ExchangePrior AuthMedium impact
Ambetter ABA Therapy PA requirements effective 6/1/26
Ambetter·AR · Psychiatry, Pediatrics·Prior Authorization
Effective date
Jun 1, 2026
We identified it
Aug 26, 2026
Summary
Effective June 1, 2026, Ambetter from Arkansas Health & Wellness is implementing prior authorization requirements for five ABA (Applied Behavior Analysis) therapy procedure codes (97151, 97153, 97154, 97155, 97156). All five codes now require prior authorization as a condition of payment. The ordering/prescribing provider is responsible for initiating the prior authorization process before service delivery.
Action Required
By May 31, 2026: Billing team must update billing system and encounter forms to require prior authorization for CPT codes 97151, 97153, 97154, 97155, and 97156. Configure system to flag these codes for mandatory pre-authorization review. Inform all providers (physicians and qualified health professionals) that they are responsible for initiating the prior authorization process for these ABA therapy codes through the Ambetter Pre-Auth Check tool at AmbetterHealth.com/ar. Train front desk and authorization staff on the new requirement. Verify eligibility and benefits for all Ambetter Arkansas members before rendering ABA services. Failure to obtain prior authorization will result in claim denials for these procedure codes.