---
title: "UnitedHealthcare / Optum ABA coverage in Massachusetts: the intake guide."
url: "https://carelu.com/payers/unitedhealthcare-massachusetts"
markdown_url: "https://carelu.com/payers/unitedhealthcare-massachusetts.md"
state: MA (Massachusetts)
payer: UnitedHealthcare / Optum in Massachusetts
kind: Commercial insurance
description: "How UnitedHealthcare / Optum covers ABA for Massachusetts families — the national clinical policy, prior authorization, the ARICA mandate (no age limits, no caps), Optum's explicit Massachusetts state-mandate entries, LABA licensure, and what intake should verify."
last_reviewed: September 2026
vob_data_updated: 2026-07-23
---

# UnitedHealthcare / Optum ABA coverage in Massachusetts: the intake guide.

_Payer Guide · UnitedHealthcare · Massachusetts · Last updated September 2026 · 8 primary sources_

> Optum BH803ABASCC + ARICA + two explicit MA entries in Optum's state-mandate supplement.

For an intake team in Massachusetts, a UnitedHealthcare card means three layers at once: the carrier's national clinical policy, Massachusetts' autism insurance mandate (ARICA, Chapter 207 of the Acts of 2010), and the plan's funding type deciding which of the two actually binds. This guide stacks them in order — and Massachusetts is one of the states Optum's written state-mandate supplement addresses by name, twice.

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Required — step 1 of Optum's two-step authorization (assessment auth via Provider Express) [1]
- **Prior auth for treatment**: Required — step 2 (treatment auth); reviews every 4–6 months [1]
- **Autism diagnosis required?**: Yes — DSM-5-TR ASD confirmed with a validated tool (ADI-R, ADOS-2, etc.); MA commercial members also covered for sole-diagnosis Down syndrome eff. 1/1/2026 (Optum state-mandate supplement) [1][2]

## At a glance

- **Covers ABA?:** Yes — for ASD, per the national UnitedHealthcare policy
- **State mandate:** ARICA — Ch. 207, Acts of 2010 (M.G.L. c. 175 § 47AA et al.)
- **Mandate age:** No age limits — any age, medical-necessity based
- **Mandate caps:** None — no dollar, visit, or unit limits on ABA
- **Exempt from mandate:** Self-funded ERISA employer plans
- **New for 2026:** Optum's supplement codifies Down syndrome coverage for MA commercial members eff. 1/1/2026
- **Licensure:** MA Licensed Applied Behavior Analyst (LABA)

## The national policy, applied in Massachusetts

UnitedHealthcare administers ABA through Optum Behavioral Health as a two-step authorization on the Provider Express portal — assessment authorized first, then treatment — under Optum's Supplemental Clinical Criteria, with continued-service reviews every 4–6 months. That clinical policy is national — what changes in Massachusetts is the legal floor underneath it: ARICA governs what fully-insured plans must cover, while self-funded employer plans answer to ERISA and federal parity instead. Plan funding type is therefore the first fact to establish on every benefits check. The full national policy breakdown lives in our UnitedHealthcare / Optum guide; this page covers what changes in Massachusetts. [1]

## The Massachusetts mandate: ARICA

ARICA — An Act Relative to Insurance Coverage for Autism, Chapter 207 of the Acts of 2010, codified at M.G.L. c. 175 § 47AA and parallel sections for HMOs, service corporations, and GIC state-employee plans — is one of the strongest autism mandates in the country. Since January 1, 2011, fully-insured plans must cover the diagnosis and treatment of ASD with no age limits and no dollar, visit, or unit-of-service caps less than those on physical conditions; ABA is covered as habilitative/rehabilitative care when supervised by a board certified behavior analyst. Self-funded ERISA employer plans — a large share of Massachusetts employment — are exempt, answering to federal parity (MHPAEA) instead. And effective January 1, 2026, Chapter 388 of the Acts of 2024 extends the mandate: plans must also cover ABA (plus PT/OT/speech) for a sole diagnosis of Down syndrome. [3][5]

## Optum's Massachusetts-specific criteria

Massachusetts appears twice in Optum's ABA State Mandates supplement (BH 803ABA STM12026, effective January 2026). First, for Massachusetts Medicaid Early Intervention members (effective 10/1/2021): ABA services should not exceed 30 hours per week, and BCBA-to-paraprofessional supervision must run at 1:10 — with supervisor and technician possibly both required present during home visits. That entry codified, years early, the exact supervision ratio MassHealth enforced statewide in its 2026 audit. Second, for Massachusetts commercial members (effective 1/1/2026): coverage for the treatment of Down syndrome — defined by trisomy-21 genetic criteria — including ABA plus speech, OT, and PT, implementing Chapter 388 in Optum's own clinical criteria. [2]

## UnitedHealthcare and MassHealth

UnitedHealthcare runs no MassHealth MCO or ACPP of its own — but Optum, its behavioral arm, administers the ABA benefit for the Mass General Brigham Health Plan MassHealth ACPP, which has its own guide. UHC's Massachusetts Medicaid-linked products — UnitedHealthcare Connected for One Care (ages 21–64) and Senior Care Options (65+) — serve adult populations, so they carry essentially no ABA volume. Practically: a Massachusetts family with a UnitedHealthcare card is on commercial coverage, and an "Optum" authorization for a MassHealth child usually means the MGB plan. [8]

## Licensure & rates in Massachusetts

Massachusetts licenses behavior analysts as Licensed Applied Behavior Analysts (LABA), with an assistant tier (LAABA), through the Board of Registration of Allied Mental Health and Human Services Professions — under M.G.L. c. 112 as amended by Chapter 429 of the Acts of 2012, with requirements at 262 CMR 10.00, built on BCBA certification. Massachusetts payers key the ABA benefit to the LABA. On rates: UnitedHealthcare does not publish commercial ABA fee schedules for Massachusetts (none of the national carriers do) — rates are contract-negotiated and live in your participating-provider agreement. The MassHealth schedule (97153 at $16.37/unit) is the in-state floor to benchmark against, knowing providers regard it as low. [6]

## Intake gates

The questions that decide whether a family can start with UnitedHealthcare / Optum in Massachusetts, and what they have to bring.

- **Who may diagnose**: A licensure test with a diagnostic-competence qualifier: "A valid diagnosis of ASD (or other applicable diagnosis as required by governing laws) must be issued by a state licensed physician, psychologist, or other state licensed clinician qualified to make such diagnosis according to the diagnostic criteria based on the DSM-5-TR." The diagnosing clinician must also confirm and document the severity level. Once the diagnosis is confirmed, the ABA provider identified for the member must be a master's- or doctoral-level BCBA, a licensed behavioral health clinician who has attested to sufficient expertise and been credentialed for ABA, or a BCaBA or non-licensed individual working under direct supervision. [1]
- **Diagnostic tools required**: Optum publishes the most explicit instrument list of any national carrier, and splits it three ways. The DSM-5 diagnosis and severity level must be confirmed "using at least one clinically validated tool (not an all-inclusive list)": first-level screeners (ABC, CHAT/M-CHAT, CSBS-DP-IT-Checklist, ASQ, AQ, CAST), second-level screeners (CARS/CARS-2, RITA-T, STAT), and formal diagnostic tools used as part of a comprehensive diagnostic evaluation — the Autism Diagnostic Interview-Revised (ADI), the Autism Diagnostic Observation Schedule (ADOS/ADOS-2), and the Diagnostic Interview for Social and Communication Disorders (DISCO). Separately, treatment intensity must be chosen against baseline measurement using at least one of ATEC, VB-MAPP, ABLLS/ABLLS-R, AFLS, PEAK, SSIS, RBS-R, SRS, VABS or CFQL-2, individualized to the client rather than applied uniformly. [1]
- **Age limit** _(plan-dependent)_: Optum's Supplemental Clinical Criteria set no age limit for ABA — coverage turns on a valid ASD diagnosis, a credentialed provider and demonstrated medical necessity, with age entering only through norm-referenced instruments that compare functioning "to age-matched neurotypical peers." The binding age question is the legal layer underneath: ARICA bars fully-insured Massachusetts plans from imposing any age limit on ASD diagnosis and treatment, so on a fully-insured card there is no upper bound at all; a self-funded ERISA plan answers to its own plan document. Optum's own Massachusetts entries are not age rules: the Medicaid Early Intervention entry caps EI members at 30 hours per week, and the 1/1/2026 commercial entry adds Down syndrome coverage. [1][2][3]
  - Ask the plan: The member's benefit document and Optum via Provider Express — funding type decides whether the state mandate or the plan document sets the age boundary.
- **Prior-auth decision time** _(plan-dependent)_: Depends on how the plan is funded. For a fully insured plan issued in Massachusetts, M.G.L. c. 176O § 12 sets the clock. An initial determination is due "within two working days of obtaining all necessary information." An approval is phoned to the provider within 24 hours and confirmed in writing within two working days after that. A concurrent review (reauthorization) is due "within one working day of obtaining all necessary information," and during that review "the service shall be continued without liability to the insured until the insured has been notified of the determination." These clocks start when the file is complete, not when the request arrives, so a request missing information is not yet on the clock. A self-funded employer plan follows the federal ERISA claims rule instead. Urgent decisions are due within 72 hours. Other pre-service decisions are due within a reasonable time "but not later than 15 days after receipt of the claim," with one 15-day extension. A request to extend an ongoing course of treatment that involves urgent care must be decided within 24 hours if made at least 24 hours before the authorization expires. Optum, which reviews UHC's ABA, sets the reauthorization window: call the ABA/Autism queue "no more than 30 days prior to the current approvals on file expiring," with "all the necessary clinical information at the time you call in." [9][10][11]
  - Ask the plan: Benefits verification call or Provider Express: ask whether the plan is fully insured in Massachusetts (c. 176O clock) or self-funded ERISA (72-hour / 15-day clock).
- **Other insurance (who pays first)** _(plan-dependent)_: Depends on the family and on plan funding. For plans regulated by the Massachusetts Division of Insurance, 211 CMR 38.05 sets the order. The plan covering the person "other than as a dependent" pays before the one covering them as a dependent. For a child whose parents are married or living together, "The Plan of the parent whose Birthday falls earlier in the calendar year is the Primary Plan." If both parents share a birthday, the plan that has covered that parent longer pays first. For parents who are divorced, separated or living apart, a court decree that makes one parent responsible controls. With no decree, the order is the custodial parent, then the custodial parent's spouse, then the non-custodial parent, then the non-custodial parent's spouse. A self-funded ERISA plan sets its COB rules in its own plan document. This plan pays before TRICARE ("By law, TRICARE pays after all other health insurance," except Medicaid and a few government programs). It also pays before CHAMPVA ("CHAMPVA is the last payer to OHI"). If the child also has MassHealth (for example CommonHealth to cover copays), this plan pays first. MassHealth's rule then requires the provider to be in this plan's network and to follow its authorization rules. A denial for missing PA or for being out of network forfeits the MassHealth secondary payment, and MassHealth needs this plan's final disposition (EOB) on the claim. When the UHC plan has no ABA benefit and the secondary payer needs a denial, Optum's instruction is: "Call the number on the back of the member's insurance card to request a denial." [12][13][14][15][16][11]
  - Ask the plan: Benefits verification: ask whether the plan is fully insured in Massachusetts or self-funded, whether the child is on a second parent's plan (both parents' birthdays, custody or court-decree terms), and whether the child also has MassHealth, TRICARE or CHAMPVA.
- **Diagnosis recency** _(ask the plan)_: Not published. Optum's ABA criteria require a valid DSM-5-TR diagnosis confirmed with at least one clinically validated tool but set no maximum age for the diagnostic evaluation. The recency Optum does police is progress rather than diagnosis: continued coverage looks for demonstrable progress within a 6-month window and for updated standardized adaptive measures with change scores. [1]
  - Ask the plan: Optum via Provider Express, or the Care Advocate handling the authorization — ask whether the plan applies a diagnostic-evaluation recency window at intake.
- **Referral required?** _(ask the plan)_: Not published as a coverage condition. Optum gates ABA on prior authorization — "Prior authorization is required for ABA (unless otherwise specified or mandated by contract or law)" — delivered as a two-step assessment-then-treatment workflow on Provider Express, with a valid diagnosis rather than a referral as the clinical trigger. What the criteria do require is coordination: documentation of communication with day care, preschool, school, early intervention and allied health providers to avoid duplication. [1]
  - Ask the plan: Optum via Provider Express and the member's benefit document — referral requirements, where they exist, are a plan-design feature.
- **Telehealth** _(ask the plan)_: Optum endorses telehealth without publishing a code list. Its ABA criteria point providers to the "Practice Parameters for Telehealth-Implementation of Applied Behavior Analysis, Second Edition" as the best-practice reference, describe telehealth guidelines as a resource "for designing, implementing, and operating ABA services delivered via telehealth in a broad range of clinical settings (e.g., home, clinic, school)," and set the boundary plainly: "The telehealth options presented are not intended to supplant in-person service; rather, they are intended to supplement the traditional in-person service delivery model." Which codes pay remotely, and with which place-of-service code, is not stated in the clinical criteria — and daily progress notes must record the place of service regardless. [1]
  - Ask the plan: The Optum Care Advocate at authorization and Provider Express — Optum runs a virtual-visits attestation on some lines of business, so confirm approval status and the billing POS before scheduling remote 97155 or 97156.

## Delivery and billing rules

Coverage decides whether UnitedHealthcare / Optum in Massachusetts 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**: Optum’s commercial reimbursement policy publishes no supervision percentage or caseload cap — it refers providers to the ABA Coding Coalition for supervision requirements. What it does police is the boundary: “CPT codes 97153 and 97155 may not be billed for technician training,” including training a technician new to the organization on a client’s programming or on reassessment-driven goal changes. And 97155 “should be reported only for services where the QHP is either engaged directly with the patient or is directing a technician in implementing a modified protocol with the patient” — treatment planning is an indirect service and not separately reimbursable. [7]
- **Concurrent billing (97153 + 97155)**: Yes, with a single-provider exclusion. “Can I report 97153 or 97154 with 97155 concurrently? A. Yes, as long as the criteria in the descriptors of both codes are met. A single QHP may not report 97153 or 97154 with 97155 concurrently.” So the concurrency has to be two people — technician on 97153, analyst on 97155 directing them with the patient present. Separately, 97155 and 97156 may both pay on the same date of service only if the services are separate, distinct and clearly documented; “a single provider can’t bill for both simultaneously (e.g., in the same 15-minute block).” [7]
- **Daily limits / MUEs**: Optum publishes its own per-day table on top of CMS MUEs — maximum frequency per day: 97151 32 units (8 hrs), 97152 16 (4 hrs), 97153 32 (8 hrs), 97154 18 (4.5 hrs), 97155 24 (6 hrs), 97156 16 (4 hrs), 97157 16 (4 hrs), 97158 16 (4 hrs), 0362T 16 (4 hrs), 0373T 32 (8 hrs). MUEs otherwise apply per CMS guidance, and billing above 32 units/day of 97153 “may be subject to non-reimbursement or recovery.” Time is counted on the CMS 15-minute rule (1 unit at ≥ 8 minutes, 2 at ≥ 23, and so on). [7]
- **Bill as provider**: One provider-level modifier per line, matching whoever actually rendered the service: HM = Registered Behavior Technician (less than bachelor’s level), HN = BCaBA (bachelor’s level), HO = BCBA or master’s-level licensed clinician, HP = BCBA-D or doctoral-level licensed clinician. A billable ABA-supervisor service is billed with the applicable CPT code plus HO. Stacking level modifiers is a denial risk: “Billing multiple provider-level modifiers (HN, HM, HO, HP) on the same service line same service and same DOS is not appropriate and may result in claim denial.” Indirect work has no code of its own — it is bundled into the direct-service code. [7]
- **Session-note signature** _(ask the plan)_: No signature rule is published, but the documentation burden is explicit where money turns on it: services billed on the same date must be “separate, distinct, and clearly documented in the progress notes,” and if documentation does not clearly separate them the claim may be denied. Who signs, and within what window, is not stated. [7]
  - Ask the plan: The UnitedHealthcare/Optum provider manual and your participation agreement’s documentation clause.
- **Place of service** _(ask the plan)_: The commercial ABA reimbursement policy sets no place-of-service rule. Optum’s published ABA State Mandates document does carry Massachusetts entries, but they are scoped — one to Medicaid Early Intervention members (≤ 30 hours per week, 1:10 BCBA supervision), one to the commercial Down syndrome coverage effective January 1, 2026 — and neither is a place-of-service rule. [2]
  - Ask the plan: UnitedHealthcare provider services and the member’s benefit document.

## What intake should collect for UnitedHealthcare / Optum in Massachusetts

- **Plan funding type:** Fully insured (ARICA applies) vs. self-funded ERISA (exempt) — it decides which rulebook governs. Ask for the employer and check the card.
- **Line of business:** Commercial vs. the Optum-administered Mass General Brigham Health Plan (MassHealth) — different rules, different guide.
- **Member ID + card photo:** Enough to run a live benefits verification — the only reliable answer on limits and cost-sharing.
- **Diagnosis report:** DSM-5-TR ASD with a validated tool (ADI-R, ADOS-2) — or, from 1/1/2026, trisomy-21 genetic confirmation for the Down syndrome pathway.
- **Supervision staffing plan:** Optum's MA entries codify 1:10 BCBA-to-paraprofessional supervision — document it in the request.

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

## Verification of benefits (VOB) data

How UnitedHealthcare / Optum in Massachusetts ABA benefits route and read on an eligibility check. Data last updated 2026-07-23.

### EDI routing

- **Payer ID (Availity):** 87726 — Sourced from the stale (2012) Availity payer list — downgraded to inferred pending reconfirmation against a current Availity export.
- **Payer ID (Change Healthcare / Optum):** 87726
- **Supports 270/271 eligibility:** Yes
- **Behavioral health administrator:** Optum Behavioral Health
- **BH administrator payer ID:** 87726

### How the 271 reports ABA benefits

- **ABA benefit bucket (service type code):** MH — UHC's own EDI feed (87726) formally supports MH/A4-A8 with financial detail, but whether members whose ABA benefit is carved to Optum Behavioral Health actually receive populated MH-flavor detail through this SAME feed — versus a referral/vendor-lookup stub via the guide's own documented EB*U 'vendor' segment mechanism — is not resolved by any source found this pass. Confirm via Provider Express / UHC provider services for the specific plan.
- **Deductible applies to ABA:** yes — Same open question as abaBenefitBucket — confirm whether the carved-out BH benefit populates deductible detail on this feed.
- **Cost-share type:** plan-dependent — Both copay and coinsurance are structurally supported per plan; which applies to a given member is plan-document-specific.
- **271 response quality for ABA:** high

### 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 (assessment, then treatment); reviews every 4–6 months | 32 units/day (≤8 hrs) per day | — | — | HN, HO, HP |
| 97152 | Yes | Required — step 1 of Optum's two-step authorization (assessment, then treatment); reviews every 4–6 months | 16 units/day (≤4 hrs) per day | — | — | HN, HM, HO, HP |
| 97153 | Yes | Required — step 1 of Optum's two-step authorization (assessment, then treatment); reviews every 4–6 months | 32 units/day (≤8 hrs) per day | — | — | HN, HM, HO, HP |
| 97154 | Yes | Required — step 1 of Optum's two-step authorization (assessment, then treatment); reviews every 4–6 months | 18 units/day (≤4.5 hrs) per day | — | — | HN, HM, HO, HP |
| 97155 | Yes | Required — step 1 of Optum's two-step authorization (assessment, then treatment); reviews every 4–6 months | 24 units/day (≤6 hrs) per day | — | — | HN, HO, HP |
| 97156 | Yes | Required — step 1 of Optum's two-step authorization (assessment, then treatment); reviews every 4–6 months | 16 units/day (≤4 hrs) per day | — | — | HN, HO, HP |
| 97157 | Yes | Required — step 1 of Optum's two-step authorization (assessment, then treatment); reviews every 4–6 months | 16 units/day (≤4 hrs) per day | — | — | HN, HO, HP |
| 97158 | Yes | Required — step 1 of Optum's two-step authorization (assessment, then treatment); reviews every 4–6 months | 16 units/day (≤4 hrs) per day | — | — | HN, HO, HP |
| 0362T | Yes | Required — step 1 of Optum's two-step authorization (assessment, then treatment); reviews every 4–6 months | 16 units/day (≤4 hrs) per day | — | — | — |
| 0373T | Yes | Required — step 1 of Optum's two-step authorization (assessment, then treatment); reviews every 4–6 months | 32 units/day (≤8 hrs) per day | — | — | — |

Code notes:

- **97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, 0362T, 0373T:** Unit caps/modifiers sourced from Optum's national ABA Reimbursement Policy (2022RP501A) — the Supplemental Clinical Criteria contains no CPT codes at all; applied here as 'inferred' absent a confirmed Massachusetts-specific override. Optum's BH803ABA State Mandates supplement separately codifies MA Medicaid EI's 30 hr/week cap + 1:10 supervision (eff. 10/1/2021) and MA commercial Down syndrome coverage (eff. 1/1/2026) — see the MGB and state-Medicaid entries for those. Verify via: Provider Express / UHC provider services.

### Contacts

- **Provider services phone:** 1-877-614-0484
- **Phone menu path:** This Provider Express "Provider Services" line handles credentialing/contracting/network-status questions, NOT eligibility or ABA precertification specifically. Provider Express's own contact page states: "Call the number on the back of the member's ID card for plan-related inquiries" - there is no single national Optum BH eligibility/precert line; check eligibility via the Provider Express portal or the member-specific ID card number.
- **Hours:** Monday-Friday, 7:00 a.m.-7:00 p.m. CT
- **Portal:** [Provider Express (Optum Behavioral Health provider portal)](https://www.providerexpress.com)

Questions to ask on a verification call:

- Does ABA ride on UHC's medical claims or a distinct Optum BH hop for this specific Massachusetts plan, given the shared payer ID 87726?
- What is UHC's current pVerify payer ID (not found in this session's query)?
- Do UHC's ABA unit caps and modifiers match Optum's national reimbursement policy, or is there a Massachusetts-specific override?
- What POS codes and telehealth billing modifiers does UHC/Optum require for ABA in Massachusetts?

### VOB data sources

- https://pverify.com/payer-list/ (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.uhcprovider.com/content/dam/provider/docs/public/resources/edi/Payer-List-UHC-Affiliates-Strategic-Alliances.pdf (accessed 2026-07-23)
- https://www.caqh.org/sites/default/files/CAQH%20CORE%20Eligibility%20Benefits%20(270_271)%20Data%20Content%20Rule%20vEB2.0.pdf (accessed 2026-07-23)
- https://www.uhcprovider.com/content/dam/provider/docs/public/resources/edi/EDI-270-271-Companion-Guide-005010X279A1.pdf (accessed 2026-07-23)
- https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/autismABA/abaSCC.pdf (accessed 2026-07-23)
- https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/guidelines/reimbPolicies/abaReimburs2020s.pdf (accessed 2026-07-23)
- https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/guidelines/scc/ABA_SCC_SM.pdf (accessed 2026-07-23)
- https://www.providerexpress.com/content/ope-provexpr/us/en/contact-us.html (accessed 2026-07-23)

## Common questions

### Does UnitedHealthcare cover ABA therapy in Massachusetts?

Yes — under Optum's national two-step authorization for ASD, layered on ARICA for fully-insured plans, which bars age limits and benefit caps. Self-funded employer plans are exempt from the mandate, so always verify plan funding type first.

### What does the Massachusetts autism mandate require?

ARICA (Ch. 207, Acts of 2010) is one of the strongest mandates nationally: fully-insured plans must cover ASD diagnosis and treatment at any age with no dollar, visit, or unit caps, including ABA supervised by a board certified behavior analyst. From 1/1/2026, Chapter 388 adds sole-diagnosis Down syndrome — which Optum's state-mandate supplement implements by name.

### Does UnitedHealthcare run MassHealth plans?

Not directly — but Optum administers ABA for the Mass General Brigham Health Plan MassHealth ACPP (see its guide), and UHC's One Care and Senior Care Options products serve adults only.

### What does UnitedHealthcare pay for ABA in Massachusetts?

Commercial ABA rates are not published — they are negotiated in your participating-provider agreement. Benchmark against the MassHealth 101 CMR 358 schedule knowing it's widely considered low.

## Primary sources

1. [Optum ABA Supplemental Clinical Criteria (BH803ABASCC)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/autismABA/abaSCC.pdf)
2. [Optum ABA State Mandates — BH 803ABA STM12026 (eff. Jan 2026)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/guidelines/scc/ABA_SCC_SM.pdf)
3. [DisabilityInfo/AIRC — ARICA fact sheet](https://disabilityinfo.org/fact-sheet-library/laws-legislation/act-relative-to-insurance-coverage-for-autism-arica/)
4. [Session Law — Acts of 2010, Chapter 207 (malegislature.gov)](https://malegislature.gov/Laws/SessionLaws/Acts/2010/Chapter207)
5. [The Arc of Massachusetts — Down syndrome ABA expansion](https://thearcofmass.org/post/expansion-of-coverage-of-applied-behavior-analysis-aba-for-individuals-with-down-syndrome/)
6. [262 CMR 10.00 — LABA/LAABA licensure requirements (mass.gov)](https://www.mass.gov/regulations/262-CMR-1000-requirements-for-licensure-as-an-applied-behavior-analyst-and-assistant-applied-behavior-analyst)
7. [Optum — Applied Behavior Analysis (ABA) Reimbursement Policy, Commercial (2022RP501A)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/guidelines/reimbPolicies/abaReimburs2020s.pdf)
8. [MassHealth Managed Care Options — plan/BH-vendor map (April 2023)](https://abh.memberclicks.net/assets/docs/KeepingCoverage/2023%20MassHealth%20Accountable%20and%20Managed%20Care%20Options%20031723.pdf)
9. [M.G.L. c. 176O § 12 — utilization review determinations (malegislature.gov)](https://malegislature.gov/Laws/GeneralLaws/PartI/TitleXXII/Chapter176O/Section12)
10. [29 CFR 2560.503-1(f)(2) — ERISA group health plan claims procedure (eCFR)](https://www.ecfr.gov/current/title-29/section-2560.503-1)
11. [Optum ABA FAQ (Provider Express)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/autismABA/abaFAQ.pdf)
12. [211 CMR 38.05 — Coordination of benefits: order of benefit determination (Cornell LII mirror)](https://www.law.cornell.edu/regulations/massachusetts/211-CMR-38-05)
13. [TRICARE — Using Other Health Insurance](https://tricare.mil/Plans/OHI)
14. [38 CFR 17.276(d) — CHAMPVA is the last payer to other health insurance (eCFR)](https://www.ecfr.gov/current/title-38/section-17.276)
15. [130 CMR 450.316 — MassHealth third-party liability: requirements (Cornell LII mirror)](https://www.law.cornell.edu/regulations/massachusetts/130-CMR-450-316)
16. [130 CMR 450.317 — MassHealth third-party liability: payment limitations (Cornell LII mirror)](https://www.law.cornell.edu/regulations/massachusetts/130-CMR-450-317)

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.