://pverify.com/wp-content/uploads/2026/03/pVerifyPayers_All-Payers-List-3-2026.pdf (accessed 2026-07-23)
- https://www.molinahealthcare.com/-/media/Molina/PublicWebsite/PDF/Providers/fl/medicaid/3-18-26-MHFL-Medicaid-Provider-Handbook-508.ashx (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)
- https://www.molinahealthcare.com/providers/fl/medicaid/contacts/contact_info.aspx (accessed 2026-07-23)

## Common questions

### Does Molina Healthcare of Florida cover ABA?

Yes — it administers the state Behavior Analysis benefit in-house since the February 2025 carve-in, on AHCA criteria: no autism diagnosis required, referral + order + CDE, PA on all BA services.

### Where are Molina's Florida BA rules published?

In its BA Quick Reference Guide (October 2025 / 2026 editions) and PA Code Lookup Tool — both access-restricted, so confirm current specifics in the Molina provider portal. Clinically, the AHCA coverage policy governs.

## Primary sources

1. [Molina FL — BA Quick Reference Guide 2026 (access-restricted)](https://www.molinahealthcare.com/providers/fl/medicaid/comm/-/media/D0605825716B47F8819AD3B554626A86.ashx)
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. [Molina Healthcare of Florida — Medicaid Provider Manual (3/18/2026)](https://www.molinahealthcare.com/-/media/Molina/PublicWebsite/PDF/Providers/fl/medicaid/3-18-26-MHFL-Medicaid-Provider-Handbook-508.ashx)
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.