Applied behavioral analysis (ABA) is a form of therapy that seeks to improve social behavior by rewarding positive behavior and punishing negative behavior. ABA therapy is frequently used for treating autism spectrum disorders. Insurance coverage for ABA varies among insurance providers. An ABA therapist must take certain steps to properly bill insurance for therapy sessions.
Verify whether coverage of ABA therapy for the client's condition is mandatory in your state. As of July 2009, Arizona, Florida, Illinois, Indiana, Louisiana, Minnesota, Pennsylvania, South Carolina and Texas require insurance providers within the state to offer coverage for ABA therapy.
Contact the insurance provider to discover what conditions and requirements must be met for coverage of ABA therapy. These requirements and conditions include credentials for the therapist providing services, time limits and restrictions for ABA therapy, whether or not in-home ABA services are covered, among others.
Obtain billing claim forms from the insurance provider and complete the forms. Make sure that you enter the proper service code, units and other information. If any of the information is incorrect, your claim will likely be denied.
Consider becoming certified through the Behavior Analyst Certification Board (see Resources). Certification is not typically required for billing purposes, but it will help establish your ability to provide ABA therapy.
- Autism Resource Connection: Insurance Coverage for ABA Therapy
- Healthcare.gov. "Essential Benefits." Accessed Feb. 28, 2020.
- American Physical Therapy Association: Choose PT. "Physical Therapy and Your Insurance." Accessed Feb. 28, 2020.
- Healthcare.gov. "Preventive Care Benefits for Adults." Accessed Feb. 28, 2020.
- Federal Register. "Ninety-Day Waiting Period Limitation and Technical Amendments to Certain Health Coverage Requirements Under the Affordable Care Act." Accessed Feb. 28, 2020.
- Department of the Treasury Internal Revenue Service. "Publication 502 Cat. No. 15002Q Medical and Dental Expenses (Including the Health Coverage Tax Credit) For use in preparing 2018 Returns." Page 16. Accessed Feb. 28, 2020.
- American Physical Therapy Association. "Preparing for Your Visit With a Physical Therapist." Accessed Feb. 28, 2020.
Matt Knouff is a mental health professional, programmer and freelance writer from Lafayette, Ind. His educational background includes a bachelor's degree in psychology and anthropology from Purdue University and undergraduate certificates in computer science and music production. He has been writing professionally for three years and currently writes for TopTenReviews.com and other online publications.