ExchangePrior AuthHigh impact
Prior Authorization Changes Are Coming to Ambetter ABA Therapy Services
Ambetter·AR · PM&R (Physical Medicine & Rehab), Pediatrics·Prior Authorization
Effective date
Aug 1, 2026
We identified it
Aug 26, 2026
Summary
Ambetter from Arkansas Health & Wellness is implementing new prior authorization requirements for three ABA therapy service codes (97152, 97157, 97158) effective August 1, 2026. Billing teams must obtain prior authorization before rendering these services or claims will be denied for non-participating providers and facilities.
Action Required
By July 15, 2026: Billing team and providers must update all systems and workflows to require prior authorization for CPT codes 97152, 97157, and 97158 (ABA therapy services) for Ambetter Arkansas Health & Wellness plans. Update billing software rules, encounter forms, and provider communication to flag these codes as requiring pre-authorization before claim submission. Implement process for providers to initiate prior auth requests through the Pre-Auth Check tool. Establish verification step to confirm member eligibility and benefits before service rendering. Failure to obtain required prior authorization will result in claim denials regardless of authorization status at time of service.