Place of Service 03: Adaptive Behavioral Treatment (ABT) and psychotherapy services reminders

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) would like to remind providers offering Adaptive Behavior Treatment/Applied Behavior Analysis (ABT/ABA) that, per our Medical Policy, ABT is not covered when services are administered in any school or educational setting.

ABT related to the treatment of diagnosed autism is covered for members of all ages with no dollar limit. These services are included within mental health benefits.

There are limited psychotherapy services that Blue Cross NC does cover under our standard benefits that are allowed to be performed in a school facility (POS 03). On all fully insured plans and many ASO plans effective 7/1/2025 and after, psychotherapy is covered in the school setting. It is important to always verify member benefits prior to rendering services.