Services for autism

Under North Carolina state law, services for Adaptive Behavioral Treatment (ABT) are covered for members up to age 19 who are diagnosed with autism spectrum disorder. Read G.S. 58-3-220 Mental Illness Benefits Coverage. For State Health Plan members, please check your benefit booklet.

Read our medical policy on Adaptive Behavioral Treatment (ABT) (PDF) to see provider qualifications and other necessary criteria to be met. Use this policy to help you talk to a provider and to help them determine if ABT services are covered under your health plan. Your benefit booklet may have more information on services, prior review and certification.

ABT must be provided or supervised by a professional who is licensed in one of these specialties and certified to provide treatment:

• Psychologist or psychological associate
• Psychiatrist or developmental pediatrician
• Speech and language pathologist
• Occupational therapist
• Clinical social worker
• Clinical mental health counselor
• Marriage and family therapist
• Board-certified behavior analyst (billed by a supervising contracted provider with a specialty listed above)

Look up a provider by type or specialty.

These providers may offer some ABT services. However, because medical practices change providers and services often, we can’t guarantee they currently offer autism services. Always call them to confirm their services before you make an appointment.

Note: You must meet the medical policy criteria through the authorization process for their services to be covered by your health plan.

Important Information:

The Blue Cross and Blue Shield of North Carolina (Blue Cross NC) provider directory is created from information provided by our network providers, facilities and third parties. We try to provide you with the most up-to-date and accurate provider lists. However, providers are added to our network often and sometimes decide not to participate in our network. We cannot always guarantee that these provider lists are accurate or current when you search.

Adaptive Behavioral Treatment (ABT) must be provided or supervised by one of the following licensed professionals who are certified to offer this treatment:

• A licensed psychologist or psychological associate
• A licensed psychiatrist or developmental pediatrician
• A licensed speech and language pathologist
• A licensed occupational therapist
• A licensed clinical social worker
• A licensed professional counselor
• A licensed marriage and family therapist

Below, you will find providers that have indicated that they may perform some ABT services. To be covered, these services still need to meet the criteria of our Medical Policies through a prior review and certification process. You should contact the provider directly to make sure these services are offered.

Last updated on 4/9/24