Consistent with North Carolina legislation, services for Adaptive Behavioral Treatment (ABT) are covered for members up to age 19 who have been diagnosed with autism spectrum disorder.
For State Health Plan members, please refer to your Benefit Booklet.
Effective Dates and Limitations
New and renewing groups: This benefit is available on or after July 1, 2016.
Members on individual grandfathered or transitional plans: This benefit is available on January 1, 2017.
Small Group ACA Plans: This benefit is available for new groups or at renewal on or after January 1, 2021.
Please Note: This law does not apply to non-grandfathered ACA (Affordable Care Act) Individual Plans. Please refer to your Benefit Booklet
IMPORTANT: Requirements for Coverage
Look in your benefit booklet for more information on these services, including prior review and certification requirements.
- ABT must be provided or supervised by one of the following licensed professionals who is also certified to provide this treatment:
- Licensed psychologist or psychological associate
- Licensed psychiatrist or developmental pediatrician
- Licensed speech and language pathologist
- Licensed occupational therapist
- Licensed clinical social worker
- Licensed clinical mental health counselor
- Licensed marriage and family therapist
Please read our Medical Policy on ABT, which shows all necessary criteria to be met, including provider qualifications. This Policy can be used in talks with a provider to help determine if services may be covered.
- Below, you will find links (by network) to providers who have indicated they may offer some ABT services. You will still need to meet the Medical Policy criteria through the authorization process for these services to be covered.
Provider Lists by Network
Because medical practices often change providers and services, Blue Cross NC is unable to guarantee that the providers listed below currently offer Autism services. Please call the provider to confirm before you make an appointment.