Coalition Updates its Model Coverage Policy

January 19, 2022

The ABA Coding Coalition has updated the Model Coverage Policy for Adaptive Behavior Services, which was initially released in September 2020. The updated version includes two additional modifier codes that some payers want providers to use to indicate services that are being provided via telehealth, and some additional ICD-10 and corresponding DSM-V diagnostic codes for conditions for which applied behavior analysis (ABA) services may be medically necessary. We encourage payers and providers to use it to guide communications and policies regarding coverage of ABA services.