Autism Insurance Billing: What Parents Need to Know

An Autism Insurance Billing prescription commonly accompanies an autism diagnosis, but many families don’t understand how this treatment is covered financially. As healthcare policies continue to evolve, navigating these changes can be challenging for even the most experienced providers.

ABA Medical Billing: Streamlining Your Revenue Cycle

The good news is that states now mandate coverage for autism spectrum disorder in most insurance plans. In addition, individual health plans must now offer coverage for autism as an add-on to existing plans or as a separate option. However, many other policy limitations still apply. These include:

Do I need a medical diagnosis for my child to qualify for ABA therapy?

Unlike most other behavioral health treatments, ABA requires a written and signed medical diagnosis from a licensed doctor. Your child’s doctor will review the initial assessment and recommend or prescribe ABA therapy based on his or her findings. This is why the initial ABA assessment is often referred to as a “diagnostic evaluation” or a “psychological testing” appointment.

Insurance companies also require pre-authorization for ABA services, which is unique to this treatment type. This allows the insurer to ensure that a client will be receiving the appropriate level of care and that the client’s ABA provider is submitting claims for the correct amount of time.

As the industry continues to evolve, so do ABA billing guidelines. For example, ABAI, APBI, and Autism Speaks have worked together to create coding categories that reduce the variation in billing practices and help standardize the documentation required to support a claim’s medical necessity. In addition, the ABAI and APBI have both developed resources to help parents and providers understand the intricacies of these new coding categories.