Applied Behavior Analysis (ABA) Review Outline

To expedite the Applied Behavior Analysis (ABA) review process with us, have your patient's complete clinical information, customer ID, and date of birth, as well as your Taxpayer Identification Number (TIN) available. In advance, please review our medical coverage policy for admission, and continued stay and discharge, which may be found in our Intensive Behavioral Interventions - (0499) policy.

Our care managers generally follow the outline below when reviewing; however, you may be asked to provide additional information.

Parent/guardian contact information

  • Phone number for parent(s)/guardian(s)

DSM diagnosis information

  • Include diagnosis date, and provider name and credentials

ABA treatment history

  • Length of treatment
  • Any gaps in treatment

Coordination of care

  • School services (e.g. IEP, 504, resource services) and coordination of care
  • Additional outpatient services (including speech, occupational therapy, social skills group, individual/family counseling)

Assessment information

  • Standardized assessment tool (e.g., VBMAPP, ABLLS, Vineland, etc.)
  • Baseline and current scores

Place of Service

  • Home/clinic/community

Current treatment plan review

  • Specific and measurable treatment goals directly related to Autism Spectrum Disorder (ASD)
    • Baseline, interim, and current data for all goals
    • Parent training goals and progress
  • Clearly defined, measurable and realistic fade, transition and/or discharge criteria
  • Plan to ensure maintenance and generalization of skills

Current request

  • Number of hours being requested, in weekly or monthly amounts, and Current Procedural Terminology (CPT®) codes