CommercialPrior AuthMedium impact
Behavioral Health Treatment for Autism Spectrum Disorder or Pervasive Developmental Disorder (BSC3.01)
Blue Shield of California·CA · Psychiatry, Pediatrics, Family Medicine·Medical Policy
Effective date
Dec 1, 2025
We identified it
Nov 1, 2025
Summary
Blue Shield of California updated their behavioral health treatment policy for autism spectrum disorder and pervasive developmental disorder, establishing specific criteria for initial assessments, treatment initiation, and continued care with detailed requirements for prior authorization and documentation.
Action Required
Before December 1, 2025: Providers treating autism spectrum disorder must obtain prior authorization from Blue Shield's mental health service administrator for all ABA services. Update intake forms to capture required standardized assessment tools and ensure treatment plans include baseline skills documentation, family collaboration, and discharge planning. Add reminder to billing system that home-based services must be obtained from participating providers only.