Insurance · Anthem Blue Cross Blue Shield

Your Anthem plan likely covers ABA therapy. We do the paperwork.

Most Anthem Blue Cross Blue Shield plans in Utah and Ohio cover Applied Behavior Analysis when a child has an autism diagnosis. We verify benefits, file the prior authorization, and translate every code — so your child can start in days, not months.

Check My Anthem Benefits Call (888) 989-5011

For most Anthem families

72hr

Benefits check turnaround

UT & OH

In-network in both states

Anthem PPO · HMO

In-network & accepted

Prior auth

Filed by us, not you

What Anthem covers

ABA therapy is a covered medical benefit on virtually every Anthem plan.

Both Utah and Ohio passed autism insurance mandates more than a decade ago. That means Anthem Blue Cross Blue Shield, Anthem BCBS of Ohio, and the BlueCard PPO network all treat Applied Behavior Analysis as medically necessary care — not a wellness extra. Here is what you can expect to be covered with a valid autism diagnosis on file.

1:1 ABA sessions

Direct therapy with a Registered Behavior Technician under BCBA supervision, billed as CPT 97153. Most plans cover 20–40 hours per week.

Initial assessment

CPT 97151 covers the BCBA’s evaluation, treatment plan, and family interview — the foundation Anthem needs to approve ongoing care.

Parent training

CPT 97156 covers BCBA-led caregiver training so you can reinforce skills at home. Almost every Anthem plan approves it alongside direct therapy.

BCBA supervision

CPT 97155 covers the BCBA’s direct supervision of your child’s program. Anthem treats this as a required part of the medical necessity standard.

Center & in-home

Anthem covers both settings. We file the place-of-service code (POS 11 or POS 12) so you do not have to choose between the clinic and your kitchen table.

Care coordination

Anthem reimburses time we spend coordinating with your child’s school, pediatrician, or SLP — so the team stays aligned without you playing middleman.

Prior authorization

We handle the paperwork mountain.

Anthem requires prior authorization before ABA begins and again every 6 months. The forms are dense, the codes are particular, and one missing signature can stall a kid’s start date for weeks. Our intake team has filed thousands of these — including for Anthem Federal Employee plans, BlueCard out-of-state members, and Medicaid managed care lines like Anthem HealthKeepers.

Start my prior auth

1

Send us your Anthem card

Front and back — that is it. We pull the group number, BIN, and member ID and call Anthem provider services the same day to confirm ABA benefits, deductible status, and any visit limits.
2

We gather the diagnostic letter

Anthem requires a diagnostic report from a licensed psychologist, neurologist, or developmental pediatrician with an F84.0 (Autism Spectrum Disorder) diagnosis. If you do not have one yet, our in-house autism testing team can complete one — usually within a week, no waitlist.
3

BCBA writes the treatment plan

After a 60–90 minute initial assessment, your BCBA writes the goal-by-goal treatment plan Anthem requires — with measurable objectives, baseline data, and the requested weekly hours for each CPT code.
4

We submit & track the auth

Our billing team submits the request through Anthem’s Availity portal and tracks it daily. Average turnaround is 7–14 business days. If Anthem requests more info, we respond — you do not get pulled into a fax war.
5

Therapy starts

Once approved, your child begins 1:1 sessions at the schedule we agreed on. We re-authorize every six months on your behalf — you will never be the one chasing Anthem at 4:30 PM on a Friday.

The codes Anthem asks for

Exactly what your Anthem auth packet needs.

Anthem rejects a lot of ABA requests for missing or mismatched codes. Here is the plain-English version of what they look for. You do not need to memorize this — our billing team builds the packet — but if you want to understand what is on your EOB, this is the map.

ICD-10 diagnosis

F84.0 · Autistic disorder

This is the only diagnosis Anthem accepts for ABA medical necessity. It must come from a licensed psychologist, neurologist, developmental pediatrician, or psychiatrist — not a primary care visit. If the report says “rule out autism” or “suspected ASD,” Anthem will deny it.

Related ICD-10s Anthem allows

F80.x · F88 · F89

Communication and developmental disorders that can appear as secondary diagnoses on the auth (e.g., F80.2 mixed receptive-expressive language disorder). They never replace F84.0 as the primary — but they sometimes unlock additional speech or OT benefits we can coordinate.

CPT service codes

97151 · 97153 · 97155 · 97156 · 97158

Assessment (97151), 1:1 technician therapy (97153), BCBA supervision (97155), parent training (97156), and group skills (97158). Each is billed in 15-minute units. Anthem caps total units by plan — we request the medically necessary number, not the maximum.

Place of service

POS 11 · POS 12 · POS 03

Clinic (11), home (12), or school (03). Anthem will reimburse all three but expects each session billed under the correct code. Mixing them up is the single most common reason an Anthem ABA claim gets clawed back — another reason to leave it to us.

Anthem member?

Find out in 72 hours what your plan actually covers.

Send us a photo of your Anthem card. We will verify your benefits, walk you through the deductible & copay, and tell you the realistic out-of-pocket — before any commitment.

Verify my Anthem benefits Call (888) 989-5011

Anthem in Utah & Ohio

What changes by state.

Anthem operates under different legal entities in each state, which means slightly different mandates, age limits, and prior auth rules. Our clinics are in-network for Anthem in both regions — here is the practical difference.

Utah

Anthem Blue Cross Blue Shield · Salt Lake Valley

Utah’s Clay’s Law (HB 88) mandates ABA coverage for children with autism — no annual dollar cap.
No age cutoff on most Anthem PPO plans; HMO plans typically cover through age 21.
Our Murray clinic at 5444 South Green Street is in-network for Anthem and Regence BCBS.
Local intake: (385) 550-3500.

Ohio

Anthem BCBS of Ohio · Cleveland & Columbus

Ohio’s autism insurance mandate covers ABA up to age 21 with no visit cap on fully-insured plans.
Self-funded employer plans (e.g., many large Ohio employers) follow federal parity — we verify both.
Three in-network locations: Mayfield Village, Gahanna, and Worthington.
Cleveland intake (216) 343-1198 · Columbus intake (614) 681-1030.

Anthem FAQs

Real parent questions.

The five things Anthem families ask us most often — with the answers we wish someone had given us upfront.

Will Anthem actually pay $0 for my child’s ABA? +

For most families, yes — once your deductible is met (or if you have a $0-deductible plan), Anthem typically covers ABA at 80–100% with no copay on most PPOs. We run a full benefits check before you commit so you see the exact dollar number, not a promise. If you are partway through the year, we factor in what you have already spent toward your deductible.

My child does not have an autism diagnosis yet — what do I do? +

We can complete the diagnostic evaluation in-house, usually within a week and with no waitlist. Our licensed psychologist uses standardized tools (ADOS-2, parent interview, developmental history) and writes the report Anthem needs to issue prior auth. Anthem covers the evaluation itself in most cases. See our autism testing page for the full process.

How long does Anthem take to approve ABA? +

Anthem’s contractual turnaround is 14 calendar days after a complete packet is received. We typically see approvals come back in 7–10 business days. Re-authorizations every 6 months are faster — usually 3–5 days. If Anthem requests more info, we respond within 24 hours so the clock does not stall.

What if Anthem denies the prior authorization? +

Denials are usually about documentation, not eligibility. We file a Level 1 appeal at no cost to you — with a letter from your BCBA showing medical necessity, supporting clinical references, and any missing info Anthem flagged. The vast majority of our appeals are overturned on the first pass. If we ever hit a true coverage wall (rare with Anthem), we lay out your options upfront.

I have Anthem from an out-of-state employer — does that work? +

Yes — this is the BlueCard PPO program. Your card will say “PPO” in a suitcase logo. We bill Anthem in your home state and they coordinate with us as the in-network provider in Utah or Ohio. Coverage rules follow your home plan, but you still get the in-network rate. We verify all of this on the benefits check — no surprises.

“

Very professional staff who are very knowledgeable about Autism. Highly recommend to any parent who wants excellent therapy for their child.

D. M. · Google review

“

This is a phenomenal ABA center. Everyone at the center is really kind and patient with my son. I have seen a huge improvement with him. I’m truly grateful for everyone at On Target. Thank you.

Andreana Tadaj · Google review

Ready when you are

Let’s get your Anthem benefits checked.

One photo of your insurance card. One short call. A clear answer in 72 hours — with no obligation. If we are not the right fit, we will tell you who is.

Start my benefits check Call (888) 989-5011

Mon–Fri, 8:00 AM – 5:00 PM · Utah & Ohio