You must have a diagnosis of Autism (F84.0) from a physician. This diagnosis must be provided to us within a written report and/or a prescription from a physician stating the diagnosis of Autism Disorder and the need for services.
Call your insurance company and ask if ABA (Applied Behavior Analysis) behavior services are covered under your plan. The CPT codes for ABA therapy are 97151, 97153, 97155 and 97156. We can also call for you.
NOTE: If your plan covers state and federal mandates, then it should cover ABA (Applied Behavior Analysis) behavioral services. However, if you have an ERISA (self funded) policy, they are not required to follow state and federal mandates. However, if you ask your human resources department and show them the need for these services, sometimes they can add this service to your policy.
Once you determine that you have the coverage and you have the documentation of Autism Disorder, fill out the two forms below.
Patient Consent Form
Patient Information Form
Also, follow up with a call to Autism Spectrum Mandate Services (ASMS) at 609.953.5793. Remember we only service individuals in Camden, Burlington, Gloucester and Cumberland counties in New Jersey.
Within 48-72 hours, you will receive a call from Autism Spectrum Mandate Services (ASMS) in order to schedule a consultation/intake with a Board Certified Behavior Analyst (BCBA). Prior to this call, ASMS will call your insurance company in order to get authorization to do the intake and initial assessment.
The initial assessment can take up to four hours depending on the insurance company requirements and the client's needs. During this initial assessment, a Board Certified Behavior Analyst (BCBA) conducts the Vineland Adaptive Behavior Scales - III (an oral questionnaire with caregiver), the Autism Treatment Evaluation Checklist (ATEC) (checklist completed by caregiver) and a Functional Behavior Assessment (FBA) caregiver interview at your home. Following these assessments, a treatment plan is developed with the caregivers input and sent to the insurance company for approval.
During the first one to three months (based on the frequency of services), an ABA technician comes out to “pair” with the child and also to collect behavior data for the FBA. Pairing refers to the technician becoming a reinforcer for the client. Additionally, a Board Certified Behavior Analyst (BCBA) also comes out to the home to supervise the technician, collaborate with caregivers, and to administer curricular assessments such as the Assessment of Basic Language and Learning Skills (ABLLS), Verbal Behavior Milestone Assessment and Placement Program (VB-MAPP) and/or Assessment of Functional Living Skills (AFLS) assessment.
Once the FBA and curricular assessments are completed, a Natural Environment Training (NET) program and Intensive Teaching at the Table (ITT) program along with a behavior intervention plan (BIP) are implemented for the child or adolescent. As the individual masters programs, training is provided to the caregivers and new goals are developed.
The continuation of these services are determined by the child’s needs, progress and insurance plan.