Identify every plan
Confirm Original Medicare or Medicare Advantage plus Medicaid or other secondary coverage.
Medicare and ABA
Verify the exact service before assuming coverage.
Medicare covers certain behavioral health and outpatient therapy services, but those categories do not automatically establish coverage for a specific ABA service. Rules can depend on the service, billing code, professional, medical necessity, care setting, and whether coverage is Original Medicare or Medicare Advantage.
Ask about the exact claim
Get the proposed billing codes and verify the professional, facility, and place of service.
Request a written answer
Ask about medical necessity, authorization, network rules, cost sharing, and appeals.