CurrentAetnaPolicy N/A

Behavioral Health for Children and Adolescents — Covered Services, Billing Codes, and Authorization Requirements

Customize your policy alerts

Sign up for all Aetna policy alerts

Know when Aetna releases new policies or updates existing guidance.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Defines covered intermediate and outpatient behavioral health services for children and adolescents, billing codes and authorization requirements, and provider resources; intended for Aetna-contracted behavioral health providers (Massachusetts bulletin referenced).

Policy Summary

PayerAetna

PolicyBehavioral Health for Children and Adolescents — Covered Services, Billing Codes, and Authorization Requirements

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionObtain prior authorization for listed services and codes (examples: H0017, ICBAT, ABA codes, H2019, H0023) as specified before billing.

SourceLink

OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

CurrentAetnaPolicy N/A

Behavioral Health for Children and Adolescents — Covered Services, Billing Codes, and Authorization Requirements

Customize your policy alerts

Sign up for all Aetna policy alerts

Know when Aetna releases new policies or updates existing guidance.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Policy Summary

PayerAetna

PolicyBehavioral Health for Children and Adolescents — Covered Services, Billing Codes, and Authorization Requirements

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionObtain prior authorization for listed services and codes (examples: H0017, ICBAT, ABA codes, H2019, H0023) as specified before billing.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

multipleservice categories

requiredauthorization

Navinet/phonerequest methods

MAMA bulletin cited

Covered Services and General Coverage Notes

Covered Services

Covered intermediate and outpatient services include but are not limited to the following when medically necessary:

Covered service categories: In-Home Behavioral Services; In-Home Therapy; Mobile Crisis Intervention; Intensive Care Coordination (ICC); Community-based Acute Treatment for Children and Adolescents (CBAT); Intensive Community-based Treatment for Children and Adolescents (ICBAT); Applied Behavior Analysis (ABA) where indicatedmedically necessary

Each service description specifies required components (e.g., functional behavioral assessment, individualized treatment plan, crisis planning, staffing/clinical presence for CBAT/ICBAT) and appropriate settings (home, community, staff-secure/24-hour for CBAT, higher-intensity unlocked setting for ICBAT).

The policy specifies that ICBAT is not used as a step-down placement following discharge from a locked, 24-hour setting. ICBAT programs are described as higher-intensity, unlocked-community alternatives that may admit children directly from the community as an alternative to inpatient hospitalization, but they are not intended to serve as post-discharge step-downs from locked inpatient units.

This portion of the document does not list any services or codes as explicitly "not medically necessary." The billing and authorization section enumerates services and codes that require authorization or do not require authorization and explains authorization request methods, but it does not contain explicit statements declaring particular services or codes to be not medically necessary.

Codes, Units, and Authorization Time Units

Codes Requiring Authorization (per 15 minutes)mixedCovered

97151	Applied Behavior Analysis - Assessment (unit)
97152	Applied Behavior Analysis - Assessment (unit)
0362T	Applied Behavior Analysis - Assessment (HCPCS/T)
97153	Applied Behavior Analysis - Treatment (unit)
97154	Applied Behavior Analysis - Treatment (unit)
97155	Applied Behavior Analysis - Treatment (unit)
97156	Applied Behavior Analysis - Treatment (unit)
97157	Applied Behavior Analysis - Treatment (unit)
97158	Applied Behavior Analysis - Treatment (unit)
0373T	Applied Behavior Analysis - Treatment (HCPCS/T)

1–10 of 14

1/2

Codes Requiring Authorization (per day)mixedCovered

H0017	Per day authorization required
ICBAT without R&B	Per day authorization required
ICBAT with R&B	Per day authorization required
H0023	Intensive Care Coordination (per day)

Codes with Specified Units (grouped)mixed

H2014	In-Home Behavioral Services - units H2014
H2019	Listed above - no separate unit associated
T1027	Listed above - unit T1027
99510	Listed above - unit 99510

Authorization Time Units

Authorization time unitPer day or per 15 minutes as specified

Prior Authorization

Authorization Requirements and Provider Actions

Prior authorization and precertification are required as specified below. Contracted providers must obtain authorization prior to rendering the listed services; precertification is implied where prior authorization is required. Authorizations can be requested via the Navinet online portal (Navinet Sign In) or by calling the number on the member's ID card. Provider resources and manuals (including provider billing guidance and authorization procedures) should be consulted for details. Step therapy is not specified for these services.

Prior authorization required for listed services/codes: H0017 per day; ICBAT (with and without R&B) per day; H0023 per day; ABA assessment and treatment codes (97151-97158, 0362T, 0373T) per 15 minutes; H2019, T1027, 99510 (In-Home Therapy/Family Stabilization Team) per 15 minutes; H2011 per 15 minutes.
Precertification and prior authorization: Precertification is required where prior authorization is indicated; providers must obtain authorization before services are rendered to avoid claim denials.

Prior Authorization, Precertification, and Documentation

Prior Authorization

Obtain prior authorization for listed codes

Prior authorization is required for the listed codes; submit authorization before rendering services for those codes.

Examples of codes requiring authorization include H0017, ICBAT per day, ABA assessment/treatment codes (97151–97158, 0362T, 0373T) per 15 minutes, H2019/T1027/99510 per 15 minutes, H2014, H0023 per day, and H2011 per 15 minutes.

Prior Authorization

Check the behavioral health precertification list before providing services

Consult Aetna's behavioral health precertification list and provider resources to determine which services require precertification or prior authorization prior to service delivery.

Precertification lists and behavioral health–specific precertification resources are available in provider materials.
Authorizations can be requested via Navinet or by calling the number on the member's ID card.

Service Definitions and Referenced Guidelines

In-Home Behavioral Services — definition and key elements

DefinitionA combination of medically necessary behavior management therapy and behavior management monitoring provided where the child resides (home, foster home, therapeutic foster home or another community setting)

Key elementsBehavior management monitoring; implementation and reinforcement of a behavior plan; supervision and coordination of interventions; crisis-response strategies; may include short-term counseling

SettingsDelivered in the child's home, a foster home, a therapeutic foster home or another community setting when indicated

Documentation focusClinical documentation should demonstrate the behavior management plan, monitoring activities, and medical necessity for in-home delivery

In-Home Therapy — definition and scope

Definition

Criteria for CBAT / ICBAT and In-Home/Outpatient Levels of Care

Applied Behavior Analysis Authorization and Criteria

Applied Behavior Analysis (ABA)

Applied Behavior Analysis entries reference assessment and treatment codes and authorization units.

ABA: Assessment and treatment using ABA codes (assessment: 97151, 97152, 0362T; treatment: 97153–97158, 0373T) require prior authorization and are authorized in 15-minute units as specifiedper 15 minutes where specified

Specific clinical eligibility criteria are not provided in this excerpt; billing and authorization must follow listed code unit rules and provider precertification procedures.

In-Home Behavioral Services and Therapy Modalities

In-Home Behavioral Services / In-Home Therapy

In-Home Behavioral Services components: Includes behavior management monitoring, functional behavioral assessment and observation in the home/community, development and supervision of a behavior plan, coordination of interventions (including crisis-response strategy), and may include short-term counseling or therapeutic support; services must be provided where the child resides when indicatedcomponents present in documentation

Documentation should demonstrate the presence of the listed components to support medical necessity and appropriate service delivery.

Authorization Unit and Visit Limit Requirements

Services and codes that specify authorization unit requirements

Per-day authorization codesH0017 and Intensive Care Coordination (Units = H0023) and ICBAT entries are shown as requiring authorization per day

Per-15-minute authorization codesApplied Behavior Analysis assessment and treatment codes (97151-97158, 0362T, 0373T), H2019/T1027/99510 (In-Home Therapy/Family Stabilization Team), and H2011 are listed as requiring authorization per 15 minutes

Unit mappingsThe document pairs 'Services that REQUIRE authorization' with explicit 'Units' entries (e.g., Rev 1001+H0017, 97153-97158, H2014, H0023) to indicate billing unit requirements

Authorization request methodsAuthorizations can be requested via Navinet online portal or by calling the number on the member's ID card

Policy Summary

PayerAetna

PolicyBehavioral Health for Children and Adolescents — Covered Services, Billing Codes, and Authorization Requirements

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionObtain prior authorization for listed services and codes (examples: H0017, ICBAT, ABA codes, H2019, H0023) as specified before billing.

SourceLink

On This Page

Authorization request methods: Contracted providers may request authorizations via Navinet (online portal) or by calling the number on the member's ID card.

Provider manuals and resources: Refer to payer provider manuals and online resources for documentation, billing rules, and submission instructions.

Step therapy: Not specified for these services.

Billing Rule

Use Navinet or phone to submit authorization requests

Request authorizations through the two available methods listed by Aetna to avoid administrative denials.

Use the online portal Navinet (requires log‑in) to submit authorization requests for contracted providers.
Alternatively, call the phone number on the member's ID card to request authorization.

Step Therapy

No step therapy specified in this policy

No step therapy or treatment‑sequencing rules are specified in this policy; consult clinical policy bulletins and guideline links for any sequencing requirements.

See clinical policy bulletins and referenced guideline sources (LOCAT, ABA, ASAM) for treatment sequencing guidance if applicable.

Denial Risk

Failure to obtain required authorization may result in claim denial

Services and codes identified in the billing table explicitly 'REQUIRE authorization'—claims for these services may be denied if prior authorization is not obtained.

Codes shown as requiring authorization include H0017, ICBAT (per day), ABA assessment/treatment codes (per 15 min), H2019/T1027/99510, H2014, H0023 (per day), and H2011 (per 15 min).

Denial Risk

Follow precertification procedures in provider resources

Follow the precertification procedures referenced in provider resources; although the policy does not list explicit denial triggers, precertification lists indicate required administrative steps to avoid denial.

Consult the behavioral health specific precertification list in provider materials for programs and codes that require prior authorization.

Documentation Required

Document service‑specific clinical elements to support medical necessity

Include service‑specific clinical documentation to demonstrate medical necessity when requesting authorization or submitting claims.

For in‑home services: functional behavioral assessments, behavior plans, supervision and coordination, and crisis‑response strategies.
For in‑home therapy: a treatment plan, structured therapeutic relationship documentation, and use of psychotherapeutic techniques.
For CBAT/ICBAT: staffing and clinical details, psychiatric evaluation, medication monitoring, and discharge planning as applicable.
Document units/time increments consistent with the code's required authorization unit (per day or per 15‑minute unit).

Note

Refer to Behavioral Health Provider Manuals and resources

Use the Behavioral Health Provider Manuals and referenced resources for administrative, precertification, and clinical policy guidance.

Provider materials include Behavioral Health Provider Manuals, precertification lists, clinical policy bulletins, and guideline links (LOCAT, ABA, ASAM).
Most Aetna links in these resources are accessible to both in‑network and out‑of‑network providers.

Medically necessary therapeutic clinical intervention or ongoing training/support provided where the child resides, including a structured therapeutic relationship between a licensed clinician and the child/family

Required componentsDevelopment of a treatment plan, use of established psychotherapeutic techniques, and family involvement to improve functioning and support implementation

Ongoing training/supportServices include teaching the child emotional/behavioral regulation and assisting the family in supporting the child and addressing emotional and health needs

Equivalency noteWhere a carrier's Family Stabilization Treatment (FST) is substantially similar to in‑home therapy, it may be considered to meet the requirements

Mobile Crisis Intervention — short-term mobile on-site response

DefinitionShort-term, mobile, on-site, face-to-face therapeutic response available 24 hours a day, 7 days a week for a child experiencing a behavioral health crisis

Primary goalsIdentify, assess, treat and stabilize the situation; reduce immediate risk to the child/others; and link to medically necessary behavioral health services and appropriate level of care

Service componentsCrisis assessment and crisis planning, which may include development or update of a crisis safety plan; interventions consistent with existing risk/safety plans

AvailabilityProvided on a mobile/onsite basis and intended for immediate crisis response and stabilization

Intensive Care Coordination (ICC) — targeted case management

DefinitionA collaborative targeted case management service for children/adolescents with serious emotional disturbance to meet comprehensive medical, behavioral health and psychosocial needs

Core componentsAssessment, individualized care plan development, referrals to appropriate levels of care, monitoring of goals, and coordination with services, supports and state agencies

Service deliveryMust be based on a system-of-care philosophy and include face-to-face and telephonic meetings, delivered in office, home or other settings as clinically appropriate

ObjectivePromote quality, cost-effective outcomes while addressing family needs and coordinating care

CBAT / ICBAT definitions

CBAT definitionMental health services provided in a staff-secure setting on a 24-hour basis with sufficient clinical staffing to ensure safety, providing intensive therapeutic services (medication monitoring, psychiatric assessment, nursing, therapy, case management, family assessment, discharge planning, psychological testing)

ICBAT definitionProvides the same services as CBAT but at higher intensity with more frequent psychiatric/psychopharmacological evaluation and intensified staffing; can admit children with more acute symptoms and care for them safely in an unlocked setting

Use and limitsCBAT may be used as an alternative to or transition from inpatient services; ICBAT is not used as a step-down placement following discharge from a locked, 24-hour setting

Admission capabilityICBAT can admit children directly from the community as an alternative to inpatient hospitalization when clinically appropriate

Referenced clinical guideline sources

Referenced guideline sourcesLOCAT, ABA and ASAM guidelines are listed as clinical policy resources for behavioral health providers

PurposeReferenced guidelines are provided for clinical policy bulletins, precertification lists and provider resources to guide care and administrative processes

Access noteMost Aetna links (including guideline resources) can be accessed by both in-network and out-of-network providers as noted in resources

Children and adolescents with serious emotional disturbance or acute behavioral health crises may require a spectrum of intermediate and outpatient services ranging from in-home supports to intensive community-based programs. Covered services include In-Home Behavioral Services and In-Home Therapy that deliver behavior management monitoring, functional behavioral assessment, individualized treatment plans, and family-focused interventions in the child’s residence; Mobile Crisis Intervention for on-site, 24/7 crisis assessment and safety planning; and Intensive Care Coordination (ICC) to provide targeted case management and coordination of services. For more severe presentations, staff-secure 24-hour CBAT programs and higher-intensity, unlocked-setting ICBAT programs provide intensive therapeutic services (psychiatric evaluation, medication monitoring, nursing, therapy, case management and discharge planning) as alternatives to inpatient care.