Authorizations for ABA Services: What Providers Need to Know to Avoid Denials

Before any ABA therapy session begins, securing insurance authorization is often required, but it’s also one of the most misunderstood and error-prone parts of the billing process. Authorizations for ABA services ensure that insurance companies approve and agree to cover treatment based on medical necessity.

In this post, we’ll walk you through the ABA therapy prior authorization process, step-by-step, and explain how Taylor Prime Solutions helps providers streamline approvals and avoid costly delays.

✅ What Is an ABA Authorization?

An ABA authorization is pre-approval from a health insurance company that confirms they will cover ABA services for a specific client under their plan.

It typically involves:

  • Submitting an initial assessment and treatment plan

  • Listing required CPT codes and service hours

  • Providing diagnostic reports (e.g., ASD diagnosis)

  • Including credentials of the supervising BCBA

📌 If you’ve ever asked, “What is required for ABA authorization?” — the answer is clear documentation, precise coding, and insurer-specific forms.

🧠 Why Is Prior Authorization Required for ABA Therapy?

Insurance companies use the ABA therapy prior authorization process to:

  • Confirm the client meets diagnostic criteria (usually an autism diagnosis)

  • Ensure the treatment plan aligns with medical necessity standards

  • Control service costs and prevent over-utilization

  • Limit approvals to specific timeframes (e.g., 6 months, 1 year)

Failing to get approval can result in denied claims, delayed payments, and out-of-pocket costs for families.

📋 Steps to Get ABA Services Authorized

Here’s how to get ABA authorization efficiently:

  1. Verify Insurance
    Confirm ABA therapy is covered under the client’s plan, including limits on hours, age, and location of service (home, clinic, school).

  2. Complete a Diagnostic Assessment
    Include formal testing (e.g., ADOS-2, Vineland) and diagnosis codes like F84.0.

  3. Submit Treatment Plan
    Outline goals, hours requested (e.g., 97153, 97155), and BCBA supervision plan. Many payers require specific forms (e.g., Optum’s ABA Treatment Request Form).

  4. Track Authorization Dates
    Most approvals are time-limited — mark expiration and reauthorization deadlines.

  5. Maintain Communication with the Payer
    Stay on top of requests for additional information or documentation.

⚠️ Common Reasons Authorizations for ABA Services Are Denied

Even with effort, many providers face denials due to:

  • Missing or incomplete treatment plans

  • Lack of documented medical necessity

  • Incorrect CPT codes or supervision structure

  • Outdated diagnostic reports

  • Services not matching the approved setting or provider type

💡 Understanding insurance authorization for ABA therapy is critical to avoiding preventable claim denials and maintaining financial stability.

🤝 How We Help with Authorizations for ABA Services

We’ve helped countless ABA providers navigate the insurance authorization for ABA therapy maze. Our team:

  • Prepares and submits accurate, payer-compliant treatment plans

  • Follows up with payers to secure timely approvals

  • Track renewal dates to prevent service interruptions

  • Ensures each claim is backed by authorization and proper documentation

We work closely with Medicaid, Optum, Aetna, Cigna, and other major payers, so you don’t have to spend hours on the phone or risk payment delays.

📞 Call us today at 844-TAYLOR-9 (844-829-5679)
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Authorizations for ABA Services