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ABA Therapy Guidelines Reminders

Date: 09/17/25

Applied Behavioral Analysis (ABA) is the application of behavioral principles to everyday situations, intended to increase skills or decrease targeted behaviors and our partners in care are essential to accurate implementation, documentation, and claims submissions.

Requirements and best practices

  • Limitation of weekly services
  • All ABA services require prior authorization
  • Ratio of case supervision to direct treatment hours

Limitation of weekly services
Meridian follows daily unit limitations as outlined on Illinois’ HFS ABA fee schedule. Members generally require between 10 and 40 hours of therapy a week. As such, services billed for more than 40 hours in any week will be denied.

Helpful Resources
HFS Coverage for Applied Behavioral Analysis services provider notice
Downloadable HFS Practitioner Fee Schedule

Ratio of case supervision to direct treatment
The Council of Autism Service Providers (CASP) has established a standard for the ratio of case supervision to direct treatment hours, recommending one – two hours of case supervision for every 10 hours of direct treatment. This standard aims to ensure quality care for individuals receiving ABA services by requiring supervisors to monitor and guide the application of treatment plans, track client progress, and coordinate with other professionals involved in the client's care.

Meridian will review claims retrospectively to ensure that there is a minimum of one hour of supervision billed for each 10 hours of direct treatment. If supervision is not provided at the appropriate level, the corresponding treatment services will be subject to recoupment. For example, 100 hours of CPT® 97513 is billed for a member, but only 6 hours of supervision is billed under CPT 97515. In this example, Meridian would request repayment of 40 hours of CPT® 97153, as the 10% supervision requirement was not met.

Meridian’s clinical policy for this standard, CP.BH.10 Applied Behavior Analysis, is available on our Clinical and Payments Policies web page.

The YouthCare clinical policy is available on the YouthCare Clinical and Payments Policies web page.