Autism Care Demonstration Benefits and Costs
- initial beneficiary assessment
- development of a treatment plan
- one-on-one care
- training of immediate family members to provide services in accordance with the treatment plan
- monitoring the progress toward treatment goals
- meetings to review progress with family members
There is no minimum or maximum age limit, nor are there duration limits for ABA services. Health Net Federal Services, LLC authorizes care for six months at a time. A clinical necessity review will take place after two years of ABA services have been provided.
Costs are based on the beneficiary's plan type for specialty outpatient services under office visits rates.
- 97151 is approved for 16 units delivered within a two-week period. A single copayment or cost-share will be assessed for all occurrences of the 97151 within the two week window.
- For 97153, 97155 and 97156, a single copayment or cost-share will be assessed per day.
- If 97151 and another code (97153, 97155, 97156) are billed on the same date of service, only one copayment or cost-share will be applied per day.
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