---
title: Wellpoint New Jersey ABA coverage (NJ FamilyCare MCO).
url: "https://carelu.com/payers/wellpoint-new-jersey"
markdown_url: "https://carelu.com/payers/wellpoint-new-jersey.md"
state: NJ (New Jersey)
payer: Wellpoint New Jersey (formerly Amerigroup)
kind: Medicaid managed care plan (MCO)
parent_program: NJ FamilyCare
description: "How Wellpoint (formerly Amerigroup New Jersey) administers NJ FamilyCare ABA — state-baseline coverage with the behavioral network run through Carelon, Availity authorization channels, the separate Carelon contracting funnel, and named ABA contacts."
last_reviewed: September 2026
vob_data_updated: 2026-07-23
---

# Wellpoint New Jersey ABA coverage (NJ FamilyCare MCO).

_Payer Guide · Wellpoint (NJ) · Last updated September 2026 · 4 primary sources_

> Ex-Amerigroup Elevance plan; state-baseline ABA via Availity, with Carelon running the BH network.

Wellpoint New Jersey — the Elevance plan formerly branded Amerigroup — administers the NJ FamilyCare ABA benefit as a state-baseline plan: no distinct ABA clinical criteria, unit caps, or fee schedule have been published. Its defining structural quirk is that the behavioral-health network runs through Carelon Behavioral Health, which means ABA contracting is a separate funnel from the medical plan — a routing fact that costs weeks when discovered late. Authorization itself flows through familiar Availity plumbing.

This plan administers the **NJ FamilyCare** ABA benefit: the state rules are the floor, and this page covers what the plan layers on top. Read it together with the [NJ FamilyCare (New Jersey Medicaid) guide](https://carelu.com/payers/new-jersey-medicaid).

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Required — NJ FamilyCare baseline; ABA authorization via Availity or (800) 454-3730 [2][1]
- **Prior auth for treatment**: Required — same channel; outpatient Medicaid fax (844) 442-8007 [2][1]
- **Autism diagnosis required?**: Yes — ASD (F84.0–F84.9) by a qualified healthcare professional (state baseline) [2]

## At a glance

- **Plan type:** NJ FamilyCare MCO (Elevance; formerly Amerigroup NJ)
- **Clinical rules:** State baseline — no NJ-specific published ABA policy found
- **Prior auth:** Required per the state benefit; via Availity or (800) 454-3730
- **BH network / UM:** Carelon Behavioral Health — a separate contracting funnel
- **Claims:** Availity, payor ID WLPNT; provider services (833) 731-2149

## State-baseline rules, Carelon plumbing

With no published Wellpoint-specific ABA criteria, plan requests against the NJ FamilyCare baseline: ASD diagnosis from a QHP, MCO-authorized assessment, treatment contingent on plan approval, and the state daily unit guide as the likely edit surface. Mechanically, ABA authorization submits through Availity (availity.com) or by phone at (800) 454-3730, with forms at provider.wellpoint.com/new-jersey-provider/resources/forms and outpatient Medicaid fax (844) 442-8007. Because hour caps and rates are unpublished, confirm authorization spans and unit handling with the plan before the first submission — and treat your contract as the only rate source. [1][2]

## The Carelon funnel, and who to call

ABA network contracting runs through Carelon Behavioral Health (provider.relations.NJ@carelon.com) — a separate funnel from the Wellpoint medical plan, so a practice contracted for medical services isn't automatically in the ABA network. The named ABA clinical contact is Ann Basil, LCSW, Director of BH Services (732-713-7636, ann.basil@wellpoint.com). Provider services runs at (833) 731-2149 / (800) 454-3730. And watch the rebrand at intake: cards and directory listings may still say Amerigroup — same plan, new name. [1]

## Intake gates

The questions that decide whether a family can start with Wellpoint New Jersey (formerly Amerigroup), and what they have to bring.

- **Age limit**: Two published numbers, and they differ in precision rather than in substance. The founding DMAHS newsletter sets the benefit for "any Medicaid eligible child, under the age of 21, who has been diagnosed with ASD as defined by ICD 10 diagnoses F84.0 through F84.9 by a qualified healthcare provider," delivered under EPSDT, which reaches "individuals under the age of twenty-one." Optum's New Jersey Medicaid entry adds the floor as well as the ceiling: "ABA services shall be made available to children 18 months to 21 years of age based on medical necessity," and its NJ FamilyCare provider orientation repeats it — "Must be 18 months – 21 years old," including in the specialized FamilyCare carve-out. No hour caps are attached to the age band. Wellpoint New Jersey publishes no deviation from this, and its own material was checked for one. [2][3]
- **Who may diagnose**: New Jersey names them twice, and the second list is narrower than the first. The newsletter's general test: "The need for ABA services must be determined by a qualified healthcare professional (QHP) capable of making a diagnosis of autism. QHPs include licensed health care professionals, who are qualified by education, training, or licensure/regulation (when applicable) to perform a professional service within his/her scope of practice." The enumerated list of acceptable QHPs "for the diagnosis and treatment planning for adaptive behavior services" is then: Physicians; Psychologists, which "Requires an active board certified behavior analyst (BCBA) certification in good standing and a qualifying doctoral-level degree (BCBA-D)"; and BCBAs, who appear for treatment planning rather than diagnosis. Optum's NJ entry restates the split: the diagnosis comes from "a physician or psychologist," and "It is not uncommon for one QHP to make the diagnosis (such as a physician) and a separate QHP (such as a BCBA) to develop and supervise the treatment plan." No Wellpoint-specific diagnostician list is published. [2][3]
- **Diagnostic tools required**: None required — and New Jersey is one of the few states that says so in terms. Optum's NJ Medicaid entry: "A comprehensive diagnostic evaluation is not required to access ABA services," with "ABA services … available to any child diagnosed with autism spectrum disorder as defined by ICD-10 diagnoses F84.0 through F84.9." The DMAHS newsletter names no instrument either. That makes this the friendliest diagnostic bar of the three states on this page — intake should not queue a New Jersey family for an ADOS-2 before starting the authorization. Wellpoint New Jersey publishes no deviation from this, and its own material was checked for one. [3][2]
- **Referral required?**: No PCP referral and no physician order. The sequence the state sets is QHP determination, then MCO authorization: "Once an individual is properly diagnosed with ASD, the MCO shall authorize a QHP to assess the child for the development of a proposed treatment plan," and treatment follows "Contingent upon approval of the treatment plan." The genuine intake asset sits one step earlier — members still fee-for-service pending MCO enrollment are covered through Gainwell with no prior authorization required at all, so enrollment status, not a referral, is the routing question. Plan practice adds paperwork rather than a referral: Horizon wants an ASD diagnosis "script" from a QHP attached to the assessment request, which is the diagnosis document under another name. One Wellpoint-specific routing fact costs weeks when it is discovered late, and it is not a clinical gate: ABA network contracting runs through Carelon Behavioral Health, separately from the Wellpoint medical plan, so being contracted for medical services does not put a practice in the ABA network. Authorization itself submits through Availity or (800) 454-3730. [2]
- **Prior-auth decision time**: Wellpoint New Jersey's manual (June 2025): "Prior authorization decisions for non-emergency services shall be made within 14 calendar days or sooner as required by the needs of the enrollee," with denials in writing under the Health Claims Authorization, Processing and Payment Act. Federal floor for every NJ FamilyCare MCO: standard decisions within 7 calendar days of the request for contract rating periods starting on or after January 1, 2026 (14 days before that), extendable by up to 14 calendar days at the member's or provider's request or when the plan justifies needing more information; expedited within 72 hours. Treat 7 calendar days as the ceiling for any contract year that began on or after January 1, 2026. An incomplete request is not approved — Wellpoint notifies you to send the missing documentation, so the file you submit sets the clock. [5][6]
- **Other insurance (who pays first)**: Wellpoint's manual: "If you're aware of third-party coverage, you must submit a claim first to the appropriate third party before submitting a claim to us." COB claims are due "within 60 days from the date of the primary insurer's Explanation of Benefits (EOB) or 180 days from the dates of service, whichever is later," and Wellpoint pays its allowable minus the primary's payment. The rule that bites ABA: "If the third-party liability did not pay for a service because the member or provider did not follow the third-party payer's guidelines, the service will not be paid by Wellpoint" — so the commercial plan's authorization and network rules must be met. Wellpoint lists pay-first-and-recover exceptions including "preventive pediatric services (including EPSDT services)" and a child in DCP&P out-of-home placement. State rule underneath: NJ FamilyCare pays last: "All TPL, for example, health insurance, Medicare, CHAMPUS, prepaid health plans… shall, if available, be used first and to the fullest extent." Bill the commercial plan first; supplementation claims "shall not be filed with the program unless accompanied by a statement of payment, Explanation of Benefits (EOB), or denial from the other carrier." Two traps: "No program payments shall be made when the third-party payer requires a contracting or participating provider to accept that third-party payer's payment as payment in full," and when NJ FamilyCare is secondary it pays the lesser of its allowed amount minus other payments, or the patient liability. TRICARE and CHAMPVA both pay ahead of Medicaid: TRICARE rules state "Medicaid is not a double coverage plan. In any double coverage situation involving Medicaid, CHAMPUS is always the primary payer," and CHAMPVA "assumes primary payer status" over Medicaid. [5][7][8][9][10]
- **Diagnosis recency** _(ask the plan)_: Not published. Neither the DMAHS newsletter nor Optum's New Jersey entry sets a maximum age for the diagnostic evaluation, and the state's written position runs the other way: Optum's NJ Medicaid entry says flatly that "A comprehensive diagnostic evaluation is not required to access ABA services," so there is no comprehensive evaluation whose recency could be gated. What is dated in New Jersey is the authorization rather than the diagnosis — Horizon issues 32 units of 97151 valid for 30 days, and treatment authorizations run in 6-month spans. [2][3]
  - Ask the plan: Wellpoint New Jersey provider services ((833) 731-2149 / (800) 454-3730), and Carelon Behavioral Health (provider.relations.NJ@carelon.com), which runs the ABA network.
- **Telehealth** _(ask the plan)_: The state is silent and the carrier layer is not. Neither the founding DMAHS newsletter nor the daily unit guide addresses telehealth, remote delivery, modifiers or place-of-service codes for ABA. The one published New Jersey position is Optum's, for its own line of business: BCBAs and licensed BH clinicians in contracted ABA practices may deliver ABA supervision and caregiver training by telehealth if the practice is an approved Optum virtual-visits provider (attestation on Provider Express) and flags virtual delivery to the Care Advocate at authorization — then bills "the same procedure code you would use for an in-person service, 97155 or 97156, on your claim with the “02” place of service code." Direct technician treatment is not in that carve-out. Wellpoint New Jersey publishes no ABA telehealth position. [2][4]
  - Ask the plan: Wellpoint New Jersey provider services ((833) 731-2149 / (800) 454-3730), and Carelon Behavioral Health (provider.relations.NJ@carelon.com), which runs the ABA network.

## Delivery and billing rules

Coverage decides whether Wellpoint New Jersey (formerly Amerigroup) 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.

- **Concurrent billing (97153 + 97155)**: New Jersey says yes, in writing, and draws the line precisely. “If the QHP is overseeing the activities of the technician, the time of direct supervision by the QHP shall be concurrently billable using code 97155.” But “billing for 97155 is limited to time where the QHP is either engaged directly with the patient or is directing a technician in implementing a modified protocol with the patient. Billing for supervision where the technician is not present is not allowed.” Two other concurrency rules ride along: 97156 may be billed while the RBT delivers direct treatment to the child “in a separate location”; and for 0373T “providers may not bill for the QHP time concurrently” and billing is limited to a single technician’s face-to-face time, never the combined time of multiple technicians (three technicians for two hours bills eight units, not twenty-four). This is NJ FamilyCare state policy and the operative floor for Wellpoint New Jersey; no plan-specific deviation was found in Wellpoint New Jersey’s published material. [2]
  - Ask the plan: Wellpoint New Jersey provider services, to confirm the plan has not layered its own concurrency edit on top.
- **Daily limits / MUEs**: New Jersey publishes its own table rather than adopting a CMS MUE regime, and labels it guidance: the limits “are for guidance purposes only and may be overridden when medically necessary based on individual need” under EPSDT. Per day, in 15-minute units: 97151 32, 97152 8, 97153 32, 97154 12, 97155 24, 97156 16, 97157 16, 97158 16, 0362T 8, 0373T 32. Treat them as soft ceilings the plans enforce as edits — a request above them needs explicit EPSDT medical-necessity framing rather than a quiet resubmission. Wellpoint New Jersey publishes no daily table of its own, so the state guide is what to plan against. [2]
  - Ask the plan: Wellpoint New Jersey’s provider manual / claim-edit list.
- **Place of service** _(plan-dependent)_: This one has moved and the two live sources disagree. The founding DMAHS newsletter is flat: “ABA services may be provided in the therapist’s office, a community setting or the child’s home. Services may not be provided within a school facility.” Optum’s ABA State Mandates document (annual review 7/2026), whose NJ Medicaid entry tracks the same state policy, now reads: “Services may be provided in the school setting as long as services are not provided during normal school hours.” Office, home and community are settled; school is plan-dependent and moving; group home is addressed by neither. Neither position is republished by Wellpoint New Jersey, so resolve it with the plan before scheduling school-based sessions. [2][3]
  - Ask the plan: Wellpoint New Jersey provider services.

## What intake should collect for Wellpoint New Jersey (formerly Amerigroup)

- **Plan identity on "Amerigroup" inquiries:** Amerigroup NJ is now Wellpoint — verify the current card.
- **ASD diagnosis + QHP script:** The state baseline applies — collect the diagnosis and script that trigger the assessment authorization.
- **Carelon contracting status:** ABA contracting runs through Carelon, separately from the medical plan — confirm you're in the right network before quoting start dates.
- **Requested units vs. the state guide:** Absent published plan caps, assume the state daily unit table is the edit surface.

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

## Verification of benefits (VOB) data

How Wellpoint New Jersey (formerly Amerigroup) ABA benefits route and read on an eligibility check. Data last updated 2026-07-23.

### EDI routing

- **Payer ID (pVerify):** 06067 — pVerify 06067 = "WELLPOINT - AMERIGROUP" (legacy "AMERIGROUP" 00025 / "AMERIGROUP (CLAIMS)" 00705).
- **Payer ID (Availity):** WLPNT — Claims payer ID WLPNT per the Wellpoint NJ EDI page (Availity is Wellpoint's sole EDI partner; supports 270/271) and the Carelon NJ QRG.
- **Payer ID (Change Healthcare / Optum):** 28806 — Change Healthcare uses the legacy "Amerigroup - New Jersey" line 28806 (NOT WLPNT) — and Optum shows 270/271 = N on that line, so prefer the Availity/WLPNT path for eligibility.
- **Supports 270/271 eligibility:** Yes
- **Behavioral health administrator:** Carelon Behavioral Health (utilization management / contracting ONLY — BH/ABA claims ride WLPNT via Availity) — Carelon provides utilization-management/authorization services only ("an independent company providing utilization management services on behalf of the health plan"); BH/ABA CLAIMS still submit to WLPNT via Availity — no separate Carelon claims payer ID. ABA network contracting runs through Carelon (provider.relations.NJ@carelon.com).
- **BH administrator payer ID:** WLPNT
- **ABA rides on:** medical benefit
- **Two-hop verification required:** No

### Code-level coverage

| Code | Covered | Prior auth | Unit cap | Place of service | Telehealth | Modifiers |
| --- | --- | --- | --- | --- | --- | --- |
| 97151 | Yes | Required via the MCO (assessment + treatment) — NO prior authorization while a member is FFS pending MCO enrollment (a real fast-start window for newly eligible children). | 32 units/day — state "suggested" MUE limit, run by the MCOs as a claim edit; overridable under EPSDT medical necessity per day | home, office/clinic (11), community, telehealth, school (outside normal school hours — see Optum NJ entry) | Allowed; school-setting services permitted outside normal school hours per Optum's Nov 2025 NJ entry (a looser position than the state's original 2020 no-school rule) — confirm per MCO. | Provider-specialty based (RBT / BCaBA render direct codes; BCBA / BCBA-D render assessment/protocol/family codes), H0032 retired for ABA by Horizon eff. 7/15/2026 — use the 97151–97158 / 0362T / 0373T set |
| 97152 | Yes | Required via the MCO (assessment + treatment) — NO prior authorization while a member is FFS pending MCO enrollment (a real fast-start window for newly eligible children). | 8 units/day — state "suggested" MUE limit, run by the MCOs as a claim edit; overridable under EPSDT medical necessity per day | home, office/clinic (11), community, telehealth, school (outside normal school hours — see Optum NJ entry) | Allowed; school-setting services permitted outside normal school hours per Optum's Nov 2025 NJ entry (a looser position than the state's original 2020 no-school rule) — confirm per MCO. | Provider-specialty based (RBT / BCaBA render direct codes; BCBA / BCBA-D render assessment/protocol/family codes), H0032 retired for ABA by Horizon eff. 7/15/2026 — use the 97151–97158 / 0362T / 0373T set |
| 97153 | Yes | Required via the MCO (assessment + treatment) — NO prior authorization while a member is FFS pending MCO enrollment (a real fast-start window for newly eligible children). | 32 units/day — state "suggested" MUE limit, run by the MCOs as a claim edit; overridable under EPSDT medical necessity per day | home, office/clinic (11), community, telehealth, school (outside normal school hours — see Optum NJ entry) | Allowed; school-setting services permitted outside normal school hours per Optum's Nov 2025 NJ entry (a looser position than the state's original 2020 no-school rule) — confirm per MCO. | Provider-specialty based (RBT / BCaBA render direct codes; BCBA / BCBA-D render assessment/protocol/family codes), H0032 retired for ABA by Horizon eff. 7/15/2026 — use the 97151–97158 / 0362T / 0373T set |
| 97154 | Yes | Required via the MCO (assessment + treatment) — NO prior authorization while a member is FFS pending MCO enrollment (a real fast-start window for newly eligible children). | 12 units/day — state "suggested" MUE limit, run by the MCOs as a claim edit; overridable under EPSDT medical necessity per day | home, office/clinic (11), community, telehealth, school (outside normal school hours — see Optum NJ entry) | Allowed; school-setting services permitted outside normal school hours per Optum's Nov 2025 NJ entry (a looser position than the state's original 2020 no-school rule) — confirm per MCO. | Provider-specialty based (RBT / BCaBA render direct codes; BCBA / BCBA-D render assessment/protocol/family codes), H0032 retired for ABA by Horizon eff. 7/15/2026 — use the 97151–97158 / 0362T / 0373T set |
| 97155 | Yes | Required via the MCO (assessment + treatment) — NO prior authorization while a member is FFS pending MCO enrollment (a real fast-start window for newly eligible children). | 24 units/day — state "suggested" MUE limit, run by the MCOs as a claim edit; overridable under EPSDT medical necessity per day | home, office/clinic (11), community, telehealth, school (outside normal school hours — see Optum NJ entry) | Allowed; school-setting services permitted outside normal school hours per Optum's Nov 2025 NJ entry (a looser position than the state's original 2020 no-school rule) — confirm per MCO. | Provider-specialty based (RBT / BCaBA render direct codes; BCBA / BCBA-D render assessment/protocol/family codes), H0032 retired for ABA by Horizon eff. 7/15/2026 — use the 97151–97158 / 0362T / 0373T set |
| 97156 | Yes | Required via the MCO (assessment + treatment) — NO prior authorization while a member is FFS pending MCO enrollment (a real fast-start window for newly eligible children). | 16 units/day — state "suggested" MUE limit, run by the MCOs as a claim edit; overridable under EPSDT medical necessity per day | home, office/clinic (11), community, telehealth, school (outside normal school hours — see Optum NJ entry) | Allowed; school-setting services permitted outside normal school hours per Optum's Nov 2025 NJ entry (a looser position than the state's original 2020 no-school rule) — confirm per MCO. | Provider-specialty based (RBT / BCaBA render direct codes; BCBA / BCBA-D render assessment/protocol/family codes), H0032 retired for ABA by Horizon eff. 7/15/2026 — use the 97151–97158 / 0362T / 0373T set |
| 97157 | Yes | Required via the MCO (assessment + treatment) — NO prior authorization while a member is FFS pending MCO enrollment (a real fast-start window for newly eligible children). | 16 units/day — state "suggested" MUE limit, run by the MCOs as a claim edit; overridable under EPSDT medical necessity per day | home, office/clinic (11), community, telehealth, school (outside normal school hours — see Optum NJ entry) | Allowed; school-setting services permitted outside normal school hours per Optum's Nov 2025 NJ entry (a looser position than the state's original 2020 no-school rule) — confirm per MCO. | Provider-specialty based (RBT / BCaBA render direct codes; BCBA / BCBA-D render assessment/protocol/family codes), H0032 retired for ABA by Horizon eff. 7/15/2026 — use the 97151–97158 / 0362T / 0373T set |
| 97158 | Yes | Required via the MCO (assessment + treatment) — NO prior authorization while a member is FFS pending MCO enrollment (a real fast-start window for newly eligible children). | 16 units/day — state "suggested" MUE limit, run by the MCOs as a claim edit; overridable under EPSDT medical necessity per day | home, office/clinic (11), community, telehealth, school (outside normal school hours — see Optum NJ entry) | Allowed; school-setting services permitted outside normal school hours per Optum's Nov 2025 NJ entry (a looser position than the state's original 2020 no-school rule) — confirm per MCO. | Provider-specialty based (RBT / BCaBA render direct codes; BCBA / BCBA-D render assessment/protocol/family codes), H0032 retired for ABA by Horizon eff. 7/15/2026 — use the 97151–97158 / 0362T / 0373T set |
| 0362T | Yes | Required via the MCO (assessment + treatment) — NO prior authorization while a member is FFS pending MCO enrollment (a real fast-start window for newly eligible children). | 8 units/day — state "suggested" MUE limit, run by the MCOs as a claim edit; overridable under EPSDT medical necessity per day | home, office/clinic (11), community, telehealth, school (outside normal school hours — see Optum NJ entry) | Allowed; school-setting services permitted outside normal school hours per Optum's Nov 2025 NJ entry (a looser position than the state's original 2020 no-school rule) — confirm per MCO. | Provider-specialty based (RBT / BCaBA render direct codes; BCBA / BCBA-D render assessment/protocol/family codes), H0032 retired for ABA by Horizon eff. 7/15/2026 — use the 97151–97158 / 0362T / 0373T set |
| 0373T | Yes | Required via the MCO (assessment + treatment) — NO prior authorization while a member is FFS pending MCO enrollment (a real fast-start window for newly eligible children). | 32 units/day — state "suggested" MUE limit, run by the MCOs as a claim edit; overridable under EPSDT medical necessity per day | home, office/clinic (11), community, telehealth, school (outside normal school hours — see Optum NJ entry) | Allowed; school-setting services permitted outside normal school hours per Optum's Nov 2025 NJ entry (a looser position than the state's original 2020 no-school rule) — confirm per MCO. | Provider-specialty based (RBT / BCaBA render direct codes; BCBA / BCBA-D render assessment/protocol/family codes), H0032 retired for ABA by Horizon eff. 7/15/2026 — use the 97151–97158 / 0362T / 0373T set |

Code notes:

- **97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, 0362T, 0373T:** No Wellpoint-specific published ABA criteria/caps/rates — state baseline. ABA authorization submits via Availity or (800) 454-3730 (Carelon runs the UM); ABA network contracting is a SEPARATE funnel through Carelon Behavioral Health (provider.relations.NJ@carelon.com). Confirm spans and unit handling with the plan before the first submission.

### Medicaid rates

Source: No Wellpoint NJ-specific ABA fee schedule is publicly posted; the NJ FamilyCare FFS schedule is the documented reference baseline (MCOs are not required to match it). Confirm the plan-paid rate in your participating-provider agreement. Effective 2022-02-01.

| Code | Rate | Unit | Modifier tiers |
| --- | --- | --- | --- |
| 97151 | $25.00 | 15min | renderedBy: BCBA / BCBA-D (assessment); status: launch-era value; current status unverified — confirm in the CY2026 Procedure Master Listing |
| 97152 | $11.20 | 15min | renderedBy: RBT / BCaBA (supporting assessment); status: launch-era value; current status unverified |
| 97153 | $15.00 | 15min | renderedBy: RBT / BCaBA; status: verified current (CY2026 Q2); raised from $11.20 eff 2/1/2022 |
| 97154 | $4.80 | 15min | renderedBy: RBT / BCaBA (group); status: launch-era value; current status unverified |
| 97155 | $21.25 | 15min | renderedBy: BCBA / BCBA-D; status: verified current (CY2026 Q2) |
| 97156 | $25.00 | 15min | renderedBy: BCBA / BCBA-D (family guidance); status: verified current (CY2026 Q2) |
| 97157 | $12.40 | 15min | status: launch-era value; current status unverified |
| 97158 | $5.60 | 15min | status: launch-era value; current status unverified |
| 0362T | $25.00 | 15min | status: launch-era value; current status unverified |
| 0373T | $16.40 | 15min | status: launch-era value; current status unverified |

### Contacts

- **Provider services phone:** 1-800-454-3730
- **Hours:** Carelon National Provider Services Line (contracting, 800-397-1630): Mon-Fri 8am-8pm ET
- **Portal:** [Availity Essentials](https://www.availity.com)
- **Fax:** 844-442-8007

Questions to ask on a verification call:

- Does Wellpoint enforce the state's daily MUE unit limits as claim edits, or apply different caps?
- Is eligibility checking real-time or batch through Availity?
- Is ABA network contracting still routed through Carelon Behavioral Health, or has that changed?

### VOB data sources

- https://www.provider.wellpoint.com/new-jersey-provider/claims/electronic-data-interchange (accessed 2026-07-23)
- https://pverify.com/wp-content/uploads/2026/03/pVerifyPayers_All-Payers-List-3-2026.pdf (accessed 2026-07-23)
- https://www.optum.com/content/dam/o4-dam/resources/pdfs/guides/professional-claims-payer-list.pdf (accessed 2026-07-23)
- https://www.nj.gov/humanservices/dmhas/documents/pdf/resources/providers/DMAHS-BH-Integration-Points-of-Contact.pdf (accessed 2026-07-23)
- https://test.njmmis.com/downloadDocuments/5010_270-271_HIPAACompanionGuide.pdf (accessed 2026-07-23)
- https://web.archive.org/web/2023/https://www.nj.gov/humanservices/dmahs/news/Provider_Newsletter_for_Applied_Behavior_Analysis_Therapy.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.providerspark.com/for-providers/medicaid-rates/new-jersey/ (accessed 2026-07-23)
- https://autismnj.org/news/autism-new-jerseys-advocacy-leads-to-medicaid-rate-increase-for-aba-services/ (accessed 2026-07-23)

## Common questions

### Does Wellpoint New Jersey cover ABA?

Yes — it administers the NJ FamilyCare ABA benefit on the state baseline (EPSDT, ASD diagnosis, MCO-authorized assessment and treatment plan), with authorization via Availity or (800) 454-3730. No plan-specific ABA criteria are published.

### Is Wellpoint NJ the same as Amerigroup?

Yes — Amerigroup New Jersey rebranded to Wellpoint under Elevance. Cards and directories may still carry the old name.

### How do I join Wellpoint NJ's ABA network?

Through Carelon Behavioral Health (provider.relations.NJ@carelon.com) — a separate contracting funnel from the Wellpoint medical plan. Being contracted for medical services doesn't put you in the ABA network.

## Primary sources

1. [DMAHS BH Integration Points of Contact V3.1 — Wellpoint ABA contacts](https://www.nj.gov/humanservices/dmhas/documents/pdf/resources/providers/DMAHS-BH-Integration-Points-of-Contact.pdf)
2. [DMAHS Provider Newsletter Vol 30 No 06 — Provision of ABA services](https://web.archive.org/web/2023/https://www.nj.gov/humanservices/dmahs/news/Provider_Newsletter_for_Applied_Behavior_Analysis_Therapy.pdf)
3. [Optum ABA State Mandates BH803ABASTM12026 — NJ Medicaid entry](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/guidelines/scc/ABA_SCC_SM.pdf)
4. [Optum/UHC Community Plan — NJ FamilyCare ABA Provider Orientation (2022)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/autismABA/njaba/NJ.FamilyCare.Medicaid.ABA.pdf)
5. [Wellpoint New Jersey — Provider Manual (June 2025)](https://www.provider.wellpoint.com/docs/gpp/NJ_WLP_Provider_Manual.pdf)
6. [42 CFR 438.210(d) — Medicaid managed care authorization timeframes (eCFR)](https://www.ecfr.gov/current/title-42/section-438.210)
7. [Wellpoint New Jersey — Provider Quick Reference Guide](https://www.provider.wellpoint.com/docs/gpp/NJ_WLP_CAID_ProviderQRG.pdf)
8. [N.J.A.C. 10:49-7.3 — Third-party liability (TPL) benefits (LII)](https://www.law.cornell.edu/regulations/new-jersey/N-J-A-C-10-49-7-3)
9. [32 CFR 199.8 — TRICARE double coverage (eCFR)](https://www.ecfr.gov/current/title-32/section-199.8)
10. [38 CFR 17.272 — CHAMPVA benefit limitations; Medicaid exception (eCFR)](https://www.ecfr.gov/current/title-38/section-17.272)

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.