MedicaidPrior AuthMedium impact
Coverage for Applied Behavioral Analysis (ABA) Services for Children 0 through 20 Years – Prior Approval
Illinois Medicaid - HFS·IL · Psychiatry, Pediatrics, Family Medicine·Provider Notice
Effective date
Jan 19, 2021
We identified it
Jun 20, 2026
Summary
Illinois Medicaid now requires prior authorization for Applied Behavioral Analysis (ABA) services for children 0-20 with autism spectrum disorder. Behavioral Assessment and Treatment Planning exceeding 6 hours per 180-day period and all Behavioral Analytic Intervention services require prior approval with specific documentation submitted to HFS.ABA@Illinois.gov.
Action Required
Immediately: Billing team must implement prior authorization process for ABA services in Illinois Medicaid fee-for-service patients. Obtain prior approval for BATP services exceeding 6 hours per 180 days and all BAI services by submitting Prior Authorization for Applied Behavioral Analysis Services form with required documentation to HFS.ABA@Illinois.gov. Ensure physician orders, diagnostic evaluations, and treatment plans are current before submitting requests. Claims will be denied without proper prior authorization.