While many services are available to TRICARE beneficiaries under the Autism Care Demonstration (ACD), there are defined exclusions which are not reimbursable and will not be authorized.

Humana Military will not reimburse for the following, to include but not limited to:


  • Asynchronous (one-way) telemedicine services
  • Applied behavior analysis (ABA) services provided via telemedicine that were not explicitly authorized to be rendered via telemedicine in accordance with ACD guidelines
  • CPT code 97156 after the first six-month authorization and if telemedicine was authorized
  • CPT codes 99366 and 99368 for Medical Team Conference (MTC), if authorized; audio-only not allowed


  • ABA services rendered at sporting events, camps or other excluded settings
  • Services rendered by Behavior Technicians (BT) or assistant behavior analysts in a school setting
  • Services outside of the home, clinic, office, school or telemedicine
  • ABA services while the beneficiary is at another medical appointment to include another family member’s appointment

Type of service and goals

  • Shadow, aid or support services rendered in a school setting by the ABA supervisor (services in school settings must target specific behavior excess or deficit for a limited duration)
  • Educational or vocational services
  • Goals targeting activities of daily living
  • Vocational and educational goals

Other activities

  • BT training
  • Supervision or training of BTs
  • Mileage to and from ABA appointments
  • Emails/phone calls
  • Report writing outside of the use of CPT code 97151
  • Office supplies or therapeutic supplies

Concurrent billing

  • Concurrent billing for all ABA Category CPT codes except when the beneficiary and family are receiving separate services and the beneficiary is not present in the family session
  • ABA services while the beneficiary is at another medical appointment to include another family member’s appointment

Other exclusions

  • ABA services for diagnoses other than ASD
  • Group ABA services billed as one-on-one services
  • ABA services that are written in the beneficiary’s Individualized Education Program (IEP)
  • Educational/Academic and vocational rehabilitation
  • Autism schools; if an autism school has a clinic setting, the clinic must have a separate tax ID number
  • School tuition
  • Any two ABA providers authorized to provide treatment at the same time
  • Custodial care, personal care, and/or child care
  • Non-ABA services
  • ABA services provided by a clinic or agency owned by the beneficiary’s immediate family members
  • ABA services provided directly by the beneficiary’s responsible adult
  • Other non-medical services such as changing of diapers
  • Durable Medical Equipment (DME) whose safety and efficacy have not been established
  • Services when the beneficiary is sleeping