www.MercyCareAZ.org
April 29, 2020
Prior Authorization Form for Applied Behavioral Analysis (ABA) CPT Codes

Applicable to: Mercy Care Complete Care, Mercy Care RBHA, Mercy Care Long Term Care and Mercy Care DD
As indicated in our previous provider notification, Prior Authorization for Applied Behavioral Analysis CPT Codes , dated October 1, 2019, effective November 1, 2019, a prior authorization is required for Adaptive Behavior Treatments (CPT Codes 97153-97158).

A prior authorization form has been developed for these specific services, available on our Forms web page named Prior Authorization for ABA Services . Please be sure to use this form to attain prior authorization for these services.
 
As always, don't hesitate to contact your Mercy Care Network Management Representative with any questions or comments. You can find this notice and all other provider notices on our Mercy Care website.
 
Thanks for all you do!

                           
www.MercyCareAZ.org