ABA providers are considered outpatient specialty providers. Authorized ABA supervisors and ACSPs are allowed to bill for ABA services.
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
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).
Note: For telemedicine, the GT modifier must be used.
The ACD adopted the new Category I CPT codes that directly transferred from the Category III codes. Specifically, the ACD has adopted 97151, 97153, 97155 and 97156. Providers should use the approved new codes for all services provided on or after January 1, 2019.Learn more