Behavioral health components of AAEC evaluation do not require authorization for BCN members
The behavioral health components of an evaluation done by an approved autism evaluation center do not require authorization for BCN HMOSM (commercial) members. This applies to intake services covered by procedure codes *90791 and *90792.
We're updating the Behavioral Health chapter of the BCN Provider Manual with this information. The revised chapter will be available by the end of April.
Providers who have recently tried to submit an authorization request into the e-referral system for services associated with those codes have received an error message indicating that those services no longer require authorization.
The updated chapter will show the following:
- For the behavioral health components of the evaluation, authorization is not required.
- For the medical components of the evaluation, the AAEC needs to identify the medical specialists who will be evaluating the child so that the child's primary care physician can submit a referral for each specialist. A referral from the primary care physician is required for each medical specialist who will see the child during the evaluation process.
- The results of the multidisciplinary evaluation must be reported on the AAEC Evaluation Results Form. Follow the instructions on the form for faxing it to BCN.
Note: AAECs should submit a claim for the evaluation of each member using procedure codes *99367 and T1023.
This does not apply to members with BCN AdvantageSM, as those members generally don't have an autism benefit.
*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2018 American Medical Association. All rights reserved.