Blue Cross and Blue Shield (Excellus BCBS, New York) ABA therapy coverage
Yes. Excellus BCBS treats ABA for autism as medically appropriate, and New York law requires plans to cover autism treatment.
What the Blue Cross and Blue Shield (Excellus BCBS, New York) policy says
- Policy
- Excellus BlueCross BlueShield Medical Policy 3.01.11: Applied Behavior Analysis Source: Excellus BlueCross BlueShield.
- Coverage
- Yes. Excellus BCBS treats ABA for autism as medically appropriate, and New York law requires plans to cover autism treatment. Source: Excellus BlueCross BlueShield.
- Diagnosis
- Your child needs an autism spectrum disorder diagnosis. Reports from any psychological or other testing must be sent with the request. Source: Excellus BlueCross BlueShield.
- Prior authorization
- Excellus reviews ABA requests for medical necessity. The provider must send test reports, the treatment plan, and how often, how long, and where sessions will happen. Source: Excellus BlueCross BlueShield.
- Progress reviews
- The treatment plan and progress notes must be sent for review at least once every 12 months, or more often if state law says so. Requests to keep going must show measurable progress, often with graphs. Source: Excellus BlueCross BlueShield.
- Hours
- There is no set number of hours. Hours are based on your child's clinical need. The policy notes that early intensive ABA is often 20 to 40 hours a week. Source: Excellus BlueCross BlueShield.
- Who can provide it?
- ABA must be given by, or supervised by, a qualified behavior analyst such as a Licensed Behavior Analyst (LBA) or BCBA. Trained technicians, such as RBTs, can work under that supervision. Source: Excellus BlueCross BlueShield.
- If it's denied
- New York law gives members external appeal rights for ABA coverage, along with normal costs like deductibles and copays. Source: Excellus BlueCross BlueShield.
Each Blue Cross Blue Shield company sets its own ABA policy, so check your own plan. For example, Blue Cross and Blue Shield of Texas moved its ABA policy to MCG criteria on January 1, 2026. Excellus does not pay for ABA listed in a school IEP, requires parents to take part, and New York sets no age limit for ABA. Source: Excellus BlueCross BlueShield, Blue Cross and Blue Shield of Texas.
Before the first session, ask Blue Cross and Blue Shield (Excellus BCBS, New York) three things
- Is ABA a covered benefit on my plan, and is my plan fully insured or self-funded?
- Which ABA providers near me are in network?
- What will I pay per session after the deductible, and what is my out-of-pocket maximum?
The member number on your card is all they need. Then use the list for your city and ask each provider whether they're in network with your plan.
ABA therapy providers by city
- ABA therapy in Houston, TX
- ABA therapy in Phoenix, AZ
- ABA therapy in Charlotte, NC
- ABA therapy in San Antonio, TX
- ABA therapy in Chicago, IL
- ABA therapy in Dallas, TX
- ABA therapy in Orlando, FL
- ABA therapy in Atlanta, GA
- ABA therapy in Miami, FL
- ABA therapy in Tampa, FL
Other plans: TRICARE, Aetna, UnitedHealthcare (Optum Behavioral Health), Cigna, Medicaid by state.