Services for Autism

Benefit Overview and Provider Lists by Network

New Benefit

Due to recent North Carolina legislation, services for Adaptive Behavioral Treatment (ABT) will be 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.

Please Note: This law does not apply to non-grandfathered ACA (Affordable Care Act) Individual and Small Group Plans.


IMPORTANT: Requirements for Coverage

Look in your benefit booklet for more information on these services, including prior review and certification requirements.

  1. You must contact Magellan Behavioral Health for ABT services to be covered; see the number listed in "Who to Contact" in your benefit booklet.
  2. 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 professional counselor
    • Licensed marriage and family therapist
    You can search the above provider types on our Provider Directory. It may be necessary to contact the ones in your network to confirm if they offer ABT services.
  3. 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.

  4. 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.

Get the List of Providers for Your Plan Network: