MedicaidDocumentationMedium impact
Diagnosis Requirements for Applied Behavior Analysis (ABA) Services
Missouri Medicaid (MO HealthNet)·MO · Psychiatry, Pediatrics, Neurology·Provider Notice
We identified it
Jun 20, 2026
Summary
Missouri Medicaid (MHD) reminds providers that ABA services require a diagnosis of autism spectrum disorder by a physician or psychologist per state regulation 13 CSR 70-98.030. This is a regulatory reminder, not a new policy change, emphasizing existing eligibility requirements for ABA billing.
Action Required
Immediately: Billing team must verify all ABA service claims include proper autism spectrum disorder diagnosis from physician or psychologist in patient records before submission. Update billing workflow to flag ABA claims missing required diagnosis. Claims without proper diagnosis will be denied by Missouri Medicaid.