Applied Behavioral Analysis Documentation Requirements

This policy covers applied behavioral analysis (ABA) services—including focused and comprehensive ABA, parent/caregiver training, case supervision, initial and ongoing assessments, and individualized behavior‑analytic treatment plans—for members with a confirmed autism spectrum disorder per DSM‑5‑TR or other diagnoses as specified by applicable state ABA criteria, and requires a qualified licensed provider recommendation plus a comprehensive diagnostic and behavior assessment. Coverage is limited by authorization-period hour caps (focused 10–25 hrs/week; comprehensive 30–40 hrs/week), requires updated assessments/treatment plans at least every six months (or more frequently if clinically or state required), adherence to established behavioral principles and ABA coding/MUE guidance, and is contingent on meeting documentation, state requirements, and the member’s plan terms; non–evidence‑based techniques and insufficiently documented services are excluded.