MedicaidAdministrativeHigh impact
Applied Behavioral Analysis Therapy Diagnostic Requirements
Alabama Medicaid·AL · Pediatrics·Specialty Services
Effective date
Jul 1, 2026
We identified it
Jun 21, 2026
Summary
Effective July 1, 2026, Alabama Medicaid requires pediatricians to obtain a special ABA Specialty 175 designation before they can make autism diagnoses for ABA therapy referrals. Without this specialty designation, all ABA therapy referrals from pediatricians will be denied, and nurse practitioners can no longer diagnose autism for ABA referrals.
Action Required
Before July 1, 2026: Pediatricians enrolled as Provider Type 31 with Specialty 345 must submit a written request on official letterhead to add ABA Specialty 175 to their Alabama Medicaid enrollment. Request must include Provider Name, NPI, Alabama Medicaid Provider Number, and Service Location Address. Update billing workflows to verify pediatricians have ABA specialty designation before processing autism-related ABA therapy referrals. Claims will be denied if submitted by pediatricians without the required specialty designation.