---
title: UnitedHealthcare Community Plan of Nebraska ABA coverage (Heritage Health MCO).
url: "https://carelu.com/payers/unitedhealthcare-community-plan-nebraska"
markdown_url: "https://carelu.com/payers/unitedhealthcare-community-plan-nebraska.md"
state: NE (Nebraska)
payer: UnitedHealthcare Community Plan of Nebraska
kind: Medicaid managed care plan (MCO)
parent_program: Nebraska Medicaid (Heritage Health)
description: "How UnitedHealthcare Community Plan of Nebraska administers Medicaid ABA — the Optum-managed autism network since 2017, the two-step assessment/treatment authorization, portal and fax channels, and why concurrent review here has teeth."
last_reviewed: September 2026
vob_data_updated: 2026-07-23
---

# UnitedHealthcare Community Plan of Nebraska ABA coverage (Heritage Health MCO).

_Payer Guide · UHC Community Plan (NE) · Last updated September 2026 · 8 primary sources_

> ABA carved to Optum since 2017; all autism services need PA, two-step assessment→treatment auth.

UnitedHealthcare Community Plan of Nebraska (UnitedHealthcare of the Midlands) administers the Heritage Health ABA benefit with the autism network carved to Optum Behavioral Health — an arrangement in place since January 1, 2017, with its own NE-specific program guide, training deck, forms, and fax lines. The state MSD coverage rules and state-directed rates apply, but Optum layers its own clinical criteria, a two-step assessment-then-treatment authorization workflow, and active utilization review on top — materially more process than the state baseline, and worth designing intake around.

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

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Required — "All Autism Services require Prior Authorization"; written assessment request (treatment form marked as assessment) with the diagnostic evaluation / IDI / FBA attached [1][2]
- **Prior auth for treatment**: Required — for all services and additional units; medical necessity applies at initial and concurrent review [1]
- **Autism diagnosis required?**: State MSD rules govern — ASD or a developmental/intellectual disability qualifies; attach the diagnosing provider's evaluation to the request [3][1]

## At a glance

- **Plan type:** Heritage Health MCO — ABA network managed by Optum since 1/1/2017
- **Prior auth:** "All Autism Services require Prior Authorization" — assessment included
- **Auth structure:** Two-step: assessment auth first, then treatment auth — no treatment on the assessment auth alone
- **Submission:** Optum ABA treatment-request portal; fax 1-888-541-6691
- **Benefits check:** BH number on the member ID card or NMES line 1-800-642-6092
- **Claims:** Payer ID 87726; 180-day timely filing

## The two-step Optum funnel

Optum's Nebraska program requires prior authorization for everything: the initial ABA assessment (including write-up time) needs a written request — the treatment request form marked as an assessment request — with the diagnostic evaluation, IDI, or FBA attached. Treatment is a second, separate authorization: families cannot start treatment on the assessment auth alone. Treatment requests must include the evaluation from the diagnosing provider plus a treatment plan with baseline and mastery criteria, a transition plan, discharge criteria, parent goals, supervision hours, and coordination of care — and medical necessity applies at both initial and concurrent review, with additional units requiring their own PA. Submissions go through Optum's online ABA treatment-request portal or fax 1-888-541-6691 (an older quick-reference guide lists 1-855-268-9392); claims run on payer ID 87726 with 180-day timely filing. [1][2]

## What intake should know about this plan

Optum runs the ABA network separately from the medical plan — verify benefits via the behavioral-health number on the member ID card or the NMES line at 1-800-642-6092, not the medical line. Per Optum's program documents, eligibility is described as members younger than 20 covered under Heritage Health. Treatment requests probe school hours and parent participation, and expect concurrent review to have teeth: ProPublica's 2024–2025 reporting on Optum strategy documents around ABA cost containment in Medicaid plans named Nebraska among focus states. Rates are not an Optum variable — DHHS's HPA 25-08 requires MCO ABA rates to reflect the revised state fee schedule effective August 1, 2025 — so the plan-specific work is process: clean two-step requests, complete treatment-plan elements, and progress data ready at every concurrent review. [1][4][8]

## Intake gates

The questions that decide whether a family can start with UnitedHealthcare Community Plan of Nebraska, and what they have to bring.

- **Age limit**: Two documents, two numbers, and they are worth quoting separately rather than averaging. The state service definitions set admission at "Age: 0-20" (with DD-waiver recipients able to receive 97151/97152 regardless of age). Optum's own Nebraska Heritage Health program training states member eligibility as "Be younger than age 20" and "Be covered under Nebraska Heritage Health." The one-year gap is unresolved in the published material — for a 20-year-old member, confirm with the Care Advocate before scheduling rather than assuming either document wins. [3][2]
  - Ask the plan: The Optum Care Advocate / the NE Heritage Health Medicaid Autism-ABA Program page on Provider Express.
- **Diagnosis recency**: Follows the Nebraska Medicaid rule: an Initial Diagnostic Interview within the previous 12 months must establish the need for the ABA assessment, with an addendum where the presentation has changed. Optum turns that into an attachment requirement: the written assessment request goes in with "the diagnostic evaluation, IDI, or FBA" attached, and treatment requests must carry the evaluation from the diagnosing provider. [3][1]
- **Who may diagnose**: Follows the Nebraska Medicaid rule: the IDI is performed by "A licensed practitioner who is able to diagnose and treat major mental illness within his/her scope of practice" — Physician, Physician Assistant, APRN/NP, Psychologist or LIMHP — with ASD or a developmental or intellectual disability as the qualifying diagnosis. Optum does not publish a Nebraska diagnostician list of its own; what it requires is the evaluation from the diagnosing provider in the request packet. [5][1]
- **Diagnostic tools required**: Follows the Nebraska Medicaid rule: no ASD diagnostic instrument is mandated, and the instruments Nebraska names (Vineland, VB-MAPP, ABLLS) sit in the treatment plan and continued-stay review rather than behind the diagnosis. Optum's Nebraska program asks for the FBA or diagnostic evaluation in the packet and for a treatment plan with baseline and mastery criteria, but names no instrument. [3][2]
- **Referral required?**: No referral or order is required by the state — the gate is the IDI plus the ABA assessment. Optum replaces it with an authorization gate that is stricter than the state's: "All Autism Services require Prior Authorization," including the initial assessment and its write-up time, requested in writing on the treatment request form marked as an assessment request with the diagnostic evaluation, IDI or FBA attached. Treatment is a second, separate authorization — families cannot start treatment on the assessment authorization alone. [1][3]
- **Telehealth**: Follows the Nebraska Medicaid rule: audiovisual telehealth is available for 97155 (only while 97153 runs concurrently), 97156 and the 97151 assessment under the conditions the service definitions spell out; 97152, 97153, 97154 and 97158 cannot be delivered remotely. Optum's Nebraska Heritage Health program material publishes no telehealth section of its own, and Optum's virtual-visits attestation requirement is documented on other lines of business rather than this one — do not assume it applies here without asking. [3][6]
  - Ask the plan: The Optum Care Advocate / the NE Heritage Health Medicaid Autism-ABA Program page on Provider Express.
- **Prior-auth decision time**: UnitedHealthcare Community Plan's 2026 Nebraska manual sets the clocks, and Optum (United Behavioral Health) decides ABA requests. Non-urgent pre-service: "Within 5 working days of receipt of medical record information required but no longer than 7 calendar days of receipt of request." Urgent: "Within 72 hours of request receipt." Either can be extended up to 14 days at your or the family's request, or when more information is justified. Concurrent review: "Within 24 hours from receipt of the request," extended to 72 hours if the plan documents an attempt to get clinical information. Approvals are communicated within 24 hours of the decision; written denials go out within 2 business days. For lead time, the manual says to seek prior authorization for "Nonemergency admissions or outpatient services (except maternity) – at least 14 business days beforehand." Use that as the reauthorization window. [9]
- **Other insurance (who pays first)**: "UnitedHealthcare Community Plan is, by law, the payer of last resort for eligible members." You "must bill and obtain an explanation of benefits (EOB) from any other insurance or health care coverage resource before billing UnitedHealthcare Community Plan." Then "attach a copy of the EOB to the submitted claim"; it "must be complete to understand the paid amount or denial reason." For deadlines, the manual says: "Refer to your Agreement for third party claim submission deadlines." Benefits are coordinated "based on the member's benefit contract and applicable regulations." Neither the manual nor Optum's Nebraska ABA guides say whether Optum's ABA prior auth is required when a commercial plan is primary. [9]
  - Ask the plan: Optum / UnitedHealthcare Community Plan 1-866-331-2243: ask whether ABA prior authorization is required when a commercial plan is primary, and what third-party claim deadline your Agreement sets.

## Delivery and billing rules

Coverage decides whether UnitedHealthcare Community Plan of Nebraska 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 Nebraska Medicaid rule: direct supervision by observation of the technician at no less than 10% of weekly direct service hours (97153/97154/97155), at least one hour a month of in-person observation of each technician or LaBA, at least one hour a month of in-person direct service by the treating LBA or psychologist, and no more than 24 technicians per LBA. Optum layers staff-level network rules on top rather than a competing ratio: supervising BCBAs must hold BACB supervisory certification, technicians need RBT (or equivalent national) certification with "appropriate training and supervision by BCBAs or licensed clinician," a BCBA or licensed clinician must provide program oversight and "performs skills assessments and provides direct supervision of behavior technician in joint sessions," and groups carry $1M/$3M professional liability cover. [3][2]
- **Daily limits / MUEs**: Follows the Nebraska Medicaid rule: direct ABA "may not exceed 6 hours in a single day or a total of 20 hours per week," with more available on prior authorization and clinical justification; group work runs one technician to 2-5 children on 97154 and one licensed clinician to 2-5 on 97158. Optum publishes no Nebraska per-day unit table — and its commercial ABA reimbursement policy's per-day maximums are a different product and should not be assumed onto this plan. What binds in practice here is the authorization: medical necessity applies at initial and concurrent review, and additional units need their own PA. [3][1]
  - Ask the plan: The Optum Care Advocate / the NE Heritage Health Medicaid Autism-ABA Program page on Provider Express.
- **Session-note signature**: Nebraska says what a progress note must contain, sets the deadline by reference, and never names a session-note signer. Progress notes "must be completed within the time frame specified in the program's policies and procedures" and must substantiate each service through narrative description, "Include an accurate start and end time for the service," tie the service to plan goals and priorities, document participation and revision of goals, and record the individual's response "in the individual's own words if possible, if age and developmentally appropriate." Signatures attach to the other documents: the treatment plan must "Be approved and signed by the licensed clinician or supervisor if provisionally licensed" and carry the individual's or guardian's signature (a parent or guardian where the individual is under 19); the ABA assessment report "must be signed by the licensed clinicians who participated in the development of the report, including the supervising practitioner, when applicable"; and the discharge summary must "contain the signature of the supervising clinician and date of signature." Supervision itself must be documented in progress notes. Optum's Nebraska program material adds documentation expectations for the request packet — baseline and mastery criteria, transition and discharge plans, parent goals, supervision hours, coordination of care — but names no session-note signer or signing deadline. [7][1]
- **Place of service**: Community, home, office or clinic — and school is not yours to bill. The treatment MSD lists the allowable settings as "Community, Home, Office or Clinic," then carves the school out entirely: "ABA services are covered as part of the Medicaid school-based services program, and are the responsibility of the school as outlined in Nebraska Administrative Code Title 471, Chapter 25 and the Medicaid State Plan. Independent providers may not bill Medicaid directly for services provided at a school." The assessment MSD keeps School on its settings list under the same carve-out. Where ABA does run in an educational setting, "A school plan is required for all educational settings, to include both public and private schools" (not daycare or after-school), it must be included in the student's IEP, it must focus on reducing behaviors that impede academic engagement rather than on general skill acquisition, and it must be time-limited with a transition plan shifting instructional control to school staff. Excluded outright: "Services delivered in the school setting as a shadow, or an aide, or to provide general support to the child or youth," and training for school personnel. Group homes are not addressed. Optum publishes no Nebraska-specific deviation; its Nebraska treatment requests do probe school hours, which is a scheduling question rather than a billable-setting one given the 471 NAC 25 carve-out. [3][6][1]
- **Concurrent billing (97153 + 97155)** _(ask the plan)_: Not stated in billing terms, though the definitions read as if it happens. The telehealth rule allows 97155 by audiovisual telehealth only where "The individual is receiving 97153 services concurrently," and the supervision percentage is measured against "direct service hours (97153/97154/97155)" as a single weekly pool — both of which presume the analyst and the technician on the clock at the same time. But neither MSD says in terms that both codes may be billed for the same clock time. What Nebraska does prohibit by name is a different concurrency: "Services delivered concurrently (at the same time) as another treatment modality (i.e. ST, OT, PT)," and "Services delivered by 2 LBAs unless non-duplicative and clinically appropriate." Optum publishes no Nebraska-specific concurrency edit. [3]
  - Ask the plan: The Optum Care Advocate / the NE Heritage Health Medicaid Autism-ABA Program page on Provider Express.
- **Bill as provider** _(ask the plan)_: Nebraska controls this through code-level provider eligibility rather than a modifier set. Licensed clinicians who may bill 97151 — and who render 97155, 97156 and 97158 — are a psychiatrist, physician, psychologist or provisionally licensed psychologist, each with training in ABA, or a Licensed Behavior Analyst. Technicians who may bill 97152, 97153 and 97154 under a licensed clinician's supervision are a Licensed assistant Behavior Analyst or a Registered Behavior Technician. Since January 1, 2025 every BCBA must be licensed as an LBA and every BCaBA as a LaBA, so the state license rather than the BACB certificate is what makes the claim payable, and RBT is enrolled as its own Medicaid provider type (85) on the fee schedule. Which NPI carries the claim line is not stated. Optum credentials the group and its staff through its own network process, and claims run on payer ID 87726 with 180-day timely filing, but which NPI carries technician-delivered 97153 is not stated. [3][1]
  - Ask the plan: The Optum Care Advocate / the NE Heritage Health Medicaid Autism-ABA Program page on Provider Express.

## What intake should collect for UnitedHealthcare Community Plan of Nebraska

- **Diagnostic evaluation / IDI / FBA:** Must attach to the written assessment request — the two-step funnel starts with this packet.
- **BH number from the member card:** The ABA network is Optum, separate from medical — verify via the BH line or NMES 1-800-642-6092.
- **Parent goals + participation plan:** Treatment requests require parent goals and probe participation — capture commitment at intake.
- **School-hours picture:** Optum's treatment request asks about school hours — document the schedule before submission.
- **Progress data cadence:** Concurrent review is active here — baseline/mastery data ready at every review, not just reauthorization.

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

## Verification of benefits (VOB) data

How UnitedHealthcare Community Plan of Nebraska ABA benefits route and read on an eligibility check. Data last updated 2026-07-23.

### EDI routing

- **Payer ID (Availity):** 87726
- **Payer ID (Change Healthcare / Optum):** 87726 (ERA 86047)
- **Supports 270/271 eligibility:** Yes
- **Behavioral health administrator:** Optum Behavioral Health (branded "United Behavioral Health")
- **BH administrator payer ID:** 87726 (ERA 86047)

### Code-level coverage

| Code | Covered | Prior auth | Unit cap | Place of service | Telehealth | Modifiers |
| --- | --- | --- | --- | --- | --- | --- |
| 97151 | Yes | Required — step 1 of Optum's two-step authorization. "All Autism Services require Prior Authorization" including the assessment (which includes write-up time); a written request (the treatment request form marked as an assessment request) must attach the diagnostic evaluation, IDI, or FBA. Treatment cannot begin on the assessment auth alone. | No per-code daily/weekly unit cap published. Staffing ratio: 1 licensed clinician : 1 child. | home, community, office or clinic, telehealth — POS 02 (patient not at home) or POS 10 (patient at home) | Yes, conditional — audiovisual only (modifier 95). Allowed if caregivers are on-site using live synchronous methods, the environment is assessed safe (or modified to be), caregivers have a secure internet connection, the individual does not need more than 1:1 support, and use is documented as clinically necessary (not for provider/caregiver convenience). | 95 (telehealth, audiovisual — informational modifier, placed after any payment modifier), with POS 02 or 10, No CPT modifier for licensure tier — billed by enrolled Provider Type 1 (MD), 2 (DO), 57 (Provisionally Licensed PhD), 67 (Licensed Psychologist), or 83 (BCBA/LBA); Provider Types 84 (BCaBA/LaBA) and 85 (RBT) are not reimbursed for this code ($0 in the fee schedule) |
| 97152 | Yes | Required — step 1 of Optum's two-step authorization. "All Autism Services require Prior Authorization" including the assessment (which includes write-up time); a written request (the treatment request form marked as an assessment request) must attach the diagnostic evaluation, IDI, or FBA. Treatment cannot begin on the assessment auth alone. | No per-code daily/weekly unit cap published. Staffing ratio: 1 technician : 1 child. | home, community, office or clinic | No — the ABA Behavior Identification Assessment MSD states verbatim this code "cannot be completed via telehealth." | No telehealth modifier applicable (telehealth not allowed for this code), Billed by Provider Type 57 (Provisionally Licensed PhD), 67 (Licensed Psychologist), 84 (BCaBA/LaBA), or 85 (RBT); Provider Types 1 (MD), 2 (DO), and 83 (BCBA/LBA) are not reimbursed for this code ($0 in the fee schedule) |
| 97153 | Yes | Required — step 2 (treatment authorization), a separate auth from the assessment. Must include the diagnosing provider's evaluation plus a treatment plan with baseline/mastery criteria, a transition plan, discharge criteria, parent goals, supervision hours, and coordination of care. Medical necessity applies at initial AND concurrent review; additional units require their own PA. | Grouped with 97154/97155 under the MSD's "direct ABA service hours" definition (the same codes subject to the 10%-of-hours direct-supervision rule): may not exceed 24 units/day (6 hrs) per the treatment MSD's literal text, with a weekly cap the state's own documents state two different ways — 80 units/week (20 hrs) per the treatment MSD's literal text; 120 units/week (30 hrs) per Provider Bulletin 25-02 and the DHHS ABA Facts page. Both figures given deliberately, not resolved by fiat — request against the 20-hr/week reading as the conservative floor and cite the 30-hr materials when clinical need justifies more; either way, hours above 6/day require PA'd clinical justification. per day (verified: 24 units / 6 hrs) and week (conflicting: 80 vs 120 units / 20 vs 30 hrs — see unitCap) | home, community, office or clinic | No — the treatment MSD states verbatim: "Other ABA treatment services (CPT 97153, 97154, 97158) cannot be provided via telehealth." | No telehealth modifier applicable (telehealth not allowed for this code), Billed by Provider Type 57, 67, 83 (BCBA/LBA), 84 (BCaBA/LaBA), or 85 (RBT); Provider Types 1 (MD)/2 (DO) not reimbursed ($0 in the fee schedule) |
| 97154 | Yes | Required — step 2 (treatment authorization), a separate auth from the assessment. Must include the diagnosing provider's evaluation plus a treatment plan with baseline/mastery criteria, a transition plan, discharge criteria, parent goals, supervision hours, and coordination of care. Medical necessity applies at initial AND concurrent review; additional units require their own PA. | Grouped with 97153/97155 under the MSD's "direct ABA service hours" definition — see the 97153 entry for the same 6-hr/day, 20-vs-30-hr/week conflict. Staffing ratio: 1 technician : 2-5 children (group). per day (verified: 24 units / 6 hrs, combined w/ 97153/97155) and week (conflicting — see 97153) | home, community, office or clinic | No — the treatment MSD states verbatim: "Other ABA treatment services (CPT 97153, 97154, 97158) cannot be provided via telehealth." | No telehealth modifier applicable (telehealth not allowed for this code), Billed by Provider Type 57, 67, 83 (BCBA/LBA), 84 (BCaBA/LaBA), or 85 (RBT); Provider Types 1 (MD)/2 (DO) not reimbursed ($0 in the fee schedule) |
| 97155 | Yes | Required — step 2 (treatment authorization), a separate auth from the assessment. Must include the diagnosing provider's evaluation plus a treatment plan with baseline/mastery criteria, a transition plan, discharge criteria, parent goals, supervision hours, and coordination of care. Medical necessity applies at initial AND concurrent review; additional units require their own PA. | Grouped with 97153/97154 under the MSD's "direct ABA service hours" definition — see the 97153 entry for the same 6-hr/day, 20-vs-30-hr/week conflict. Staffing ratio: 1 licensed clinician : 1 child. per day (verified: 24 units / 6 hrs, combined w/ 97153/97154) and week (conflicting — see 97153) | home, community, office or clinic, telehealth — POS 02 (patient not at home) or POS 10 (patient at home) | Yes, conditional — audiovisual only (modifier 95). Allowed only if the individual is receiving 97153 services concurrently, plus environment/safety and documented-necessity conditions from the treatment MSD are met. | 95 (telehealth, audiovisual), with POS 02 or 10 — conditional, see telehealth field, Billed by Provider Type 1 (MD), 2 (DO), 57, 67, or 83 (BCBA/LBA); Provider Types 84 (BCaBA/LaBA)/85 (RBT) not reimbursed ($0 in the fee schedule) |
| 97156 | Yes | Required — step 2 (treatment authorization), a separate auth from the assessment. Must include the diagnosing provider's evaluation plus a treatment plan with baseline/mastery criteria, a transition plan, discharge criteria, parent goals, supervision hours, and coordination of care. Medical necessity applies at initial AND concurrent review; additional units require their own PA. | Not grouped into the MSD's "direct ABA service hours" definition (that phrase is specifically 97153/97154/97155) — no separate per-code daily/weekly unit cap was found for 97156 itself. A distinct, non-unit-cap mechanism applies instead: caregiver participation minimums of 1 hr/month (services <=10 hrs/month) or 2-4 hrs/month (services >10 hrs/month), tracked for continued-stay review rather than billed as a cap. | home, community, office or clinic, telehealth — POS 02 (patient not at home) or POS 10 (patient at home) | Yes, conditional — audiovisual only (modifier 95), per the treatment MSD's documented-necessity and environment/safety conditions for family training. | 95 (telehealth, audiovisual), with POS 02 or 10 — conditional, see telehealth field, Billed by Provider Type 1 (MD), 2 (DO), 57, 67, or 83 (BCBA/LBA); Provider Types 84 (BCaBA/LaBA)/85 (RBT) not reimbursed ($0 in the fee schedule) |
| 97157 | No | N/A — not a billable Nebraska Medicaid ABA code | N/A per N/A | — | N/A | — |
| 97158 | Yes | Required — step 2 (treatment authorization), a separate auth from the assessment. Must include the diagnosing provider's evaluation plus a treatment plan with baseline/mastery criteria, a transition plan, discharge criteria, parent goals, supervision hours, and coordination of care. Medical necessity applies at initial AND concurrent review; additional units require their own PA. | No per-code daily/weekly unit cap found (not part of the "direct ABA service hours" 97153/97154/97155 grouping). Staffing ratio: 1 licensed clinician : 2-5 children (group). | home, community, office or clinic | No — the treatment MSD states verbatim: "Other ABA treatment services (CPT 97153, 97154, 97158) cannot be provided via telehealth." | No telehealth modifier applicable (telehealth not allowed for this code), Billed by Provider Type 1 (MD), 2 (DO), 57, 67, or 83 (BCBA/LBA); Provider Types 84 (BCaBA/LaBA)/85 (RBT) not reimbursed ($0 in the fee schedule) |
| 0362T | No | N/A — not a billable Nebraska Medicaid ABA code | N/A per N/A | — | N/A | — |
| 0373T | No | N/A — not a billable Nebraska Medicaid ABA code | N/A per N/A | — | N/A | — |

Code notes:

- **97151:** Rate $38.16/15min is flat across every eligible provider type — no BCBA-vs-physician differential where both are eligible to bill (see rates.byCode).
- **97153:** Direct supervision by observation required for no less than 10% of weekly direct-service hours (97153/97154/97155 combined), documented in progress notes; failure must be documented with a corrective-action plan. An LBA may supervise at most 24 technicians. Claims bill on payer ID 87726, 180-day timely filing, per Optum's NE QRG.
- **97156:** Staffing ratio: 1 licensed clinician : 1 family. Teachers count for at most 25% of required caregiver-training hours; IEP meetings are not billable.
- **97157, 0362T, 0373T:** Not part of Nebraska Medicaid's billable ABA code set — confirmed absent from Provider Bulletin 25-14, the DHHS "Applied Behavior Analysis Facts" page, the MHSUD fee schedule's "ABA" tab, and both ABA Medicaid Service Definitions' own "Fee schedule codes for this service are" lists (checked directly, all four, this pass). If a family's MCO nonetheless authorizes this code, verify the rate directly with DHHS Rate & Reimbursement (DHHS.ratesreimbursement@nebraska.gov) — do not assume a rate from the pattern of the other 7 codes.

### Medicaid rates

Source: Nebraska DHHS Provider Bulletin 25-14 sets the statewide fee-for-service rate; Health Plan Advisory 25-08 directs all 3 Heritage Health MCOs to track it identically — no independent MCO-negotiated ABA rate found. Effective 2025-08-01.

| Code | Rate | Unit | Modifier tiers |
| --- | --- | --- | --- |
| 97151 | 38.16 | 15min | 1 (MD): 38.16; 2 (DO): 38.16; 57 (Provisionally Licensed PhD): 38.16; 67 (Licensed Psychologist): 38.16; 83 (BCBA/LBA): 38.16; 84 (BCaBA/LaBA): not billable — $0 in the fee schedule; 85 (RBT): not billable — $0 in the fee schedule |
| 97152 | 25.88 | 15min | 57 (Provisionally Licensed PhD): 25.88; 67 (Licensed Psychologist): 25.88; 84 (BCaBA/LaBA): 25.88; 85 (RBT): 25.88; 1 (MD): not billable — $0 in the fee schedule; 2 (DO): not billable — $0 in the fee schedule; 83 (BCBA/LBA): not billable — $0 in the fee schedule |
| 97153 | 18.70 | 15min | 57 (Provisionally Licensed PhD): 18.70; 67 (Licensed Psychologist): 18.70; 83 (BCBA/LBA): 18.70; 84 (BCaBA/LaBA): 18.70; 85 (RBT): 18.70; 1 (MD): not billable — $0 in the fee schedule; 2 (DO): not billable — $0 in the fee schedule |
| 97154 | 7.49 | 15min | 57 (Provisionally Licensed PhD): 7.49; 67 (Licensed Psychologist): 7.49; 83 (BCBA/LBA): 7.49; 84 (BCaBA/LaBA): 7.49; 85 (RBT): 7.49; 1 (MD): not billable — $0 in the fee schedule; 2 (DO): not billable — $0 in the fee schedule |
| 97155 | 22.72 | 15min | 1 (MD): 22.72; 2 (DO): 22.72; 57 (Provisionally Licensed PhD): 22.72; 67 (Licensed Psychologist): 22.72; 83 (BCBA/LBA): 22.72; 84 (BCaBA/LaBA): not billable — $0 in the fee schedule; 85 (RBT): not billable — $0 in the fee schedule |
| 97156 | 26.06 | 15min | 1 (MD): 26.06; 2 (DO): 26.06; 57 (Provisionally Licensed PhD): 26.06; 67 (Licensed Psychologist): 26.06; 83 (BCBA/LBA): 26.06; 84 (BCaBA/LaBA): not billable — $0 in the fee schedule; 85 (RBT): not billable — $0 in the fee schedule |
| 97158 | 12.05 | 15min | 1 (MD): 12.05; 2 (DO): 12.05; 57 (Provisionally Licensed PhD): 12.05; 67 (Licensed Psychologist): 12.05; 83 (BCBA/LBA): 12.05; 84 (BCaBA/LaBA): not billable — $0 in the fee schedule; 85 (RBT): not billable — $0 in the fee schedule |

### Contacts

- **Provider services phone:** 1-866-331-2243 (Customer Service Center)
- **Phone menu path:** For automated statewide Medicaid eligibility, call NMES at 1-800-642-6092. For benefits specific to this plan, verify online at Provider Express or call the Behavioral Health number on the back of the member's ID card. Treatment Authorization Requests submit online via Optum PEER Access (optumpeeraccess.secure.force.com/ABAtreatment) or fax.
- **Portal:** [Provider Express](https://public.providerexpress.com)
- **Fax:** 1-855-268-9392 (Treatment Authorization Request)

Questions to ask on a verification call:

- Does ABA ride on the medical benefit or the behavioral-health benefit for this member's eligibility response?
- Is a second authorization/EDI hop required beyond the 87726 payer ID for ABA claims, or does everything route through the same ID?
- Does this payer support real-time (vs. batch) 270/271 eligibility responses?

### VOB data sources

- https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/autismABA/neaba/neNEMedicaidQRG.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://dhhs.ne.gov/Documents/270-271%20Companion%20guide.pdf (accessed 2026-07-23; source document older than 18 months)
- https://dhhs.ne.gov/Behavioral%20Health%20Service%20Definitions/Applied%20Behavior%20Analysis%20Behavior%20Identification%20Assessment.pdf (accessed 2026-07-23)
- https://dhhs.ne.gov/Behavioral%20Health%20Service%20Definitions/Applied%20Behavior%20Analysis.pdf (accessed 2026-07-23)
- https://dhhs.ne.gov/Medicaid%20Provider%20Bulletins/Provider%20Bulletin%2025-14.pdf (accessed 2026-07-23)
- https://dhhs.ne.gov/Medicaid%20Practitioner%20Fee%20Schedules/REVISED%20MHSUD%20SFY27%20Fee%20Schedule.xlsx (accessed 2026-07-23)
- https://dhhs.ne.gov/Medicaid%20Provider%20Bulletins/Provider%20Bulletin%2025-02.pdf (accessed 2026-07-23)
- https://dhhs.ne.gov/Pages/Applied-Behavior-Analysis.aspx (accessed 2026-07-23)
- https://dhhs.ne.gov/Guidance%20Docs/Health%20Plan%20Advisory%2025-08%20-%20Applied%20Behavior%20Analysis%20Rates.pdf (accessed 2026-07-23)
- https://dhhs.ne.gov/Medicaid%20Practitioner%20Fee%20Schedules/Mental%20Health%20and%20Substance%20July%201%202025%20Updated%207.31.25.xlsx (accessed 2026-07-23)

## Common questions

### Does UnitedHealthcare Community Plan of Nebraska cover ABA?

Yes — it administers the Heritage Health ABA benefit under the state Medicaid Service Definitions, with the autism network managed by Optum Behavioral Health since 2017. All autism services, the assessment included, require prior authorization.

### Does the ABA assessment need PA at UHC Community Plan of Nebraska?

Yes — the initial assessment needs a written request (the treatment request form marked as an assessment request) with the diagnostic evaluation, IDI, or FBA attached. Treatment is a second, separate authorization.

### How do I submit an ABA authorization to UHC/Optum in Nebraska?

Through Optum's online ABA treatment-request portal or fax 1-888-541-6691, with the full treatment-plan package (baseline/mastery criteria, transition and discharge plans, parent goals, supervision hours, coordination of care). Claims use payer ID 87726 with 180-day timely filing.

## Primary sources

1. [NE Heritage Health Medicaid ABA Program Quick Reference Guide (Optum BH4233)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/autismABA/neaba/neNEMedicaidQRG.pdf)
2. [NE Heritage Health Medicaid Autism/ABA Program provider training (NE_4556)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/autismABA/neaba/NE_4556_ABA-HeritageTrain.pdf)
3. [ABA Medicaid Service Definition (treatment MSD)](https://dhhs.ne.gov/Behavioral%20Health%20Service%20Definitions/Applied%20Behavior%20Analysis.pdf)
4. [Health Plan Advisory 25-08 — ABA Rates (to Heritage Health MCOs)](https://dhhs.ne.gov/Guidance%20Docs/Health%20Plan%20Advisory%2025-08%20-%20Applied%20Behavior%20Analysis%20Rates.pdf)
5. [Initial Diagnostic Interview Medicaid Service Definition](https://dhhs.ne.gov/Behavioral%20Health%20Service%20Definitions/Initial%20Diagnostic%20Interview.pdf)
6. [ABA Behavior Identification Assessment MSD](https://dhhs.ne.gov/Behavioral%20Health%20Service%20Definitions/Applied%20Behavior%20Analysis%20Behavior%20Identification%20Assessment.pdf)
7. [Medicaid Requirements for Substance Use Disorder and Applied Behavior Analysis Services (umbrella staffing document)](https://dhhs.ne.gov/Behavioral%20Health%20Service%20Definitions/Medicaid%20Requirements%20for%20Substance%20Use%20Disorder%20and%20Applied%20Behavior%20Analysis%20Services.pdf)
8. [ProPublica — UnitedHealth limiting ABA access in Medicaid](https://www.propublica.org/article/unitedhealthcare-insurance-autism-denials-applied-behavior-analysis-medicaid)
9. [UnitedHealthcare Community Plan of Nebraska — 2026 Care Provider Manual, Chapter 4: Medical management](https://www.uhcprovider.com/content/dam/provider/docs/public/admin-guides/comm-plan/NE-Care-Provider-Manual.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.