Services for autism

Under North Carolina state law, services for Adaptive Behavioral Treatment (ABT) are covered for members up to age 19 who are diagnosed with autism spectrum disorder. Read G.S. 58-3-220 Mental Illness Benefits Coverage. For State Health Plan members, please check your benefit booklet.

Read our medical policy on Adaptive Behavioral Treatment (ABT) (PDF) to see provider qualifications and other necessary criteria to be met. Use this policy to help you talk to a provider and to help them determine if ABT services are covered under your health plan. Your benefit booklet may have more information on services, prior review and certification.

ABT must be provided or supervised by a professional who is licensed in one of these specialties and certified to provide treatment:

• Psychologist or psychological associate
• Psychiatrist or developmental pediatrician
• Speech and language pathologist
• Occupational therapist
• Clinical social worker
• Clinical mental health counselor
• Marriage and family therapist
• Board-certified behavior analyst (billed by a supervising contracted provider with a specialty listed above)

Look up a provider by type or specialty.

These providers may offer some ABT services. However, because medical practices change providers and services often, we can’t guarantee they currently offer autism services. Always call them to confirm their services before you make an appointment.

Note: You must meet the medical policy criteria through the authorization process for their services to be covered by your health plan.