autism resources TRICARE providers

Autism Care Demonstration (ACD) and Applied Behavior Analysis (ABA)

The TRICARE Autism Care Demonstration (ACD) covers ABA services for all eligible TRICARE beneficiaries diagnosed with Autism Spectrum Disorder (ASD). The demonstration began July 25, 2014, and will continue through December 31, 2023.

See what's covered

Contact us about ABA services at: (866) 323-7155

ABA certification and credentialing

All ABA providers must be TRICARE-certified. To become an ABA TRICARE-certified provider, please complete the appropriate form and fax to (608) 221-7544.

All behavior analysts must be credentialed if they choose to become a network provider. Apply to become a TRICARE network provider

TRICARE recognizes the following National Autism certification boards for ABA providers

  • Behavior Analyst Certification Board (BACB):
    1. Behavior analyst certification as a Board Certified Behavior Analyst (BCBA) or Board Certified Behavior Analyst-Doctoral (BCBA-D)
    2. Assistant behavior analyst certification as a Board Certified Assistant Behavior Analyst (BCaBA)
    3. Behavior technician certification as a Registered Behavior Technician (RBT)
  • Qualified Applied Behavior Analysis Certification Board (QABA)
    1. Assistant behavior analyst certification as a Qualified Autism Services Practitioner (QASP) or Qualified Autism Services Practitioner-Supervisor (QASP-S)
    2. Behavior technician certification as a Applied Behavior Analysis Technician (ABAT)
  • Behavioral Intervention Certification Council (BICC)
    1. Behavior technician certification as a Board Certified Autism Technician (BCAT)

Identifying ASD

Explore our tools and resources to aid in the identification and diagnosis of ASD.

Learn more

Billing, claims and reimbursement

ABA providers are considered outpatient specialty providers. Authorized ABA supervisors and ACSPs are allowed to bill for ABA services.

Claims processing

All claims must be submitted electronically with Wisconsin Physicians Service (WPS) in order to receive payment for services. Claims can take up to 30 days to process. All claims for benefits must be filed no later than one year after the date the services were provided. Network providers can submit new claims and check the status of claims online using provider self-service. Log in or register

CPT codes for ABA

In accordance with TOM Chapter 18 Section 4, prior authorization is required prior to rendering ABA services. Claims for services rendered without prior authorization will be denied. All claims must be submitted by BCBA/BCBA-D for services covered under the Autism Care Demonstration (ACD).

  • CPT 97151 - Behavior identification assessment and treatment plan
  • CPT T1023 - PDDBI assessment/Outcome measures completed and submitted by BCBA/BCBA-D
  • CPT 97153 - Adaptive behavior treatment by protocol
  • CPT 97155 - Adaptive behavior treatment by protocol modification
  • CPT 97156 - Family adaptive behavior treatment guidance

*Please note: For telemedicine, the GT modifier must be used.

Changes to CPT codes for ABA were implemented on 1/1/2019. Learn more

Autism Care Demonstration: Guide for providers

Topics covered include TRICARE certification requirements, Humana Military credentialing requirements,
referrals and authorizations, claims requirements, forms and key provider resources.

Provider guide

Referrals and authorization for ABA services

The quickest, most efficient way to request ABA services is online through provider self-service. Providers may also fax referrals and supporting documentation to (877) 378-2316.

Submit referral or authorization

ABA referrals and authorization forms

Referral and authorization process

  • Initial referrals are provided by the ASD diagnosing provider. If the initial diagnosis is made by a Physician-Primary Care Manager (P-PCM), the P-PCM must also submit a referral for a specialized ASD diagnosing provider who must confirm the diagnosis within one year. The specialized ASD provider must also complete the Vineland-3 and SRS-2 outcome measures within the first year of the initial diagnosis.
  • Upon receipt of the referral, Humana Military authorizes an initial ABA evaluation/assessment, treatment plan development and PDDBI outcome measure. At an initial evaluation with the authorized ABA supervisor, target symptoms are identified and a treatment plan is developed.
  • Once the initial evaluation/assessment, treatment plan and PDDBI (parent form) are submitted, Humana Military will authorize six months of ABA services based on the referral request and there is a TRICARE-authorized ABA supervisor with an opening to accept the beneficiary.
  • Treatment plans are reviewed for medical necessity twice annually to allow re-assessment and document progress in improving core deficits. Prior to the expiration of each six month authorization period, the authorized ABA supervisor or ACSP must request re-authorization of ABA services for the next six months from Humana Military (up to 60 days in advance). Providers must submit reassessments, updated treatment plans and PDDBI outcome measures for re-authorization.
  • Every two years from the initial authorization, a new referral for ABA services and a new referral for outcome measures from the P-PCM or specialized ASD diagnosing provider is required.