---
title: "TennCare Select ABA coverage (TennCare's statewide PIHP)."
url: "https://carelu.com/payers/tenncare-select"
markdown_url: "https://carelu.com/payers/tenncare-select.md"
state: TN (Tennessee)
payer: TennCare Select
kind: Medicaid managed care plan (MCO)
parent_program: TennCare
description: "How TennCare Select — the statewide PIHP run by Volunteer State Health Plan/BlueCare Tennessee for SSI children, foster youth, and IDD/CHOICES members — administers ABA: its own state contract, 37,095-member census, shared tri-MCO clinical rules, and Select-specific phone/fax lines."
last_reviewed: September 2026
vob_data_updated: 2026-07-23
---

# TennCare Select ABA coverage (TennCare's statewide PIHP).

_Payer Guide · TennCare Select · Last updated September 2026 · 11 primary sources_

> Statewide PIHP (VSHP) — separate contract from BlueCare; SSI kids, foster youth, IDD/CHOICES. 37,095 members.

TennCare Select is not a fourth TennCare MCO alongside BlueCare, UnitedHealthcare Community Plan, and Wellpoint — it's a separate state contract. TennCare Select operates as a Prepaid Inpatient Health Plan (PIHP) under its own agreement between the Division of TennCare and Volunteer State Health Plan, Inc. (d/b/a BlueCare Tennessee) — a distinct Edison contract ID from BlueCare's own MCO contract, even though both are run by the same BlueCross BlueShield of Tennessee subsidiary. Members don't choose TennCare Select; TennCare assigns them to it because they fall into specific categories — children receiving SSI, children in DCS (foster care) custody, enrollees in intellectual-disability HCBS waivers, and a handful of statewide safety-net groups. For ABA, the clinical rules are the same shared tri-MCO program covered in our main TennCare guide — what's different here is the population TennCare Select serves and the phone/fax/contact structure built around it.

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

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Required — shared tri-MCO universal ABA request form; submit via Availity (in-state) or Cohere (out-of-state) [8][6]
- **Prior auth for treatment**: Required — 26-week (6-month) authorization periods; continuation reports severity level and hours used [7][11]
- **Autism diagnosis required?**: ASD or another qualifying DSM-5-TR diagnosis — not strictly autism-only (shared TennCare baseline) [11][6]

## At a glance

- **Structure:** Statewide PIHP — separate state contract from BlueCare's MCO contract, both run by VSHP/BCBST
- **Enrollment:** 37,095 average monthly members (CY2024, TennCare's CMS-submitted MCPAR) — 2.5% of TennCare
- **Who's assigned here:** SSI children, DCS custody/foster youth ("SelectKids"), IDD 1915(c)/CHOICES waiver members, out-of-state and safety-net enrollees
- **TennCare Select-only programs:** SelectCommunity (IDD Target Population) and Katie Beckett Part A
- **ABA clinical rules:** Shared tri-MCO program description — same as BlueCare, UHC, Wellpoint
- **Prior auth:** Required — universal ABA request form via Availity or Cohere (out-of-state)
- **Provider Service Line:** 1-800-276-1978 (distinct from BlueCare's 1-800-468-9736)

## A separate contract, the same clinical rules

The state's own contract text describes it plainly: "The Contractor shall operate under and market the services delivered via the prepaid Inpatient Health Plan (PIHP) as 'TennCare Select.'" That PIHP agreement (Edison Contract ID 83332, term 1/1/2025–12/31/2027) is separate from BlueCare Tennessee's standard MCO contract, though both sit with Volunteer State Health Plan. BlueCare Tennessee's own Provider Administration Manual confirms the setup: "TennCareSelect is the State's self-insured TennCare Health Maintenance Organization... administered by BlueCare Tennessee... Enrollees cannot choose TennCareSelect as their TennCare MCO; TennCare members assigned to the TennCareSelect MCO must meet certain criteria and must be assigned to the TennCareSelect MCO by the Division of TennCare." For ABA specifically, the same PAM section covers both BlueCare and TennCareSelect members under one shared policy — the same CPT codes (97151–97155, 0362T, 0373T), the same RBT/BCaBA/BCBA billing structure, and the same tri-MCO baseline (26-week authorization periods, severity-level justification, no fixed annual hour cap) that governs the rest of TennCare. Practically: if a family is on TennCare Select, plan clinically exactly as you would for BlueCare — the differences that matter are contact numbers and, for a subset of members, LTSS-specific programs. This structure is independently confirmed in the generic TennCare MCO Statewide Contract template (now current through Amendment 25, effective July 1, 2026, per its own cover page), which defines TennCare Select as a statewide backup MCO whose risk the State of Tennessee backs — created for MCO failure/inadequate-capacity scenarios and as the assigned plan for children in state custody and SSI-eligible children (who may opt out). [1][9][2]

## Who ends up on TennCare Select

TennCare assigns — rather than lets members pick — enrollees who fall into defined categories: children under 21 who are SSI-eligible; children in DCS (foster care) custody and those transitioning out of custody (branded "SelectKids"); enrollees receiving services in an institution or an HCBS 1915(c) waiver for intellectual disabilities; enrollees living out-of-state; enrollees TennCare couldn't contact; and members of the "Integrated Health Services Delivery Model" target population for intellectual disabilities, branded "SelectCommunity" — largely 1915(c) waiver enrollees and former ICF/IID ("Arlington class") residents. TennCare Select is also the sole administrator of the Katie Beckett Program Part A (non-Medicaid-eligible-by-income children with significant disabilities up to 18). For an ABA intake team, the practical read is: TennCare Select skews toward higher-acuity, higher-support-need members — foster youth, IDD/CHOICES populations, and SSI kids — more than a random cross-section of TennCare. [2]

## Census: 37,095 members

TennCare's own Managed Care Program Annual Report (MCPAR), submitted to CMS on 6/29/2025 for reporting period CY2024, lists average monthly enrollment across TennCare's four managed-care products: Wellpoint Tennessee 438,735; BlueCare Tennessee 552,517; UnitedHealthcare Community Plan 439,049; and TennCare Select 37,095 — about 2.5% of statewide TennCare enrollment. That's the most current figure independently confirmed against a primary source; TennCare also publishes monthly enrollment spreadsheets that may carry a more current number, but those weren't retrievable during this review — treat 37,095 as the latest verified figure, not necessarily the latest available one. [3]

## Submission mechanics and TennCare Select-specific contacts

ABA requests use the shared tri-MCO universal request form, submitted through Availity for in-state providers or Cohere for out-of-state providers; PA questions route to (423) 535-5717, option 2. Two BCBST-hosted ABA forms — an "ABA Therapy Services Assessment Request Form" and an "Initiation and Continuation of ABA Therapy Form" (the latter confirming the 26-week/6-month certification period and a severity-level 1–3 field) — surfaced in this review, consistent with the tri-MCO baseline, but neither form's text explicitly labels itself TennCare Select-specific versus a general BCBST form; confirm the exact required form with BlueCare/TennCare Select provider relations before submitting. What is confirmed distinct is the contact structure: TennCare Select runs its own Member Service Line (1-800-263-5479, vs. BlueCare's 1-800-468-9698), Provider Service Line (1-800-276-1978, vs. 1-800-468-9736), and Prior Auth phone (1-800-711-4104, vs. BlueCare's 1-888-423-0131) — though the PA fax (1-800-292-5311) is shared with BlueCare. SelectKids (the foster-care population) carries its own further layer: Provider/Family Services at 1-800-451-9147 (fax 1-800-330-2842) and Member Services at 1-888-422-2963. SelectCommunity (the IDD population) has its own line, 1-800-292-8196 (fax 1-888-255-9175). [2][6][7]

## CHOICES, ECF CHOICES, and background-check screening

TennCare Select is the exclusive administrator of SelectCommunity and Katie Beckett Part A, and shares CHOICES/ECF CHOICES LTSS administration with BlueCare — the MLTSS Provider Manual states plainly that "all BlueCare/TennCare Select billing guidelines apply" for these populations. That matters for staffing: TennCare's Aligned Background Check Protocol (effective July 1, 2024) governs providers serving 1915(c) waiver, Katie Beckett, Employment and Community First CHOICES, and CHOICES members — criminal background checks plus registry screening (TN Abuse Registry, National/TN Sex Offender Registry, LEIE, SAM, TennCare Terminated Provider List) within 30 days before first contact, monthly SAM/LEIE/TTPL rechecks. The protocol document itself refers generically to "Managed Care Organizations" rather than naming TennCare Select, but because TennCare Select administers exactly these programs, any ABA agency serving a TennCare Select family through SelectCommunity, ECF CHOICES, or Katie Beckett falls under it — the same guidance our main TennCare guide gives: if you serve Katie Beckett or CHOICES children, run the full protocol for everyone rather than trying to split by plan. [4][5]

## Intake gates

The questions that decide whether a family can start with TennCare Select, and what they have to bring.

- **Age limit**: Follows the TennCare rule: EPSDT covers “children from birth through age 20 who have TennCare,” and the shared tri-MCO program description sets no age of its own. TennCare Select’s population skews younger and higher-acuity — SSI children under 21, DCS custody youth, Katie Beckett Part A children up to 18 — but the ABA age boundary is the state’s. [10][11][2]
- **Diagnosis recency**: Follows the TennCare rule: no recency limit on the ASD diagnosis, with updated evaluation of functioning by standardized tools expected at least every two years, and 26-week (six-month) certification periods. The BCBST forms that serve TennCare Select members ask for “Initial/First Date ASD Diagnosed” and the DSM severity level (1–3) without capping the report’s age; continuation requests “must be submitted at least once every six months.” [11][7]
- **Who may diagnose**: Follows the TennCare rule — the diagnosis must come from “a qualified health professional, practicing within their scope, with training in assessment of individuals with ASD and/or other neurodevelopmental concerns,” with a TN-licensed clinician documenting medical necessity. No TennCare Select-specific diagnostician rule exists; the BCBST forms ask only for diagnostic confirmation and severity level. [11][6]
- **Diagnostic tools required**: Follows the TennCare rule: no named instrument, but the diagnosis must be validated by a documented comprehensive assessment against DSM-5-TR criteria, and the ABA assessment must include direct observation, file review, informant interviews and standardized assessments across cognition, communication, social, adaptive and behavioral domains. BCBST’s forms capture severity level and measurable goals rather than a required test battery. [11][7]
- **Referral required?**: Follows the TennCare rule — the assessment request needs the diagnostic report plus a doctor’s order; the BCBST forms ask for “diagnostic confirmation like diagnostic reports, doctor’s orders, etc.” TennCare Select-specific mechanics: Tennessee providers submit in Availity, out-of-state providers through Cohere, and PA questions route to (423) 535-5717, option 2, with TennCare Select’s own prior-auth line at 1-800-711-4104 (fax 1-800-292-5311 is shared with BlueCare). [6][7][11]
- **Telehealth**: Follows the TennCare rule: telehealth hours are requested per code on the universal tri-MCO form, which carries a telehealth checkbox on every ABA code row and lists Telehealth among the places of service. No TennCare Select-specific ABA telehealth policy was located — the BCBST forms collect proposed service locations without a telehealth rule of their own — so the shared program description’s appropriateness, HIPAA and competence cautions govern. [8][11][6]
- **Prior-auth decision time**: TennCareSelect is administered by BlueCare Tennessee, and the shared July 2026 BlueCare Tennessee manual governs it: for a standard request, BlueCare "will provide notice as expeditiously as the member's condition requests and within State-established timeframes that may not exceed 7 calendar days following the receipt of the request for service." It may add "up to 14 additional calendar days" if the member or provider asks, or if BlueCare justifies needing more information. Expedited requests are decided "no later than 72 hours after the receipt of the request for service." That 72 hours can also stretch by up to 14 days on the same grounds. The clock runs from receipt. BlueCare's ABA form says continuation requests "must be submitted at least once every six months" (26-week periods) but sets no lead time before expiry. [2][9][7]
- **Other insurance (who pays first)**: Other coverage is routine on TennCareSelect. Children in Katie Beckett Part A "must have a primary payer or third-party liability (TPL) that will be their first payor with Medicaid paying secondary," and TennCareSelect is their plan. BlueCare, TennCareSelect and CoverKids "are always the payers of last resort." Bill the commercial plan first. The secondary claim must carry "the primary payer's explanation of benefits" and must be "received within 120 days from the date the primary insurer's remittance was produced." BlueCare pays only the gap up to its own allowed amount: if the other carrier paid at or above BlueCare's allowable, "BCT will make no additional reimbursement." Pay-and-chase exception: claims for "TennCare Kids," "Preventive pediatric care," all CoverKids members under 21, and absent-parent insurance "will not be denied for a primary carrier's EOB." BlueCare pays and recovers from the other plan, though the manual notes billing the other carrier first earns "the higher reimbursement rate." The manual does not say whether an ABA claim counts as "TennCare Kids." It also says to seek the primary insurer's prior authorization first only when BlueCare is secondary to Medicare. It is silent on a commercial primary. The TennCare contract lets the MCO deny a claim the primary denied for "failure to obtain prior authorization." Get the commercial PA, and confirm with BlueCare whether its own ABA PA is still needed. TRICARE by statute pays only after other coverage "except in the case of a plan administered under title XIX" (Medicaid), so TRICARE goes before TennCare. CHAMPVA is the reverse: "If you are eligible under Medicaid, CHAMPVA will pay first." [2][9][12][13]
  - Ask the plan: BlueCare Tennessee Provider Service / UM (Availity) — ask whether an ABA claim falls under the "TennCare Kids" pay-and-chase line, and whether TennCareSelect wants its own ABA authorization when a commercial plan is primary.

## Delivery and billing rules

Coverage decides whether TennCare Select 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 TennCare rule: direct ABA must be delivered or supervised by a TN Licensed Behavior Analyst (or a health professional permissible under TN law), unlicensed persons work under the LBA’s extended authority and direction, and RBTs with their supervising BCBAs must meet all current BACB supervision requirements — the operative floor being 5% of monthly service hours with two face-to-face contacts. One TennCare Select-specific staffing overlay matters more than the ratio: members in CHOICES, ECF CHOICES, 1915(c) waivers or Katie Beckett trigger TennCare’s Aligned Background Check Protocol for every employee with direct member contact. [11][2]
- **Daily limits / MUEs**: No per-day ceiling and no annual benefit limit. Authorizations run 26 weeks and the BCBST initiation/continuation form asks for hours per week by code plus a clinical justification for any increase and, “if concurrent,” hours approved versus hours used in the last authorization period — the same sub-90% utilization discipline the whole program applies to 97153. Group sizes are capped as best practice at six to eight participants. [7][11]
- **Place of service**: Follows the TennCare rule — Clinic, Home, Community, School, Telehealth and Other are all requestable, and medically necessary school-based behavioral health services need not be in an IEP to be reimbursable; IEP services and functioning as an educational aide stay non-covered. BCBST’s assessment form asks providers to state the “proposed location(s)” where ABA will be delivered, so setting is authorized rather than assumed. [11][8][6]
- **Bill as provider**: Follows the TennCare rule — the claim rides on the group or servicing provider, with practitioner level carried as a modifier (HO analyst-delivered, HM technician-delivered, 97153 split). BlueCare’s Provider Administration Manual covers BlueCare and TennCareSelect members under one shared ABA policy with the same codes (97151–97155, 0362T, 0373T) and the same RBT/BCaBA/BCBA billing structure, and the BCBST forms collect “Provider ID, NPI Number, or Tax ID.” Rates are contract-negotiated. [2][8][7]
- **Concurrent billing (97153 + 97155)** _(ask the plan)_: Not answered for 97153 with 97155. The shared program description bars only more than one licensed analyst serving a member during a specific time interval and ABA delivered simultaneously with OT, speech, PT or psychotherapy; BlueCare’s own form states the converse for scheduling — “the hours per week authorized aren’t inclusive of other services being provided.” [11][7]
  - Ask the plan: TennCare Select prior auth 1-800-711-4104 or (423) 535-5717 option 2, and the BlueCare Tennessee Provider Administration Manual’s ABA and claim-editing sections.

## What intake should collect for TennCare Select

- **Confirm TennCare Select vs. BlueCare:** Both are run by the same BCBST/VSHP entity — check the card or portal for which contract the member is actually on; contact numbers differ.
- **Program sub-type if applicable:** SelectKids (foster care), SelectCommunity (IDD/1915c), or Katie Beckett Part A each carry their own dedicated contact lines.
- **Diagnostic report + doctor's order:** Same shared tri-MCO baseline as BlueCare — required for the assessment PA.
- **LBA licensure:** Confirm the supervising/rendering analyst holds a Tennessee LBA license, per the shared TennCare program description.
- **Background-check applicability:** CHOICES/ECF CHOICES/Katie Beckett members trigger TennCare's Aligned Background Check Protocol — confirm program sub-type at intake.

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

## Verification of benefits (VOB) data

How TennCare Select ABA benefits route and read on an eligibility check. Data last updated 2026-07-23.

### EDI routing

- **Supports 270/271 eligibility:** Yes
- **Behavioral health administrator:** none — in-house (same finding as bluecare-tennessee): TennCare Select's ABA benefit is administered directly by Volunteer State Health Plan/BlueCare Tennessee under the SAME shared tri-MCO Provider Administration Manual policy that covers BlueCare — no external BH vendor (Carelon/Optum/Magellan) named
- **BH administrator payer ID:** N/A
- **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 — Universal Request for ABA form (assessment + treatment) | No fixed numeric cap published — "Units Per Week"/"Units per Authorization period" are blank fields on the Universal Request form, justified via the severity/unit guide (levels 1-3 across communication, social, behavior, and adaptive domains) per 26 weeks (6 months) per authorization period | clinic, home, community, school, telehealth | BlueCare's general (not ABA-code-specific) telehealth billing policy (eff. 10/1/2024) requires POS 10 (patient's home) or POS 02 (elsewhere) — POS 03 for school-based, POS 50/72 for RHC/FQHC — with modifiers GT, 93, 95, G0, GQ, FQ, or FR "for informational purposes." Whether this code is on BlueCare's separately-published "Telehealth Approved Code List" (referenced but not included in the manual read this pass) is not directly confirmed. | HO |
| 97152 | Yes | Required — Universal Request for ABA form (assessment + treatment) | No fixed numeric cap published — "Units Per Week"/"Units per Authorization period" are blank fields on the Universal Request form, justified via the severity/unit guide (levels 1-3 across communication, social, behavior, and adaptive domains) per 26 weeks (6 months) per authorization period | clinic, home, community, school, telehealth | BlueCare's general (not ABA-code-specific) telehealth billing policy (eff. 10/1/2024) requires POS 10 (patient's home) or POS 02 (elsewhere) — POS 03 for school-based, POS 50/72 for RHC/FQHC — with modifiers GT, 93, 95, G0, GQ, FQ, or FR "for informational purposes." Whether this code is on BlueCare's separately-published "Telehealth Approved Code List" (referenced but not included in the manual read this pass) is not directly confirmed. | HM |
| 97153 | Yes | Required — Universal Request for ABA form (assessment + treatment) | No fixed numeric cap published — "Units Per Week"/"Units per Authorization period" are blank fields on the Universal Request form, justified via the severity/unit guide (levels 1-3 across communication, social, behavior, and adaptive domains) per 26 weeks (6 months) per authorization period | clinic, home, community, school, telehealth | BlueCare's general (not ABA-code-specific) telehealth billing policy (eff. 10/1/2024) requires POS 10 (patient's home) or POS 02 (elsewhere) — POS 03 for school-based, POS 50/72 for RHC/FQHC — with modifiers GT, 93, 95, G0, GQ, FQ, or FR "for informational purposes." Whether this code is on BlueCare's separately-published "Telehealth Approved Code List" (referenced but not included in the manual read this pass) is not directly confirmed. | HO (BCBA/LBA-delivered — billed "97153HO" per BlueCare's Provider Administration Manual, eff. DOS 9/1/2019+), HM (RBT/technician-delivered) |
| 97154 | Yes | Required — Universal Request for ABA form (assessment + treatment) | No fixed numeric cap published — "Units Per Week"/"Units per Authorization period" are blank fields on the Universal Request form, justified via the severity/unit guide (levels 1-3 across communication, social, behavior, and adaptive domains) per 26 weeks (6 months) per authorization period | clinic, home, community, school, telehealth | BlueCare's general (not ABA-code-specific) telehealth billing policy (eff. 10/1/2024) requires POS 10 (patient's home) or POS 02 (elsewhere) — POS 03 for school-based, POS 50/72 for RHC/FQHC — with modifiers GT, 93, 95, G0, GQ, FQ, or FR "for informational purposes." Whether this code is on BlueCare's separately-published "Telehealth Approved Code List" (referenced but not included in the manual read this pass) is not directly confirmed. | HM |
| 97155 | Yes | Required — Universal Request for ABA form (assessment + treatment) | No fixed numeric cap published — "Units Per Week"/"Units per Authorization period" are blank fields on the Universal Request form, justified via the severity/unit guide (levels 1-3 across communication, social, behavior, and adaptive domains) per 26 weeks (6 months) per authorization period | clinic, home, community, school, telehealth | BlueCare's general (not ABA-code-specific) telehealth billing policy (eff. 10/1/2024) requires POS 10 (patient's home) or POS 02 (elsewhere) — POS 03 for school-based, POS 50/72 for RHC/FQHC — with modifiers GT, 93, 95, G0, GQ, FQ, or FR "for informational purposes." Whether this code is on BlueCare's separately-published "Telehealth Approved Code List" (referenced but not included in the manual read this pass) is not directly confirmed. | HO |
| 97156 | Yes | Required — Universal Request for ABA form (assessment + treatment) | No fixed numeric cap published — "Units Per Week"/"Units per Authorization period" are blank fields on the Universal Request form, justified via the severity/unit guide (levels 1-3 across communication, social, behavior, and adaptive domains) per 26 weeks (6 months) per authorization period | clinic, home, community, school, telehealth | BlueCare's general (not ABA-code-specific) telehealth billing policy (eff. 10/1/2024) requires POS 10 (patient's home) or POS 02 (elsewhere) — POS 03 for school-based, POS 50/72 for RHC/FQHC — with modifiers GT, 93, 95, G0, GQ, FQ, or FR "for informational purposes." Whether this code is on BlueCare's separately-published "Telehealth Approved Code List" (referenced but not included in the manual read this pass) is not directly confirmed. | HO |
| 97157 | Yes | Required — Universal Request for ABA form (assessment + treatment) | No fixed numeric cap published — "Units Per Week"/"Units per Authorization period" are blank fields on the Universal Request form, justified via the severity/unit guide (levels 1-3 across communication, social, behavior, and adaptive domains) per 26 weeks (6 months) per authorization period | clinic, home, community, school, telehealth | BlueCare's general (not ABA-code-specific) telehealth billing policy (eff. 10/1/2024) requires POS 10 (patient's home) or POS 02 (elsewhere) — POS 03 for school-based, POS 50/72 for RHC/FQHC — with modifiers GT, 93, 95, G0, GQ, FQ, or FR "for informational purposes." Whether this code is on BlueCare's separately-published "Telehealth Approved Code List" (referenced but not included in the manual read this pass) is not directly confirmed. | HO |
| 97158 | Yes | Required — Universal Request for ABA form (assessment + treatment) | No fixed numeric cap published — "Units Per Week"/"Units per Authorization period" are blank fields on the Universal Request form, justified via the severity/unit guide (levels 1-3 across communication, social, behavior, and adaptive domains) per 26 weeks (6 months) per authorization period | clinic, home, community, school, telehealth | BlueCare's general (not ABA-code-specific) telehealth billing policy (eff. 10/1/2024) requires POS 10 (patient's home) or POS 02 (elsewhere) — POS 03 for school-based, POS 50/72 for RHC/FQHC — with modifiers GT, 93, 95, G0, GQ, FQ, or FR "for informational purposes." Whether this code is on BlueCare's separately-published "Telehealth Approved Code List" (referenced but not included in the manual read this pass) is not directly confirmed. | HO |
| 0362T | Yes | Required — Universal Request for ABA form (assessment + treatment); listed with a full CPT description in BlueCare's own Provider Administration Manual (this code, unlike the shared tri-MCO documents, which omit it) | 26 weeks (6 months) per authorization period | clinic, home, community, school, telehealth | BlueCare's general (not ABA-code-specific) telehealth billing policy (eff. 10/1/2024) requires POS 10 (patient's home) or POS 02 (elsewhere) — POS 03 for school-based, POS 50/72 for RHC/FQHC — with modifiers GT, 93, 95, G0, GQ, FQ, or FR "for informational purposes." Whether this code is on BlueCare's separately-published "Telehealth Approved Code List" (referenced but not included in the manual read this pass) is not directly confirmed. | — |
| 0373T | Yes | Required — Universal Request for ABA form (assessment + treatment); listed with a full CPT description in BlueCare's own Provider Administration Manual (this code, unlike the shared tri-MCO documents, which omit it) | 26 weeks (6 months) per authorization period | clinic, home, community, school, telehealth | BlueCare's general (not ABA-code-specific) telehealth billing policy (eff. 10/1/2024) requires POS 10 (patient's home) or POS 02 (elsewhere) — POS 03 for school-based, POS 50/72 for RHC/FQHC — with modifiers GT, 93, 95, G0, GQ, FQ, or FR "for informational purposes." Whether this code is on BlueCare's separately-published "Telehealth Approved Code List" (referenced but not included in the manual read this pass) is not directly confirmed. | — |

Code notes:

- **97153:** Continuation requests must report % of authorized units used on this code — under 90% requires a written explanation. Billed "97153HO" when BCBA/QHP-delivered vs. plain 97153 when technician-delivered (eff. DOS 9/1/2019+, per the shared BlueCare/TennCare Select Provider Administration Manual).
- **97155:** Per the shared BlueCare/TennCare Select Provider Administration Manual: may be billed concurrently with technician-delivered codes when the BCBA is directing an RBT, the client is present, and one or more protocols have been modified.
- **97156:** Parent-training volume delivered is tracked separately at continuation, per week/month, on the Universal Request form.

### Contacts

- **Provider services phone:** 1-800-276-1978 — TennCare Select Provider Service Line (distinct from BlueCare's 1-800-468-9736)
- **Phone menu path:** PA questions: 1-800-711-4104 (TennCare Select Prior Auth phone, distinct from BlueCare's 1-888-423-0131). SelectKids (foster care) has its own line: Provider/Family Services 1-800-451-9147. SelectCommunity (IDD): 1-800-292-8196. Member Service Line (for confirming enrollment): 1-800-263-5479.
- **Portal:** [BlueCare online provider tool (bluecare.bcbst.com) / Availity](https://bluecare.bcbst.com)
- **Fax:** 1-800-292-5311 (Prior Auth fax — shared with BlueCare Tennessee); SelectKids fax 1-800-330-2842; SelectCommunity fax 1-888-255-9175

Questions to ask on a verification call:

- Confirm this member is on TennCare Select rather than standard BlueCare — contact numbers and forms differ even though both run through the same BCBST/VSHP entity.
- Is this member on a TennCare Select sub-program (SelectKids/foster care, SelectCommunity/IDD, or Katie Beckett Part A) with its own dedicated contact line?
- Is 0362T (or 0373T) on the current Telehealth Approved Code List, and is there a published unit cap for either code?
- What is the negotiated per-unit rate for the ABA code set under this member's TennCare Select provider contract, since TennCare publishes no statewide ABA fee schedule?
- What EDI payer ID should be used for this member's 270/271 eligibility check — no TennCare-Select-specific code was confirmed this pass?

### VOB data sources

- https://www.capitol.tn.gov/Archives/Joint/committees/fiscal-review/contracts/2025/05-21-25/28.%20TennCare%20(Volunteer%20State%20Health%20Plan%20d.b.a%20BlueCare)%20Amend%201%20Redacted.pdf (accessed 2026-07-23)
- https://www.tn.gov/content/dam/tn/tenncare/documents/2025ManagedCareProgramAnnualReport.pdf (accessed 2026-07-23)
- https://content.bcbst.com/api/public/content/prov-bct-pam.pdf (accessed 2026-07-23)
- https://www.tn.gov/content/dam/tn/tenncare/documents/HCFATennCareEDIFrontMatter.pdf (accessed 2026-07-23)
- https://pverify.com/wp-content/uploads/2026/03/pVerifyPayers_All-Payers-List-3-2026.pdf (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.insuranceverifier.finthrive.com/Document/FinThrive%20Payer%20List.pdf (accessed 2026-07-23; source document older than 18 months)
- https://www.provider.wellpoint.com/docs/gpp/TN_WLP_CAID_BH_ABARequirements.pdf (accessed 2026-07-23)
- https://www.provider.wellpoint.com/docs/gpp/TN_WLP_CAID_BH_RequestABA.pdf (accessed 2026-07-23)
- https://content.bcbst.com/api/public/content/aba_initiation_continuation_for_therapy.pdf (accessed 2026-07-23)

## Common questions

### Is TennCare Select the same as BlueCare Tennessee?

No — they're separate state contracts (different Edison contract IDs) even though both are administered by Volunteer State Health Plan, a BlueCross BlueShield of Tennessee subsidiary. Members are assigned to TennCare Select by the Division of TennCare, not chosen; contact numbers and some LTSS programs differ.

### Who is on TennCare Select?

SSI-eligible children under 21, children in DCS foster-care custody ("SelectKids"), members in intellectual-disability HCBS waivers ("SelectCommunity"), Katie Beckett Part A children, and some out-of-state or safety-net enrollees — roughly 37,095 members statewide (CY2024 average).

### Does TennCare Select cover ABA therapy?

Yes — the same shared tri-MCO ABA program that governs BlueCare, UnitedHealthcare Community Plan, and Wellpoint: EPSDT members under 21, prior authorization on assessment and treatment, TN Licensed Behavior Analyst licensure, 26-week authorization periods.

### How do I submit an ABA prior authorization to TennCare Select?

The shared tri-MCO universal ABA request form, via Availity (Tennessee providers) or Cohere (out-of-state providers). TennCare Select's own Provider Service Line is 1-800-276-1978 and PA phone is 1-800-711-4104 — both distinct from BlueCare's numbers.

## Primary sources

1. [TennCare (Volunteer State Health Plan d.b.a. BlueCare) Contract Amendment #1 (Edison ID 83332)](https://www.capitol.tn.gov/Archives/Joint/committees/fiscal-review/contracts/2025/05-21-25/28.%20TennCare%20(Volunteer%20State%20Health%20Plan%20d.b.a%20BlueCare)%20Amend%201%20Redacted.pdf)
2. [BlueCare Tennessee Provider Administration Manual](https://content.bcbst.com/api/public/content/prov-bct-pam.pdf)
3. [TennCare Managed Care Program Annual Report (MCPAR), CY2024](https://www.tn.gov/content/dam/tn/tenncare/documents/2025ManagedCareProgramAnnualReport.pdf)
4. [MLTSS Provider Manual (BlueCare/TennCare Select)](https://content.bcbst.com/api/public/content/prov-mltss-manual.pdf)
5. [TennCare Aligned Background Check Protocol (eff. July 1, 2024)](https://www.tn.gov/content/dam/tn/tenncare/documents/AlignedBackgroundCheckProtocol.pdf)
6. [BCBST — ABA Therapy Services Assessment Request Form](https://content.bcbst.com/api/public/content/aba_therapy_assessment_request_form.pdf)
7. [BCBST — Initiation and Continuation of ABA Therapy Form](https://content.bcbst.com/api/public/content/aba_initiation_continuation_for_therapy.pdf)
8. [Universal Request for ABA form (all 3 MCOs, Jan 2026)](https://www.provider.wellpoint.com/docs/gpp/TN_WLP_CAID_BH_RequestABA.pdf)
9. [TennCare MCO Statewide Contract (template, current through Amendment 25, eff. 7/1/2026)](https://www.tn.gov/content/dam/tn/tenncare/documents/MCOStatewideContract.pdf)
10. [TennCare Kids (EPSDT) — birth through age 20](https://www.tn.gov/tenncare/tenncare-kids.html)
11. [ABA Provider Requirements & Program Description — TennCare MCOs (rev. 06/2024)](https://www.provider.wellpoint.com/docs/gpp/TN_WLP_CAID_BH_ABARequirements.pdf)
12. [10 U.S.C. 1079(i)(1) — TRICARE pays after other coverage, Medicaid excepted](https://www.govinfo.gov/content/pkg/USCODE-2023-title10/html/USCODE-2023-title10-subtitleA-partII-chap55-sec1079.htm)
13. [CHAMPVA Guidebook (updated Jan. 1, 2025) — Other Health Insurance](https://www.va.gov/COMMUNITYCARE/docs/pubfiles/programguides/CHAMPVA-Guide.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.