Updated Clinical Criteria for ABA and TMS Services
Defines the clinical guidelines Optum will use to determine medical necessity for Applied Behavior Analysis (ABA) and Transcranial Magnetic Stimulation (TMS) for Commercial members in Colorado beginning May 15, 2026.
Optum Behavioral Health will use independent, nationally recognized clinical guidelines developed by nonprofit organizations to evaluate medical necessity for ABA and TMS services for Commercial members in Colorado.
ABA services will be evaluated using Council of Autism Service Providers (CASP) guidelines.
TMS services will be evaluated using CANMAT (2016 and 2023 editions) and the APA Position Statement on TMS.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.