---
title: "UnitedHealthcare / Optum ABA coverage in North Carolina: the intake guide."
url: "https://carelu.com/payers/unitedhealthcare-north-carolina"
markdown_url: "https://carelu.com/payers/unitedhealthcare-north-carolina.md"
state: NC (North Carolina)
payer: UnitedHealthcare / Optum in North Carolina
kind: Commercial insurance
description: "How UnitedHealthcare / Optum covers ABA for North Carolina families — the national clinical policy, prior authorization, the N.C.G.S. § 58-3-192 mandate (ages, caps, exemptions), North Carolina behavior-analyst licensure, and what intake should verify."
last_reviewed: September 2026
vob_data_updated: 2026-07-23
---

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

_Payer Guide · UnitedHealthcare · North Carolina · Last updated September 2026 · 4 primary sources_

> Optum Supplemental Clinical Criteria (BH803ABASCC) + the N.C.G.S. § 58-3-192 mandate layer.

For an intake team in North Carolina, a UnitedHealthcare card means three layers at once: the carrier's national clinical policy, North Carolina's autism insurance mandate (N.C.G.S. § 58-3-192), and the plan's funding type deciding which of the two actually binds. This guide stacks them in order.

## 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** _(ask the plan)_: Required — step 2 (treatment auth); reviews every 4–6 months [1]
  - Ask the plan: Optum/Provider Express portal support at (866) 209-9320 — ask what review interval will be set on this member's ABA treatment authorization. The ABA Supplemental Clinical Criteria require prior authorization for ABA but publish no 4–6 month reauthorization cycle; the span is assigned per authorization.
- **Autism diagnosis required?**: Yes — DSM-5-TR ASD confirmed with a validated tool (ADI-R, ADOS-2, etc.) [1]

## At a glance

- **Covers ABA?:** Yes — for ASD, per the national UnitedHealthcare policy
- **State mandate:** N.C.G.S. § 58-3-192
- **Mandate age:** May be limited to 18 and younger (parity-limited)
- **Mandate caps:** $40,000/yr cap, CPI-indexed (parity-limited)
- **Exempt from mandate:** Non-grandfathered individual/small group; self-funded ERISA
- **Licensure:** NC Licensed Behavior Analyst (NCBALB, since 2023)

## The national policy, applied in North Carolina

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 and an operational flag when utilization falls below 80% of authorized hours. That clinical policy is national — what changes in North Carolina is the legal floor underneath it: the state mandate below 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 North Carolina. [1]

## The North Carolina mandate: what it guarantees (and doesn't)

North Carolina’s mandate (effective July 2016) requires covered health benefit plans to cover “adaptive behavior treatment” — the statutory term; ABA itself isn’t named, but board certified behavior analysts are among the eight authorized provider categories, and treatment must be ordered by a licensed physician or licensed psychologist. Coverage may be limited to individuals 18 or younger and capped at $40,000/year (CPI-indexed from 2017). Two big carve-outs: the mandate does not apply to non-grandfathered individual and small-group plans (the ACA essential-health-benefits segment), and self-funded ERISA plans are exempt by preemption. The age and dollar limits are quantitative treatment limits of doubtful enforceability under MHPAEA for large-group plans. [2][3]

## UnitedHealthcare Medicaid in North Carolina

A family saying “we have UnitedHealthcare” in North Carolina may actually be on the carrier’s Medicaid plan — UnitedHealthcare Community Plan of North Carolina — which follows the state Medicaid rules, not this commercial policy. Verify which line of business the card belongs to, and use the dedicated guide for the Medicaid plan.

## Licensure & rates in North Carolina

North Carolina licenses behavior analysts under the Behavior Analyst Licensure Act (2021), with the NC Behavior Analyst Licensure Board accepting applications since July 2023 — ending the old regime where BCBAs worked under licensed-psychologist supervision. Commercial credentialing now runs on the LBA/LaBA license. On rates: UnitedHealthcare does not publish commercial ABA fee schedules for North Carolina (none of the national carriers do) — rates are contract-negotiated and live in your participating-provider agreement, so treat rate expectations as a contracting conversation, not a lookup. [4]

## Intake gates

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

- **Diagnosis recency**: The SCC set no expiry on the ASD diagnosis itself; what they require is that the DSM-5-TR diagnosis and severity level be confirmed and documented by the diagnosing clinician using validated tools. The clocks run on review instead: where there has been inadequate or no demonstrable progress with targeted symptoms or behaviors within a 6-month period, or goals have not been achieved within the estimated timeframes, the reasons must be assessed and interventions modified; and continued-service review specifically addresses utilization of prior-authorization-period hours below 80% over a 2-week period, which requires documented barriers. [1]
- **Who may diagnose**: 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 a diagnosis according to the DSM-5-TR criteria. [1]
- **Diagnostic tools required**: The SCC give a three-tier, explicitly non-exhaustive list and require the diagnosing clinician to confirm and document the DSM-5 diagnosis and severity level using at least one clinically validated tool. First-level screening tools: Autism Behavior Checklist, CHAT / M-CHAT, CSBS-DP-IT Checklist, Autism Screening Questionnaire, Autism Quotient, Childhood Autism Screening Test. Second-level screening tools: CARS and CARS-2, RITA-T, STAT. Formal diagnostic tools used as part of a comprehensive diagnostic evaluation: ADI-R, ADOS and ADOS-2, and DISCO. Treatment intensity must then be set from a baseline measured with at least one validated tool from a named list including ATEC, VB-MAPP, ABLLS and ABLLS-R, AFLS, PEAK, SSIS, RBS-R, SRS, Vineland and CFQL-2. [1]
- **Referral required?**: The SCC require no separate physician referral or order; what they require is prior authorization for ABA, unless otherwise specified or mandated by contract or law. In practice UnitedHealthcare administers this as a two-step Optum flow on Provider Express — an authorization for the assessment, then a second for treatment — with continued-service reviews on the authorization cycle. For a fully insured North Carolina plan the state mandate adds an ordering requirement the carrier policies do not: adaptive behavior treatment must be ordered by a licensed physician or licensed psychologist. The mandate does not reach non-grandfathered individual and small-group plans, and self-funded ERISA plans sit outside state insurance law entirely — establish plan funding type before relying on it. [1][2]
- **Age limit** _(plan-dependent)_: Optum’s ABA Supplemental Clinical Criteria carry no age criterion — coverage turns on the member-specific benefit plan, which supersedes the guideline, and on any federal or state regulatory requirement that supersedes the benefits. North Carolina’s mandate permits coverage to be limited to individuals 18 or younger and capped at $40,000 a year (CPI-indexed from 2017) on fully insured plans — quantitative treatment limits of doubtful enforceability against large-group plans under MHPAEA. The mandate does not apply to non-grandfathered individual and small-group plans, and self-funded ERISA plans are exempt by preemption. [1][2]
  - Ask the plan: Provider Express benefits check under a One Healthcare ID, or the behavioral health number on the member ID card — establish fully insured vs. self-funded ERISA first.
- **Prior-auth decision time** _(plan-dependent)_: UHC’s 2026 commercial administrative guide says standard requests take "up to 15 calendar days" and expedited "72 hours", and asks for requests "at least 15 calendar days in advance, if possible, but must be submitted at least 5 business days before the planned service date"; ABA itself is authorized by Optum Behavioral Health, whose network manual publishes no prospective decision clock (retrospective requests are decided within 30 calendar days). So the governing clock depends on funding. For a fully insured plan issued in North Carolina, G.S. 58-50-61(f) governs: "Prospective and concurrent determinations shall be communicated to the covered person's provider within three business days after the insurer obtains all necessary information" — the clock starts on complete information, not receipt, and the statute sets no separate faster clock for an urgent first decision (its expedited track is for appeals). In concurrent review "the insurer shall remain liable for health care services until the covered person has been notified of the noncertification." A self-funded employer plan sits outside state law and follows ERISA: a non-urgent pre-service decision "not later than 15 days after receipt of the claim by the plan", extendable once by up to 15 days; an urgent one within 72 hours; the clock starts when the request is filed, whether or not it is complete; and an urgent request to extend an approved course is decided within 24 hours if made "at least 24 hours prior to the expiration" of the current authorization. [5][6][7][8]
  - Ask the plan: At benefits verification, ask whether the plan is fully insured (a policy issued in the state) or a self-funded employer (ERISA) plan — that decides which clock applies — then ask the carrier’s behavioral health precert line its expected ABA turnaround and how early it wants the reauth.
- **Other insurance (who pays first)** _(plan-dependent)_: North Carolina’s COB rule for insured group plans (11 NCAC 12 .0514) sets the order: the plan covering the person as employee or subscriber pays before the plan covering them as a dependent; for a child of parents not separated, "the benefits of the Health Plan of the parent whose birthday falls earlier in a year are determined before those of the Health Plan of the parent whose birthday falls later" (same birthday: the longer-running plan first); for separated or divorced parents the custodial parent’s plan pays first, then the custodial parent’s spouse’s, then the non-custodial parent’s, unless a court decree the plan knows of assigns responsibility; Medicaid is expressly outside that rule. Self-funded plans follow their own plan document. UHC says "COB is administered according to the member's benefit plan and in accordance with law"; Optum’s network manual tells providers to determine other coverage, "bill the primary insurance carrier first, then notify Optum of your findings," and says it applies industry-standard COB rules and state law. Government coverage sorts itself by federal rule: a commercial plan pays before TRICARE, which is secondary to every other health plan but "In any double coverage situation involving Medicaid, CHAMPUS is always the primary payer"; CHAMPVA "is the last payer to OHI"; and Medicaid pays after all of them (42 CFR 433.139), so a child with commercial plus Medicaid needs this plan’s authorization and EOB before Medicaid will pay. [9][5][6][10][11][12]
  - Ask the plan: Collect both parents’ plans, dates of birth, and any custody decree at intake; confirm primary/secondary with each carrier’s COB unit (and whether the plan is self-funded) before the first claim.
- **Telehealth** _(ask the plan)_: Not addressed. The ABA Supplemental Clinical Criteria set no telehealth rules, place-of-service codes or modality limits for ABA; telehealth terms for a commercial member come from the plan’s own telehealth policy rather than from this guideline. [1]
  - Ask the plan: Provider Express (Clinical Resources → ABA Information) or the behavioral health number on the member ID card — ask which ABA codes are payable by telehealth on this plan and with which POS code.

## Delivery and billing rules

Coverage decides whether UnitedHealthcare / Optum in North Carolina 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**: Consistent with CASP standards of care, direct case supervision is required at one to two hours for every ten hours of direct treatment per week. Technicians must be under the applicable supervision of a BCBA or a licensed behavioral health clinician and should be Registered Behavior Technicians or another appropriately certified behavior technician as allowable by state mandate. Optum adds that it is not recommended that parents serve in an RBT role, and that a BCBA acting in a supervisory role for a parent serving as RBT for their own child would violate the ethics code with a duty to self-report. [1]
- **Daily limits / MUEs**: The SCC set no numeric hour cap — the number of service hours requested must be justified by the member’s documented clinical need according to level of impairment, symptom severity, treatment history and response, at the least restrictive and most clinically appropriate level. The operative review trigger runs the other way: utilization below 80% of prior-authorization-period hours over a two-week period is specifically addressed at continued-service review and requires documentation of barriers and how they will be addressed. [1]
- **Place of service**: ABA must be provided at the least restrictive and most clinically appropriate level, with generalization and maintenance of skills outside the treatment environment into natural settings such as home and community forming part of the continued-service test. Not covered: services that are not ABA therapy, such as a 1:1 aide delivered simultaneously during classroom instruction, or services covered under IDEA. School-based ABA does allow coordination of services and covers teacher training, meetings with school personnel, and observations in the school setting, and the treatment plan is expected to coordinate with the school and any IFSP or IEP. [1]
- **Bill as provider**: Once an ASD diagnosis is confirmed, a credentialed ABA provider is identified for the member: a master’s- or doctoral-level Board-Certified Behavior Analyst, or a licensed behavioral health clinician who has attested to sufficient expertise and been credentialed to provide ABA. A BCaBA or non-licensed individual works under the direct supervision of a BCBA or licensed behavioral health clinician who takes responsibility for the individual’s care, assisting in assessment or implementing a treatment plan developed by that BCBA or clinician. [1]
- **Concurrent billing (97153 + 97155)** _(ask the plan)_: Not addressed. The ABA Supplemental Clinical Criteria are a medical-necessity document and say nothing about billing 97153 and 97155 for the same clock time; direct case supervision is defined as occurring concurrently with direct treatment, but the reimbursement consequence is not stated there. [1]
  - Ask the plan: Optum Provider Express National Network Manual and the participating-provider agreement, or a written coding determination from Optum.
- **Session-note signature** _(ask the plan)_: Not addressed. The ABA Supplemental Clinical Criteria specify what must be documented for coverage — progress by targeted symptom and behavior, standardized and norm-referenced measures, caregiver involvement, barriers — but not who must sign a session note or within what time. [1]
  - Ask the plan: Optum Provider Express National Network Manual (documentation standards) and the participating-provider agreement.

## What intake should collect for UnitedHealthcare / Optum in North Carolina

- **Plan funding type:** Fully insured (mandate applies) vs. self-funded ERISA (exempt) — it decides which rulebook governs. Ask for the employer and check the card.
- **Line of business:** Commercial vs. UnitedHealthcare Community Plan of North Carolina (Medicaid) — 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 ASD diagnosis, diagnosing provider and credentials, evaluation date.
- **Age:** Where the mandate carries age terms, flag edge cases for the parity analysis rather than turning families away.

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

## Verification of benefits (VOB) data

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

### EDI routing

- **Payer ID (pVerify):** 00192
- **Payer ID (Availity):** 87726
- **Payer ID (Change Healthcare / Optum):** 87726
- **Supports 270/271 eligibility:** Yes
- **Behavioral health administrator:** Optum Behavioral Health
- **BH administrator payer ID:** 87726 — Confirmed for MEDICAID: Optum's own “UnitedHealthcare Community Plan of North Carolina ABA Program Quick Reference Guide” states verbatim “Claims Payer ID 87726” (same as medical) for autism/ABA claims, addressed to Optum Behavioral Health. Applied to this COMMERCIAL guide as inferred cross-LOB pattern evidence, not a commercial-specific confirmation — pVerify separately lists a distinct “UHG007 United Healthcare - Optum Behavioral Solutions” payer ID not reconciled against 87726 for commercial NC. Confirm directly via Provider Express / UHC provider services before automating commercial routing.
- **ABA rides on:** medical benefit — Same as administratorPayerId.
- **Two-hop verification required:** No — Same as administratorPayerId.

### 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 — two-step Optum authorization (assessment, then treatment); continued-service review every 4–6 months | 32 units/day (≤8 hrs) per day | — | — | HN, HO, HP |
| 97152 | Yes | Required — two-step Optum authorization (assessment, then treatment); continued-service review every 4–6 months | 16 units/day (≤4 hrs) per day | — | — | HN, HM, HO, HP |
| 97153 | Yes | Required — two-step Optum authorization (assessment, then treatment); continued-service review every 4–6 months | 32 units/day (≤8 hrs) per day | — | — | HN, HM, HO, HP |
| 97154 | Yes | Required — two-step Optum authorization (assessment, then treatment); continued-service review every 4–6 months | 18 units/day (≤4.5 hrs) per day | — | — | HN, HM, HO, HP |
| 97155 | Yes | Required — two-step Optum authorization (assessment, then treatment); continued-service review every 4–6 months | 24 units/day (≤6 hrs) per day | — | — | HN, HO, HP |
| 97156 | Yes | Required — two-step Optum authorization (assessment, then treatment); continued-service review every 4–6 months | 16 units/day (≤4 hrs) per day | — | — | HN, HO, HP |
| 97157 | Yes | Required — two-step Optum authorization (assessment, then treatment); continued-service review every 4–6 months | 16 units/day (≤4 hrs) per day | — | — | HN, HO, HP |
| 97158 | Yes | Required — two-step Optum authorization (assessment, then treatment); continued-service review every 4–6 months | 16 units/day (≤4 hrs) per day | — | — | HN, HO, HP |
| 0362T | Yes | Required — two-step Optum authorization (assessment, then treatment); continued-service review every 4–6 months | 16 units/day (≤4 hrs) per day | — | — | — |
| 0373T | Yes | Required — two-step Optum authorization (assessment, then treatment); continued-service review 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 and modifiers sourced from Optum's NATIONAL ABA Reimbursement Policy (2022RP501A), same as the Georgia build — applied absent a confirmed NC-specific override. Claims-routing payer ID (87726, same as medical) is corroborated by Optum's own NC MEDICAID ABA Quick Reference Guide, applied here as inferred cross-LOB evidence, not a commercial-specific confirmation. Verify via: Provider Express / UHC provider services.

### Contacts

- **Provider services phone:** 866-209-9320
- **Hours:** 8 a.m.–8 p.m. Eastern time
- **Portal:** [Optum Provider Express](https://www.providerexpress.com)

Questions to ask on a verification call:

- Does ABA route to Optum Behavioral Health (payer ID 87726) for this specific commercial plan, or does it stay on standard medical routing — please confirm whether a second EDI hop is required?
- Do you support real-time or only batch 270/271 for this payer ID?
- Is ABA cost share a copay or coinsurance for this plan (UHC's family default is plan-dependent)?
- Is the copay charged per-visit or per-day, and does the deductible apply?
- Does the plan's out-of-pocket max apply to ABA services?
- What telehealth modifiers and place-of-service settings are accepted for ABA billing under this plan?

### VOB data sources

- 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)
- 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/autismABA/ncaba/ncABA-QRG.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/guidelines/reimbPolicies/abaReimburs2020s.pdf (accessed 2026-07-23)
- https://public.providerexpress.com/content/ope-provexpr/us/en/about-us/provider-express-support.html (accessed 2026-07-23)

## Common questions

### Does UnitedHealthcare cover ABA therapy in North Carolina?

Yes — under the carrier's national policy for ASD, layered on North Carolina's mandate (N.C.G.S. § 58-3-192) for fully-insured plans. Self-funded employer plans are exempt from the mandate, so always verify plan funding type first.

### What does the North Carolina autism mandate require?

North Carolina’s mandate (effective July 2016) requires covered health benefit plans to cover “adaptive behavior treatment” — the statutory term; ABA itself isn’t named, but board certified behavior analysts are among the eight authorized provider categories, and treatment must be ordered by a licensed physician or licensed psychologist. See the mandate section above for ages, caps, and exemptions — and remember federal parity limits how hard the numeric caps can be enforced against group plans.

### What does UnitedHealthcare pay for ABA in North Carolina?

Commercial ABA rates are not published — they are negotiated in your participating-provider agreement. Benchmark against the North Carolina Medicaid fee schedule where one exists, and treat rate-setting as part of contracting.

## Primary sources

1. [Optum ABA Supplemental Clinical Criteria (BH803ABASCC)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/autismABA/abaSCC.pdf)
2. [N.C. Gen. Stat. § 58-3-192 (autism coverage mandate)](https://codes.findlaw.com/nc/chapter-58-insurance/nc-gen-st-sect-58-3-192/)
3. [Autism Speaks — North Carolina state-regulated coverage](https://www.autismspeaks.org/north-carolina-state-regulated-insurance-coverage)
4. [North Carolina Behavior Analyst Licensure Board](https://ncbehavioranalystboard.org/)
5. [UnitedHealthcare — 2026 Care Provider Administrative Guide (Commercial, eff. 4/1/2026)](https://www.uhcprovider.com/content/dam/provider/docs/public/admin-guides/2026-UHC-Administrative-Guide.pdf)
6. [Optum Behavioral Health — National Network Manual (eff. 9/1/2026)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/adminResourcesMain/netwmanual/NNManual.pdf)
7. [N.C. Gen. Stat. § 58-50-61 — utilization review (prospective/concurrent determinations)](https://www.ncleg.gov/EnactedLegislation/Statutes/HTML/BySection/Chapter_58/GS_58-50-61.html)
8. [29 CFR 2560.503-1(f) — ERISA claims procedure: group health plan decision timeframes](https://www.ecfr.gov/current/title-29/section-2560.503-1)
9. [11 NCAC 12 .0514 — coordination of benefits, order of benefit determination (readopted eff. 7/1/2020)](http://reports.oah.state.nc.us/ncac/title%2011%20-%20insurance/chapter%2012%20-%20life%20and%20health%20division/11%20ncac%2012%20.0514.pdf)
10. [32 CFR 199.8 — TRICARE double coverage (secondary to other plans, primary to Medicaid)](https://www.ecfr.gov/current/title-32/subtitle-A/chapter-VII/subchapter-M/part-199/section-199.8)
11. [38 CFR 17.276 — CHAMPVA is the last payer to other health insurance](https://www.ecfr.gov/current/title-38/section-17.276)
12. [42 CFR 433.139 — payment of claims involving third-party liability](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-433/subpart-D/section-433.139)

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.