Notification of New Codes for Applied Behavior Analysis (MO)

Anthem Blue Cross and Blue Shield (Anthem) in Missouri would like to make you aware of changes to the Missouri Anthem Blue Cross and Blue Shield coding for Applied Behavior Analysis. The new coding will apply to covered services rendered on or after January 1, 2019 for plans that use the Blue Access®, Blue Access Choice®, Blue Preferred®, and the Exchange/Off Exchange Networks.

 

As you submit new and renewing treatment plans for your Anthem members, beginning with dates of service January 1, 2019, please request ABA services using the new codes set forth by the American Medical Association (AMA).

 

Current ABA treatment authorizations that have already been approved through 2019 will be updated to reflect the new codes for the portion of the service that falls in 2019. Updated authorization letters reflecting the changes to the authorization will be sent to members and providers. You do not need to call and request that this update to current authorization take place. Claims submitted for 2019 dates of service should reflect the new codes.

 

Please note that the online fee schedules provide allowable amounts for current as well as historical codes and rates. Fee schedules with an effective date of January 1, 2019 may be available online at Availity on or after February 1, 2019. Go to www.anthem.com/provider > select Missouri > select Find Resources for Missouri > and on the left side of the Provider home page log in to the Availity portal. Or go to www.availity.com and select the Anthem Provider Portal.

 

For treatment plans authorized effective January 1, 2019 or after, the only codes payable to Applied Behavior Analysts will be the new codes approved by the AMA. All other codes will be denied.

 

Requests for concurrent reviews and/or new authorizations will reflect the coding changes and should be billed to match what is authorized. Coding other than what is reflected in an authorization for ABA services should not be billed and is not covered.

 

Please contact your Network Consultant for any additional questions.