Title 36 O.S. 2011, Section 6060.21, Health Coverage with Individuals with Autism, mandates coverage for applied behavior analysis. HealthChoice covers these services when performed by a board-certified behavioral analyst (BCBA), board-certified assistant behavioral analyst (BCaBA) or doctoral-level psychologist.
Please note that services billed by a registered behavioral technician, at any place of service, or any applied behavioral analysis services performed in a school setting (POS 03), regardless of provider type, are not eligible for reimbursement.
The maximum benefit for applied behavior analysis is 25 hours per week and no more than $25,000 per calendar year. A current treatment plan from the BCBA or BCaBA, which includes a prescription from the treating physician, is required upon receipt of the first claim each rolling year.
All plan policies, provisions, deductible, copay and coinsurance apply.
For additional information on coverage of autism spectrum disorders, call the medical claims administrator toll-free at 800-323-4314. TTY users call 711 or toll-free 800-545-8279.