Start free

PolicyChanges tracks payer policy changes for medical practices and tells you what to do before they take effect.

Create a free accountPolicy Monitoring is free. No card required.
← Back to list
HumanaMedicaid · Prior Auth · Medicaid · OK · Pediatrics, Psychiatry, NeurologyHigh impact

Applied Behavior Analysis - MEDICAID - OKLAHOMA (New)

Effective date
Sep 16, 2026
Identified
Sep 15, 2026

Summary

Humana has released a new Applied Behavior Analysis (ABA) coverage policy for Oklahoma Medicaid effective 09/16/2026. The policy establishes coverage limits for ABA initial assessments (24 units/6 hours) and reassessments (16 units/4 hours every 6 months), with defined exception criteria for complex cases including regression, comorbid conditions, major treatment changes, severe behaviors, language barriers, and multi-system coordination. Billing teams must implement prior authorization requirements and ensure documentation supports medical necessity for any units exceeding standard limits.

Get alerts when payers change rules like this one

We check Humana and other payers every day and email you when a change matches your specialty and state.

Get Humana alertsPolicy Monitoring is free. No card required.

What to do

Action · 7 steps
01Billing team must implement prior authorization workflow for all ABA services (CPT 97151, 97153, 97155, 97156) submitted to Humana Oklahoma Medicaid.
02Update billing system to enforce coverage limits: 24 units for initial assessment and 16 units for reassessment every 6 months.
03Configure system to flag requests exceeding limits and require documentation of exception criteria (regression, comorbid conditions, treatment changes, severe behaviors, language barriers, or multi-system coordination).
04Providers must document specific clinical justification in encounter notes when requesting units beyond standard limits, including incident reports or progress notes for safety-related exceptions.
05Train billing and clinical staff on exception criteria requirements.
06Update prior auth request templates to capture required documentation elements.
07Claims submitted without prior authorization or supporting documentation for exceptions will be denied.

Codes mentioned

97151971539715597156

Original notice

Applied Behavior Analysis - MEDICAID - OKLAHOMA (New)
mcp.humana.com · Always check the source before changing claims.
View original ↗

Related policy hubs

Humana policiesOK policy changesPediatricsPsychiatryNeurologyCode 97151Code 97153Code 97155Code 97156

Summaries are AI-assisted. Always confirm against the original payer notice.

What is PolicyChanges

One workspace for payer rules, prior auth, coding and compliance

Medical practices use PolicyChanges to catch payer changes before they cause denials. Every change is summarized in plain English, with the codes involved, the date it takes effect and what to do.

Policy MonitoringPayer policy, prior auth and coding changes, filtered to your saved searchesOIG ScreeningStaff and vendors screened every month against OIG LEIE, SAM.gov and state Medicaid listsPrior Auth LookupKnow if a service needs prior authorization before you schedule itCredentialing TrackerLicenses, CAQH, Medicare revalidation and payer enrollments, with reminders before anything lapsesCompliance CenterKeep your HIPAA program documented and ready to show
Start freePolicy Monitoring is free. No card required.
Get alerts for changes like thisPolicy Monitoring is free. No card required.Create a free account