ABA Therapy Referral & Medical Documentation Requirements by Health Plan

To ensure timely authorization for ABA therapy, please review the documentation requirements by health plan below. Submitting complete and compliant documentation helps avoid delays or denials. If you have any questions or concerns please reach out: clientcare@tillytherapy.com. Happy to help!

Florida Medicaid – Title 19 (Traditional Medicaid)

Required Documents:

ABA Prescription/Referral
- Must specifically state "ABA" or "BA" (not just “Behavioral Therapy”)
- Include ICD-10: F84.0 (ASD)
- Signed by an MD, DO, PhD, or PsyD
Comprehensive Diagnostic Evaluation (CDE)
- Completed within 3 years
- Signed by:
  - Pediatric Neurologist
  - Developmental Pediatrician
  - Clinical Pediatric Psychologist
  - Pediatric Psychiatrist
Must use at least 1–2 validated tools (e.g., ADOS-2, CARS-2)
Must include:
- Developmental/medical history (via parent/caregiver interview)
- DSM-5 criteria for ASD

Optional but Helpful:

IEP, teacher assessments, genetic or medical testing
Does not replace a CDE but supports treatment planning

Florida Medicaid – Title 21 (CHIP)

Key Differences from Title 19:

CDE must be within the past 6 months
ABA prescription must also be dated within 6 months

All other requirements match Title 19 (see above).

Texas Medicaid

Required Documents:

ABA Prescription/Referral
- Can be signed by nurses or PCPs
- Must include:
  - Child's age
  - Year of ASD diagnosis
  - Any comorbidities or trauma history
  - DSM-5 ASD severity level
  - CDE (no older than 3 years)
- Signed by qualified MD, DO, PsyD, PhD or interdisciplinary team (with autism expertise)
- Must include:
  - DSM-5 criteria and severity level
  - Child’s medical/developmental history
  - Diagnostic tools (1–2 from approved list)

Illinois Medicaid

Required Documents:

ABA Prescription/Referral
- Can be signed by nurse or PCP
- Must include DSM-5 ASD symptom severity
CDE (valid up to 5 years)
- Signed by qualified MD/DO/PsyD/PhD or autism-specialist interdisciplinary team

Commercial Plans

Required Documents:

ABA Prescription/Referral
- Required for most plans except PPOs
- Must be signed by MD, DO, PhD, or PsyD
- Include ICD-10 code: F84.0
CDE
- Valid within 3 years
- Must show DSM-5 criteria and F84.0 code
- Completed by:
  - Pediatric Neurologist
  - Developmental Pediatrician
  - Clinical Pediatric Psychologist
  - Pediatric Psychiatrist
- Diagnostic tools (1–2 required)

Optum (e.g., UnitedHealthcare)

Required Documents:

ABA Prescription/Referral
- Signed by MD, DO, PhD, or PsyD
- Must detail:
  - Age and year of diagnosis
  - Comorbid conditions
  - DSM-5 symptom severity
CDE
- Valid within 1 year
- Must show:
  - DSM-5 diagnostic criteria across all 3 domains
  - Functional impairment
  - Differential diagnosis ruling out other causes
- Assessment tools: ADOS-2, CARS-2, SCQ, SRS-2, M-CHAT, etc.
- Additional assessments may include:
- Cognitive/adaptive testing
- Communication evaluation
- Medical/genetic screening

Blue Shield of California – Administered by Magellan Health

Required Documents:

DSM-5 diagnosis confirmation from the last 24 months, using:
- Validated tools (ADOS, CARS, GARS, etc.)
- AND signed note from a licensed doctoral-level clinician
ABA Prescription/Authorization Request
- Must include completed Request for Initial Authorization form
Recommended: Use BSC’s official Treatment Plan Template:
Treatment Plan Template

Diagnostic Tools (Accepted Across Plans):

ADOS-2, CARS-2, M-CHAT-R
CSBS, ADI-R, BDI-2
SCQ, ASRS, DISCO
BOSA, GARS-3, SRS-2