Does Aetna Cover ABA Therapy?

Reviewed by:
Hannah Andreasen

May 12, 2022

Yes, Aetna covers Applied Behavior Analysis (ABA) Therapy, but there may be limitations to full coverage. Aetna also acknowledges that there are possible evidence-based gaps in Applied Behavior Analysis in terms of Autistic Spectrum Disorder (ASD).

At Aetna, behavioral interventions are reimbursed under the member's behavioral health coverage. A multidisciplinary team of health care specialists from within and outside Aetna Behavioral Health endorse the recommendations for ABA therapy.

Benefits of Aetna's behavioral therapy coverage plans

The many benefits of Aetna's ABA therapy plan include: 

  • For mental health solutions, ABA is already on the Aetna® precertification registry.
  • Speech-language pathologists' speech, language, and total communication evaluations are included in Aetna's autism-specific developmental evaluations. 
  • Aetna offers enhanced accountability in drafting guidelines, including the addition of a references section.
  • Aetna's insurance criteria and suggestions are constantly updated to reflect the latest evidence-based research.
  • The provider emphasizes objective and standardized performance indicators.
  • A limitation includes; some Aetna policies do not cover educational services, for instance, speech therapy or ABA therapies in the classroom,  could be eliminated.

According to studies, approximately half of children diagnosed with autism, who get ABA therapy before the age of four have a considerable improvement in their IQ, language abilities, and social functioning. As a result, it is critical to recognize autism characteristics early and begin ABA therapy as soon as possible. 

Aetna maintains to adopt the American Medical Association's (AMA) Current Procedural Terminology®) values for adaptive behavior therapy despite changing standards and laws surrounding insurance coverage for children with autism.

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