Intensive Behavioral Interventions - (EN0499)

This policy covers ABA services (assessment, initiation, continued treatment, family/stakeholder and group training, focused/comprehensive ABA, telehealth) only for individuals with a confirmed DSM‑5‑TR diagnosis of autism spectrum disorder (ICD‑10 F84.0–F84.9 except F84.2) and excludes ABA for non‑ASD indications (including Rett syndrome), non‑ABA intensive behavioral programs, services that are primarily educational/vocational, concurrent delivery with other treatment modalities, and uncoordinated multi‑provider or unsupported retrospective requests. Coverage requires assessment by a BCBA/LBA or independently licensed clinician trained in ABA with a valid standardized ASD instrument (within 60 days for initiation, within one year for continued care), an individualized measurable treatment plan with baseline/interim/current quantitative data, documented supervision/stakeholder training, and additional documentation/safety/consultation for severe behavior or feeding/toileting goals.