[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-316426-105":59,"doc-detail-316426-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","model-coverage-policy-for-adaptive-behavior-services-overview","Model Coverage Policy for Adaptive Behavior Services - Overview","","Model health insurance coverage policy for adaptive behavior services, developed in 2020 by the ABA Coding Coalition. The document helps ABA providers communicate with payers about appropriate coverage determinations, including indications, limitations, and competence recommendations. It addresses how coverage can vary across payers and encourages consistent coverage discussions with Medicaid, Medicare, TRICARE, and commercial payers. It also references questions about model coverage policy and related CPT codes.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/model-coverage-policy-for-adaptive-behavior-services-overview/316426/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/model-coverage-policy-for-adaptive-behavior-services-overview/316426.png","ImageObject",300,407,{"name":92,"@type":93},"Aladdin","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-22","2026-09-20",true,{"@type":102,"interactionType":103,"userInteractionCount":52},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What is the purpose of this model coverage policy?","Question",{"text":112,"@type":113},"It helps ABA providers communicate with payers about appropriate coverage determinations, including indications, limitations, and competence recommendations.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"Who developed the model coverage policy and when?",{"text":117,"@type":113},"It was developed in 2020 by the ABA Coding Coalition, including representatives of multiple professional and provider organizations.",{"name":119,"@type":110,"acceptedAnswer":120},"Which payers can providers use the policy to discuss coverage with?",{"text":121,"@type":113},"Providers may use it in conversations with Medicaid, Medicare, TRICARE, and commercial payers.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},316426,1790221204,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":52,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":139,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145},2336478503145,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Model Coverage Policy  \nfor Adaptive Behavior Services  \nOverview  \nThis document is a model health insurance coverage policy. It was developed in 2020 by the ABA Coding Coalition (representatives of the Association of Professional Behavior Analysts, Autism Speaks, Behavior Analyst Certification Board, Council of Autism Service Providers, and their CPT® consultant). The Coalition comprises most of the individuals and organizations who authored the application that was submitted to the American Medical Association in 2016 to obtain Category I CPT® codes for adaptive behavior (applied behavior analysis; ABA) assessment and treatment services.  \nThe purpose of this model coverage policy is to help providers of ABA services communicate with payers about appropriate coverage determinations, including indications, limitations, and competence recommendations. Providers may use this document in conversations with Medicaid, Medicare, TRICARE, and commercial payers. Many commercial payers have national policies, but several have local discretion. At present there is considerable variability across payers in policies regarding these services. We encourage use of this model coverage policy to enhance consistency in the coverage of ABA services.  \nIf you have questions regarding this model coverage policy or the 2019 CPT® codes for adaptive behavior services, please feel free to contact the ABA Coding Coalition at [https://abacodes.org/contact/](https://abacodes.org/contact/)  \nTable of Contents  \nI. Sample Coverage Policy................................................................................................................... 1  \na. AMA CPT Copyright Statement ........................................................................................1  \nb. CMS National Coverage Policies .....................................................................................1  \nII. Indications............................................................................................................................................ 2  \na. General coverage requirements ..................................................................................... 3  \nb. Service authorizations........................................................................................................ 4  \nc. Approved providers ............................................................................................................ 5  \nd. Treatment models................................................................................................................ 5  \ne. ABA procedures................................................................................................................... 6  \nf. Treatment settings .............................................................................................................. 7  \ng. Patient age ............................................................................................................................ 7  \nh. Treatment dosage ............................................................................................................... 7  \ni. Components of a treatment plan .................................................................................... 8  \nj. Dosage of case supervision ............................................................................................. 9  \nk. Caseload size........................................................................................................................ 9  \nl. Caregivers as important contributors to outcomes ................................................. 10  \nm. Coordination with other professionals.......................................................................... 11  \nn. Discharge, transition planning, and continuity of care ............................................ 12  \no. Telehealth service delivery............................................................................................. 12  \nI","cbCairTvMr9FA8dy","https://ap.wps.com/l/cbCairTvMr9FA8dy","pdf",732705,35,"English","# Sample Coverage Policy\n## AMA CPT Copyright Statement\n## CMS National Coverage Policies\n# Indications\n## General coverage requirements\n## Service authorizations\n## Approved providers\n## Treatment models\n## ABA procedures\n## Treatment settings\n## Patient age\n## Treatment dosage\n## Components of a treatment plan\n## Dosage of case supervision\n## Caseload size\n## Caregivers as important contributors to outcomes\n## Coordination with other professionals\n## Discharge, transition planning, and continuity of care\n## Telehealth service delivery\n# Limitations\n# Coverage Topics\n# Types of Billing Codes\n## Revenue Codes\n## CPT/HCPCS Codes\n## Category I Code Vignettes\n## Category III Code Vignettes\n## Modifiers for Consideration\n## Medically Unlikely Edits-Per-Patient Per-Day Service Units Guidelines\n## ICD-10 Codes that Support Medical Necessity\n## Diagnoses that Support Medical Necessity\n## ICD-10-CM Codes that DO NOT Support Medical Necessity\n## Diagnoses that DO NOT Support Medical Necessity\n# Acceptable Levels of Competence\n# Documentation Requirements\n# General Information","[{\"question\":\"What is the purpose of this model coverage policy?\",\"answer\":\"It helps ABA providers communicate with payers about appropriate coverage determinations, including indications, limitations, and competence recommendations.\"},{\"question\":\"Who developed the model coverage policy and when?\",\"answer\":\"It was developed in 2020 by the ABA Coding Coalition, including representatives of multiple professional and provider organizations.\"},{\"question\":\"Which payers can providers use the policy to discuss coverage with?\",\"answer\":\"Providers may use it in conversations with Medicaid, Medicare, TRICARE, and commercial payers.\"}]","Model Coverage Policy for Adaptive Behavior Services - Overview | PDF",1789916795,88]