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The member's benefit plan determines coverage.

The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. Members should discuss any matters related to their coverage or condition with their treating provider.Įach benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Treating providers are solely responsible for medical advice and treatment of members. The ABA Medical Necessity Guide does not constitute medical advice. The Applied Behavior Analysis (ABA) Medical Necessity Guide helps determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. Two Category III codes (0362T and 0373T) were revised and maintained.īy clicking on “I Accept”, I acknowledge and accept that: The AMA replaced or revised the following codes effective January 1, 2019:Įight new Category I codes for adaptive behavior assessments (9712) and adaptive behavior treatments (97153–97158) were added.įourteen associated Category III codes (0359T, 0360T, 0361T, 0363T–0372T and 0374T) have been deleted. What procedure codes does Aetna use for ABA?Īetna continues to use the American Medical Association (AMA) CPT® (Current Procedural Terminology®) codes for adaptive behavior treatment. See Autism Spectrum Disorders and Applied Behavior Analysis. Where can I find the Aetna clinical policy bulletin on autism spectrum disorders? See the Applied behavior analysis medical necessity guide (PDF). Where can I find the Aetna medical necessity guidelines for ABA? You may also use the ABA Treatment Request form (PDF), when applicable. Here’s more information on precertification. You can call the number on the member’s ID card and speak to a customer service representative.

You can see these contact details or just call the number on the member’s ID card. Who can I contact with benefits and claims questions? Yes, ABA is on the Aetna® precertification list for behavioral health services.

Applied behavior analysis (ABA) provider FAQs

Abby fine reader 12 coportate concurrent license