Massachusetts insured health plans use a standard form for prior authorization of applied behavior analysis (ABA) for autism spectrum disorder. A licensed applied behavior analyst meets it when requesting an evaluation, initial services, continued services or an amended continuing request. It lists ABA CPT codes, units and service locations for an authorization period of up to six months, and goes to the plan with a treatment plan.
The licensed applied behavior analyst (LABA) rendering or supervising the autism services completes and signs the form. An evaluation request needs only Section 1; initial, continued and amended requests need Sections 1 and 2.
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Massachusetts Standard Form for Applied Behavioral Analysis Services Prior Authorization Requests
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The standard form states that the authorization period may not exceed six months. Requests must also align with the provider's contract and the member's covered benefits, and units can be requested per week or for the whole period depending on the health plan's policy.
The form says the licensed applied behavior analyst who renders or supervises the autism services should complete it, and the treating LABA signs it. The Division of Insurance issued the form with Bulletin 2024-01 in January 2024 for Massachusetts insured health plans.
The authorization code chart lists 97151 through 97158 for behavior identification assessment, technician and professional treatment, family guidance and group protocols, plus 0362T and 0373T for services needing two or more technicians. Each line takes units per week or per period and a planned service location.