---
title: "UnitedHealthcare / Optum ABA coverage in Ohio: the intake guide."
url: "https://carelu.com/payers/unitedhealthcare-ohio"
markdown_url: "https://carelu.com/payers/unitedhealthcare-ohio.md"
state: OH (Ohio)
payer: UnitedHealthcare / Optum in Ohio
kind: Commercial insurance
description: "How UnitedHealthcare / Optum covers ABA for Ohio families — the national clinical policy, prior authorization, the Ohio R.C. § 3923.84 mandate (ages, caps, exemptions), Ohio behavior-analyst licensure, and what intake should verify."
last_reviewed: September 2026
vob_data_updated: 2026-07-23
---

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

_Payer Guide · UnitedHealthcare · Ohio · Last updated September 2026 · 4 primary sources_

> Optum Supplemental Clinical Criteria (BH803ABASCC) + the Ohio R.C. § 3923.84 mandate layer.

For an intake team in Ohio, a UnitedHealthcare card means three layers at once: the carrier's national clinical policy, Ohio's autism insurance mandate (Ohio R.C. § 3923.84), 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:** Ohio R.C. § 3923.84
- **Mandate age:** Service floors apply under age 14
- **Mandate caps:** Floors, not caps: ≥20 hrs/wk ABA-inclusive intervention
- **Exempt from mandate:** Limited-benefit policy types; self-funded ERISA
- **Licensure:** Certified Ohio Behavior Analyst (COBA, Board of Psychology)

## The national policy, applied in Ohio

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 Ohio 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 Ohio. [1]

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

Ohio’s mandate (HB 463, 2017; R.C. 3923.84, with § 1751.84 for HMOs) sets service floors for insureds under age 14 rather than caps: at least 20 hours/week of “clinical therapeutic intervention” — explicitly defined to include applied behavior analysis — plus 20 visits/year each for speech and OT and 30 outpatient mental-health visits/year. Mandated ABA must be provided by or under the supervision of a Certified Ohio Behavior Analyst (or licensed psychologist/counselor/social worker/MFT), and since a March 2025 amendment, clinical nurse specialists and certified nurse practitioners can also prescribe or order ASD services. Dollar limits and cost-sharing can’t be less favorable than substantially all medical/surgical benefits; self-funded ERISA plans are exempt by preemption, and carriers in practice authorize on medical necessity rather than the statutory hour counts. [2]

## Optum's Ohio-specific criteria

Ohio has its own entries in Optum’s ABA State Mandates supplemental criteria: for Ohio fully-insured members (effective March 2025), ASD screening, diagnosis, and treatment may also be performed, prescribed, or ordered by clinical nurse specialists and certified nurse practitioners — mirroring the 2025 amendment to the state mandate and widening who can generate a qualifying order. [4]

## UnitedHealthcare Medicaid in Ohio

A family saying “we have UnitedHealthcare” in Ohio may actually be on the carrier’s Medicaid plan — UnitedHealthcare Community Plan of Ohio — 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 Ohio

Ohio’s COBA certificate (ORC Chapter 4783, Ohio Board of Psychology, with a direct BCBA pathway) is baked into the mandate itself — R.C. 3923.84 conditions mandated ABA on COBA-supervised delivery — so COBA status is a commercial coverage requirement in Ohio, not just a Medicaid credentialing detail. On rates: UnitedHealthcare does not publish commercial ABA fee schedules for Ohio (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. [3]

## Intake gates

The questions that decide whether a family can start with UnitedHealthcare / Optum in Ohio, 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 Ohio plan the state mandate adds an ordering requirement the carrier policies do not: R.C. 3923.84 makes coverage contingent on the services being prescribed or ordered by a psychologist trained in autism, a developmental pediatrician, or — since Senate Bill 196 took effect March 20, 2025 — a clinical nurse specialist or certified nurse practitioner specialising in pediatric health. Prior authorization is written into the mandate as the other condition of coverage. Non-grandfathered individual and small-group plans are carved out, and self-funded ERISA plans sit outside state insurance law. Ohio matters here: the SCC’s own benefit considerations list "Ohio Fully Insured" and "Ohio Medicaid" among the lines of business for which the ABA State Mandates document supplies state-mandated criteria that control where they conflict with this document. [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. Ohio sets a floor rather than a cap: R.C. 3923.84 requires at least 20 hours a week of clinical therapeutic intervention for an insured under age fourteen and says the section "shall not be construed as limiting benefits that are otherwise available." Non-grandfathered individual and small-group plans and limited-benefit policies are carved out by name, and self-funded ERISA plans are exempt by preemption. Ohio matters here: the SCC’s own benefit considerations list "Ohio Fully Insured" and "Ohio Medicaid" among the lines of business for which the ABA State Mandates document supplies state-mandated criteria that control where they conflict with this document. [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)_: For insured Ohio plans the state clock is faster than the federal floor. When the request is submitted electronically, the insurer “shall respond to all prior authorization requests within forty-eight hours for urgent care services, or ten calendar days for any prior authorization request that is not for an urgent care service, of the time the request is received” (R.C. 3923.041 for sickness-and-accident insurers and public employee benefit plans; R.C. 1751.72 for health insuring corporations). An incomplete request must get a reply naming the missing information. Plans outside those statutes, such as a self-funded private employer plan, are held to the federal floor: pre-service decisions “not later than 15 days after receipt of the claim,” one 15-day extension, and urgent care “not later than 72 hours after receipt” (29 CFR 2560.503-1). The same floor applies to non-grandfathered individual and marketplace plans (45 CFR 147.136). [5][6][7][8]
  - Ask the plan: Optum Behavioral Health (number on the member ID card): whether the plan is insured in Ohio (R.C. 3923.041 / 1751.72 apply), self-funded (ERISA floor) or grandfathered; the plan’s own standard and urgent turnaround for ABA; and how far ahead of expiry a reauthorization must be filed.
- **Other insurance (who pays first)** _(plan-dependent)_: Ohio’s COB rule sets the order for a child on both parents’ plans: “The plan of the parent whose birthday falls earlier in the calendar year is the primary plan”; if the birthdays match, the plan that has covered a parent longer goes first. For parents who are divorced, separated or not living together, a court decree assigning health costs controls. Without one, the order is the custodial parent’s plan, then the custodial parent’s spouse’s, then the non-custodial parent’s, then the non-custodial parent’s spouse’s (OAC 3901-8-01). That rule governs contracts issued in Ohio. Whether a self-funded employer plan follows it or its own plan document’s COB clause is a question for that plan. Public coverage pays after this plan. Ohio Medicaid “must be the last payer” (OAC 5160-1-08). TRICARE “pays after all other health insurance, except for” Medicaid. CHAMPVA “is always the secondary payer, except to Medicaid.” If this plan denies because its rules were not followed, including its prior authorization, TRICARE “may also deny the claim.” So get this plan’s authorization even when a public program is secondary. [9][10][11][12]
  - Ask the plan: Ask the family for both parents’ cards and birth dates, and ask the employer or HR whether each plan is fully insured and issued in Ohio (OAC 3901-8-01 order applies) or self-funded (the plan document’s COB clause applies).
- **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 Ohio 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 Ohio

- **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 Ohio (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 Ohio 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 — 87726 confirmed as the Optum/UHC claims payer ID via Optum Provider Express's EDI page (verified); the Availity occurrence is from the 2012 export, so the Availity source ships inferred.
- **Payer ID (Change Healthcare / Optum):** 87726
- **Supports 270/271 eligibility:** Yes
- **Behavioral health administrator:** Optum Behavioral Health
- **BH administrator payer ID:** 87726
- **ABA rides on:** medical benefit
- **Two-hop verification required:** No

### 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 — Optum ABA prior authorization via Provider Express (specific process/review cadence not confirmed in the cited sources) | 32 units/day (≤8 hrs) per day | — | — | HN, HO, HP |
| 97152 | Yes | Required — Optum ABA prior authorization via Provider Express (specific process/review cadence not confirmed in the cited sources) | 16 units/day (≤4 hrs) per day | — | — | HN, HM, HO, HP |
| 97153 | Yes | Required — Optum ABA prior authorization via Provider Express (specific process/review cadence not confirmed in the cited sources) | 32 units/day (≤8 hrs) per day | — | — | HN, HM, HO, HP |
| 97154 | Yes | Required — Optum ABA prior authorization via Provider Express (specific process/review cadence not confirmed in the cited sources) | 18 units/day (≤4.5 hrs) per day | — | — | HN, HM, HO, HP |
| 97155 | Yes | Required — Optum ABA prior authorization via Provider Express (specific process/review cadence not confirmed in the cited sources) | 24 units/day (≤6 hrs) per day | — | — | HN, HO, HP |
| 97156 | Yes | Required — Optum ABA prior authorization via Provider Express (specific process/review cadence not confirmed in the cited sources) | 16 units/day (≤4 hrs) per day | — | — | HN, HO, HP |
| 97157 | Yes | Required — Optum ABA prior authorization via Provider Express (specific process/review cadence not confirmed in the cited sources) | 16 units/day (≤4 hrs) per day | — | — | HN, HO, HP |
| 97158 | Yes | Required — Optum ABA prior authorization via Provider Express (specific process/review cadence not confirmed in the cited sources) | 16 units/day (≤4 hrs) per day | — | — | HN, HO, HP |
| 0362T | Yes | Required — Optum ABA prior authorization via Provider Express (specific process/review cadence not confirmed in the cited sources) | 16 units/day (≤4 hrs) per day | — | — | — |
| 0373T | Yes | Required — Optum ABA prior authorization via Provider Express (specific process/review cadence not confirmed in the cited sources) | 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); the ABA Supplemental Clinical Criteria contains no CPT codes. Ohio HAS an entry in Optum's ABA State Mandates supplement (eff. 3/2025): CNSs and CNPs may screen/diagnose/order ASD services for OH fully-insured members, mirroring the R.C. 3923.84 amendment. Verify via: Provider Express / UHC provider services. Ohio mandate (R.C. 3923.84): fully-insured plans set service FLOORS for insureds under age 14 (>=20 hrs/wk ABA-inclusive clinical therapeutic intervention), COBA-supervised; self-funded ERISA plans are exempt. Verify plan funding type on the live benefits check.

### Contacts

- **Provider services phone:** (877) 842-3210
- **Portal:** [UnitedHealthcare Provider Portal / Provider Express](https://secure.uhcprovider.com/)

Questions to ask on a verification call:

- What is the current review cadence/process for an Optum ABA prior-authorization request?
- What POS code and modifier should be used for a telehealth ABA session?
- Do the national unit caps and HN/HM/HO/HP modifier tiers in Optum's ABA Reimbursement Policy (2022RP501A) apply as published for this Ohio plan?
- Is this member's plan fully-insured or self-funded? Ohio mandate (R.C. 3923.84): fully-insured plans set service FLOORS for insureds under age 14 (>=20 hrs/wk ABA-inclusive clinical therapeutic intervention), COBA-supervised; self-funded ERISA plans are exempt. Verify plan funding type on the live benefits check.

### 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; source document older than 18 months)
- https://public.providerexpress.com/content/ope-provexpr/us/en/admin-resources/claim-tips/electronic-claim-submission-and-electronic-data-interchange.html (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://codes.findlaw.com/oh/title-xxxix-insurance/oh-rev-code-sect-3923-84/ (accessed 2026-07-23)
- https://www.uhcprovider.com/en/contact-us.html (accessed 2026-07-23)

## Common questions

### Does UnitedHealthcare cover ABA therapy in Ohio?

Yes — under the carrier's national policy for ASD, layered on Ohio's mandate (Ohio R.C. § 3923.84) for fully-insured plans. Self-funded employer plans are exempt from the mandate, so always verify plan funding type first.

### What does the Ohio autism mandate require?

Ohio’s mandate (HB 463, 2017; R.C. 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 Ohio?

Commercial ABA rates are not published — they are negotiated in your participating-provider agreement. Benchmark against the Ohio 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. [Ohio Rev. Code § 3923.84 (autism coverage mandate)](https://codes.findlaw.com/oh/title-xxxix-insurance/oh-rev-code-sect-3923-84/)
3. [Ohio Admin. Code 4783-4-01 — COBA requirements](https://www.law.cornell.edu/regulations/ohio/Ohio-Admin-Code-4783-4-01)
4. [Optum — ABA State Mandates supplemental criteria (BH 803ABA, Jan 2026)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/guidelines/scc/ABA_SCC_SM.pdf)
5. [R.C. 3923.041 — prior authorization: sickness and accident insurers and public employee benefit plans](https://codes.ohio.gov/ohio-revised-code/section-3923.041)
6. [R.C. 1751.72 — prior authorization: health insuring corporations](https://codes.ohio.gov/ohio-revised-code/section-1751.72)
7. [29 CFR 2560.503-1 — ERISA claims procedure (eCFR)](https://www.ecfr.gov/current/title-29/section-2560.503-1)
8. [45 CFR 147.136 — internal claims and appeals, group and individual coverage (eCFR)](https://www.ecfr.gov/current/title-45/section-147.136)
9. [OAC 3901-8-01 — Coordination of benefits (order of benefit determination)](https://codes.ohio.gov/ohio-administrative-code/rule-3901-8-01)
10. [OAC 5160-1-08 — Medicaid coordination of benefits](https://codes.ohio.gov/ohio-administrative-code/rule-5160-1-08)
11. [TRICARE — Using Other Health Insurance](https://www.tricare.mil/Plans/OHI)
12. [VA — CHAMPVA: Information for Outpatient Providers (IB 10-1587, updated 9/20/2023)](https://www.va.gov/COMMUNITYCARE/docs/pubfiles/factsheets/FactSheet_01-20.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.