CommercialPrior AuthMedium impact
Applied Behavior Analysis 3.01.11
Excellus BlueCross BlueShield·Psychiatry, Pediatrics·Behavioral Health (Psychiatry/Psychology)
Effective date
Jun 26, 2025
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield updated their Applied Behavior Analysis (ABA) policy effective June 26, 2025, establishing medical appropriateness for ABA services with specific prior authorization, documentation, and provider credential requirements. The policy also clarifies that non-ABA interventions like DIR Floortime and TEACCH are considered investigational.
Action Required
Before June 26, 2025: Billing team must update prior authorization workflows for ABA services to include required documentation (psychological testing reports, IEP documents, treatment plans with discharge criteria, provider credentials, and clinical supervision hours). Establish process for annual treatment plan reviews and monthly progress documentation updates. Verify provider credentials meet Excellus requirements before billing ABA services.