091 Form

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Applied Behavior Analysis (ABA) Table of Contents • Policy: Commercial • Coding Information
• Information Pertaining to All Policies
• Policy: Medicare • Description
• References
• Authorization Information • Policy History
• Endnotes Policy Number: 091 BCBSA Reference Number: N/A NCD/LCD: N/A Related Policies
None Policy 1 Commercial Members: Managed Care (HMO and POS), PPO, and Indemnity

Subscriber Certificate Applied Behavior Analysis services are covered according to the individual’s subscriber certificate in effect at the time the service is rendered, and medical policy criteria at the time of the prior authorization request.

Overview of Covered Services BCBSMA covers medically necessary ABA services for the treatment of autism spectrum disorders (ASD) and/or Down Syndrome when diagnosed by a psychiatrist, psychologist, neurologist, developmental pediatrician, or other licensed physician experienced in the diagnosis and treatment of autism/Down Syndrome and when clinical direction is provided by an appropriately trained licensed psychologist or a licensed applied behavior analyst (LABA)/ board certified behavior analyst (BCBA). This coverage may include medically necessary ABA services in certain community settings, such as the home, center (office), daycare, preschool, or camp.

Adaptive Behavior Assessment Services:

BCBSMA covers medically necessary ABA assessment services including review of medical record and prior assessments, response to prior treatment, completion of interviews and rating scales assessing skill deficits and behavioral excesses, and direct assessment and observation to identify skill deficits and behavioral excesses. Behavior identification assessment may include both functional behavior assessment and skills-based assessment. Information gained through various methods of assessment is used to develop an individualized treatment plan by the appropriately trained licensed psychologist or a licensed applied behavior analyst (LABA)/ board certified behavior analyst (BCBA . Assessment may include direct assessment and development of a treatment plan by the appropriately trained licensed psychologist or a licensed applied behavior analyst (LABA)/ board certified behavior analyst (BCBA), direct, face-to-face assessment by a behavior technician, or direct, face-to-face assessment by more than

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one behavior technician under the on-site guidance of the appropriately trained licensed psychologist or a licensed applied behavior analyst (LABA)/ board certified behavior analyst (BCBA).

Behavior Identification Assessment (CPT code 97151) Behavior identification assessment includes face-to-face, standardized and non-standardized assessments, and direct behavior observations to assess skills across various domains (e.g., social skills, behavior, daily living skills, communication). Assessment results are used to develop a treatment plan which includes goals and objectives for skill acquisition and behavior reduction. The appropriately trained licensed psychologist or a licensed applied behavior analyst (LABA)/ board certified behavior analyst (BCBA) must have conducted both the face-to-face and non-face-to-face activities to report this service.

Behavior identification assessment services may be considered MEDICALLY NECESSARY for the following scenarios: • For individuals with a diagnosis of autism spectrum disorder and/or Down Syndrome, AND
• For assessment and treatment plan development activities, AND • When completed by the appropriately trained licensed psychologist or a licensed applied behavior analyst (LABA)/ board certified behavior analyst (BCBA).

A typical course of behavior identification assessment is completed in 12 hours.

Any additional scenarios not meeting the above criteria are considered INVESTIGATIONAL.

Note: Behavior identification assessment services are not clinically indicated for ongoing treatment planning and case management (e.g., preparation of materials, review of research, writing treatment protocols, charting data or plotting graphs, coordination with other service providers). Behavior identification assessment services are not clinically indicated when multiple assessment tools are utilized to assess the same domain of functioning (e.g., multiple assessments of adaptive functioning).

Behavior Identification Supporting Assessment (CPT code 97152) Behavior identification supporting assessment includes face-to-face, standardized and non-standardized assessments, and direct behavior observations to assess skills across various domains (e.g., social skills, behavior, daily living skills, communication).

Behavior identification supporting assessment may be considered MEDICALLY NECESSARY for the following scenarios: • For individuals with a diagnosis of autism spectrum disorder and/or Down Syndrome, AND • When administered face-to-face, AND • When completed by the behavior technician or appropriately trained licensed psychologist or a licensed applied behavior analyst (LABA)/ board certified behavior analyst (BCBA).

A typical course of behavior identification supporting assessment is completed in 12 hours.

Any additional scenarios not meeting the above criteria are considered INVESTIGATIONAL.

Note: Behavior identification supporting assessment services are not clinically indicated for ongoing treatment planning and case management (e.g., preparation of materials, review of research, writing treatment protocols, charting data or plotting graphs, coordination with other service providers). Behavior identification supporting assessment services are not clinically indicated when multiple assessment tools are utilized to assess the same domain of functioning (e.g., multiple assessments of verbal behavior).

Adaptive Behavior Assessment by two or more Technicians with an Appropriately Trained Licensed Psychologist or a Licensed Applied Behavior Analyst (LABA)/ Board Certified Behavior Analyst (BCBA) present (CPT Code 0362T) Adaptive behavior assessment by two or more behavior technicians with an appropriately trained licensed psychologist or a licensed applied behavior analyst (LABA)/ board certified behavior analyst (BCBA)

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present includes face-to-face, standardized and non-standardized assessments, and direct behavior observations to assess skills across various domains (e.g., social skills, behavior, daily living skills, communication). The appropriately trained licensed psychologist or a licensed applied behavior analyst (LABA)/ board certified behavior analyst (BCBA) must be on site and able to join assessment as needed. Assessment is related to significant behavioral disruption such as self-injurious behavior and intense aggression.

Adaptive behavior treatment or assessment by two or more l technicians, may be considered MEDICALLY NECESSARY for the following scenarios: • For individuals with a diagnosis of autism spectrum disorder, and/or Down Syndrome, AND • When administered face-to-face, AND • Administered by the appropriately trained licensed psychologist or a licensed applied behavior analyst (LABA)/ board certified behavior analyst (BCBA), who is on site AND • With the assistance of two or more technicians, AND • For a patient who exhibits destructive behavior, AND • Completed in an environment that is customized to the patient’s behavior.

A typical course of behavior identification supporting assessment by more than one behavioral technician is completed in 12 hours.

Any additional scenarios not meeting the above criteria are considered INVESTIGATIONAL.

Adaptive Behavior Treatment Services: Direct Treatment Services

BCBSMA covers medically necessary ABA therapy services including face-to-face implementation of treatment protocols and data collection related to each treatment goal implemented during the session. Multiple opportunities to practice skills within sessions should be provided. Services may be provided individually or within a group of at least two but no more than eight patients. Services may be provided individually by the behavior technician, in a group led by the behavior technician, or in a group led by the appropriately trained licensed psychologist or a licensed applied behavior analyst (LABA)/ board certified behavior analyst (BCBA). Services may also include treatment of severe destructive behavior requiring more than one behavior technician with the appropriately trained licensed psychologist or a licensed applied behavior analyst (LABA)/ board certified behavior analyst (BCBA) onsite. Focused ABA treatment is provided to increase select functional skills or reduce problem behavior for a limited number of targets. Comprehensive ABA treatment focuses on multiple domains of functioning and is provided between 30 to 40 hours of treatment per week. Comprehensive ABA treatment of up to 40 hours per week is inclusive of individual and group face-to-face services provided by both the behavior technician and appropriately trained licensed psychologist or a licensed applied behavior analyst (LABA)/ board certified behavior analyst (BCBA).

Adaptive Behavior Treatment by Protocol (CPT code 97153 or 97154) Adaptive behavior treatment by protocol must be administered face-to-face with implementation of individualized treatment protocols and data collection related to each treatment goal implemented during the session. Multiple opportunities to practice skills within sessions is demonstrated by data collection. Dosage is individualized and reflects the member’s symptoms, functioning, and response to treatment. Services may be provided one-to-one or within a group of at least two but no more than eight patients.

Adaptive behavior treatment by protocol may be considered MEDICALLY NECESSARY for the following scenarios: • For individuals with a diagnosis of autism spectrum disorder, and/or Down Syndrome AND • When administered face-to-face, AND • When completed by the behavior technician or appropriately trained licensed psychologist or a licensed applied behavior analyst (LABA)/ board certified behavior analyst (BCBA), AND

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• When implementing treatment protocols and data collection related to each treatment goal, AND • When progress on individual treatment goals is documented.

Any additional scenarios not meeting the above criteria are considered INVESTIGATIONAL.

Group Adaptive Behavior Treatment with Protocol Modification (CPT Code 97158) Group adaptive behavior treatment with protocol modification includes face-to-face clinical direction by the behavior analyst and modification of treatment procedures related to social and behavioral treatment goals and objectives outlined within the treatment plan by the appropriately trained licensed psychologist or a licensed applied behavior analyst (LABA)/ board certified behavior analyst (BCBA). Direct services are provided within a group of at least two but no more than eight patients.

Group adaptive behavior treatment with protocol modification may be considered MEDICALLY NECESSARY for the following scenarios: • For individuals with a diagnosis of autism spectrum disorder, and/or Down Syndrome AND • When administered face-to-face, AND • When completed by the appropriately trained licensed psychologist or a licensed applied behavior analyst (LABA)/ board certified behavior analyst (BCBA), AND • When modifying treatment protocols and data collection related to social and/or behavioral treatment goals.

A typical course of group adaptive behavior treatment with protocol modification services (social skills group) is two hours of treatment per week.

Note:
Clinical direction of the behavior technician who is providing either group or individual adaptive behavior treatment by protocol is not covered by group adaptive behavior treatment with protocol modification.

Any additional scenarios not meeting the above criteria are considered INVESTIGATIONAL

Adaptive Behavior Treatment by more than one Behavioral Technician with an Appropriately Trained Licensed Psychologist or a Licensed Applied Behavior Analyst (LABA)/ Board Certified Behavior Analyst (BCBA) (CPT code 0373T) Adaptive behavior treatment by more than one behavior technician with an appropriately trained licensed psychologist or a licensed applied behavior analyst (LABA)/ board certified behavior analyst (BCBA) present includes face-to-face implementation of treatment protocols and data collection as well as clinical direction and modification of treatment procedures outlined within the treatment plan by the appropriately trained licensed psychologist or a licensed applied behavior analyst (LABA)/ board certified behavior analyst (BCBA). The appropriately trained licensed psychologist or a licensed applied behavior analyst (LABA)/ board certified behavior analyst (BCBA) must be on site and able to join treatment as needed. Treatment is related to significant behavioral disruption such as self-injurious behavior and intense aggression.

Adaptive behavior treatment or assessment by more than one behavioral technician, may be considered MEDICALLY NECESSARY for the following scenarios: • For individuals with a diagnosis of autism spectrum disorder, and/or Down Syndrome AND • When administered face-to-face, AND • Administered by the appropriately trained licensed psychologist or a licensed applied behavior analyst (LABA)/ board certified behavior analyst (BCBA), who is on site AND • With the assistance of two or more technicians, AND • For a patient who exhibits destructive behavior, AND • Completed in an environment that is customized to the patient’s behavior.

Any additional scenarios not meeting the above criteria are considered INVESTIGATIONAL.

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Clinician Directed Services BCBSMA covers medically necessary ABA clinician directed services including face-to-face clinical direction and modification of treatment procedures related to treatment goals and objectives as well as parent and caregiver training related to treatment goals. Clinician directed services are provided in addition to direct treatment services.

Adaptive Behavior Treatment with Protocol Modification (CPT Code 97155) Adaptive behavior treatment with protocol modification includes face-to-face clinical direction and/or modification of treatment procedures related to treatment goals and objectives outlined within the treatment plan by the appropriately trained licensed psychologist or a licensed applied behavior analyst (LABA)/ board certified behavior analyst (BCBA). This may include observation of the behavior technician implementing treatment protocols, clinical direction to modify specific protocols, observation of the member in multiple settings to modify protocols, or direct work with the member to inform development or modification of a treatment protocol.

Adaptive behavior treatment with protocol modification may be considered MEDICALLY NECESSARY for the following scenarios: • For individuals with a diagnosis of autism spectrum disorder, and/or Down Syndrome AND • When administered face-to-face, AND • When completed by the appropriately trained licensed psychologist or a licensed applied behavior analyst (LABA)/ board certified behavior analyst (BCBA), AND • When providing clinical direction and/or modifying treatment protocols and data collection related to treatment goals.

A typical course of adaptive behavior treatment with protocol modification services (clinical direction) is a minimum of 1 hour and maximum of 2 hours for every 10 direct hours provided by the behavior technician implementing treatment protocols.

Any additional scenarios not meeting the above criteria are considered INVESTIGATIONAL.

Parent/Caregiver Adaptive Behavior Treatment Guidance (CPT code 97156 and 97157) Parent/caregiver adaptive behavior treatment guidance includes face-to-face clinical direction, modeling, and modification of treatment procedures related to treatment goals and objectives outlined within the treatment plan by the appropriately trained licensed psychologist or a licensed applied behavior analyst (LABA)/ board certified behavior analyst (BCBA). This may include modeling of treatment protocols and observation of parent/caregiver implementation of treatment protocols. Services may be provided to more than one family member/caregiver of a patient. Services may also be provided to multiple families of different patients at the same time. Multiple members of the same patient’s family are considered one family/caregiver group. When providing group adaptive behavior treatment guidance, services are provided within a group of at least two but no more than eight patient family/caregiver groups.

Parent/Caregiver adaptive behavior treatment guidance may be considered MEDICALLY NECESSARY for the following scenarios: • For individuals with a diagnosis of autism spectrum disorder, and/or Down Syndrome AND • When administered face-to-face, AND • When completed by the appropriately trained licensed psychologist or a licensed applied behavior analyst (LABA)/ board certified behavior analyst (BCBA), AND • When modeling and / or observing the parent/ caregiver modeling treatment protocols, AND • When generalizing and maintaining treatment goals across multiple settings.

Any additional scenarios not meeting the above criteria are considered INVESTIGATIONAL.

Additional Non-Covered Services
Non-covered tests/procedures include but are not limited to the following: • Applied behavior analysis for diagnoses other than autism spectrum disorder or Down Syndrome.

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• Preparation of materials, review of research, writing treatment protocols, charting data or plotting graphs • An ABA covered service that is furnished by an appropriately trained licensed psychologist or a licensed applied behavior analyst (LABA)/ board certified behavior analyst (BCBA) to himself or herself or to a member of his or her immediate family • Supervision/training of behavior technician, LABA/BCBA, LAABA • More than one appropriately trained licensed psychologist or a licensed applied behavior analyst (LABA)/ board certified behavior analyst (BCBA) delivering services to a member during a specific time interval • Accompanying members to appointments or activities outside of the home (e.g., recreational activities, eating out, shopping, play activities, medical appointments), when not part of members documented treatment plan addressing goals related to social and/or behavioral functioning • Transporting the member in lieu of parent/caregiver, when not part of members documented treatment plan addressing goals related to safety and behavior reduction. • Completing housework or chores, or assisting the member with housework or chores, except when done as part of documented treatment plan addressing goals related to social and/or behavioral functioning • Providing respite services (behavior technician support when not actively implementing goals included within member's active treatment plan) for a member including, but not limited to supervising mealtimes, recreational activities, and self-care tasks • Providing services that are part of an individualized education program (IEP), functioning as an educational aide to assist the member in accessing academic and non-academic activities that occur during the educational day in a public, private, or homeschool program, or providing training of educational staff. • Fees for practice expenses such as transportation costs
• Billing services during non treatment time such as nap or rest periods
• Fees or tuition for day or overnight camps, residential, educational, vocational, or recreational. programs or other fees for services that are not medically necessary ABA services • Services provided simultaneously with other medical services such as occupational therapy, speech and language therapy, physical therapy, and psychotherapy • Alternative treatment modalities, such as Relationship Development Intervention and Floor Time. Note: The medical record must be made available to the payer upon request. The medical record must include documentation of individual services provided, session notes, treatment plans, data collection, and assessment results.

Prior Authorization Information
Inpatient • For services described in this policy, precertification/preauthorization IS REQUIRED for all products if the procedure is performed inpatient.
Outpatient • For services described in this policy, see below for products where prior authorization might be required if the procedure is performed outpatient.

Outpatient Commercial Managed Care (HMO and POS) Prior authorization is required.
Commercial PPO and Indemnity Prior authorization is required.

Requesting Prior Authorization Using Authorization Manager Providers will need to use Authorization Manager to submit initial authorization requests for services. Authorization Manager, available 24/7, is the quickest way to review authorization requirements, request authorizations, submit clinical documentation, check existing case status, and view/print the decision letter. For commercial members, the requests must meet medical policy guidelines.

To ensure the request is processed accurately and quickly:

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• Enter the facility’s NPI or provider ID for where services are being performed. • Enter the appropriate provider NPI or provider ID as the servicing provider, not the billing group.

Authorization Manager Resources • Refer to our Authorization Manager page for tips, guides, and video demonstrations.

Complete Prior Authorization Request Form for Applied Behavior Analysis Service Request Form for Initial Assessment and Treatment (144) using Authorization Manager. For out of network providers: Requests should still be faxed to 888-641-5199.

CPT Codes / HCPCS Codes / ICD Codes
Inclusion or exclusion of a code does not constitute or imply member coverage or provider reimbursement. Please refer to the member’s contract benefits in effect at the time of service to determine coverage or non-coverage as it applies to an individual member.

Providers should report all services using the most up-to-date industry-standard procedure, revenue, and diagnosis codes, including modifiers where applicable. CPT Codes 97151 Behavior identification assessment, administered by a physician or other qualified health care professional, each 15 minutes of the physician's or other qualified health care professional's time face-to-face with patient and/or guardian(s)/caregiver(s) administering assessments and discussing findings and recommendations, and non- face-to-face analyzing past data, scoring/interpreting the assessment, and preparing the report/treatment plan 97152 Behavior identification-supporting assessment, administered by one technician under the direction of a physician or other qualified health care professional, face-to-face with the patient, each 15 minutes 97153 Adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with one patient, each 15 minutes 97154 Group adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with two or more patients, each 15 minutes 97155 Adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional, which may include simultaneous direction of technician, face-to-face with one patient, each 15 minutes 97156 Family adaptive behavior treatment guidance, administered by physician or other qualified health care professional (with or without the patient present), face-to-face with guardian(s)/caregiver(s), each 15 minutes 97157 Multiple-family group adaptive behavior treatment guidance, administered by physician or other qualified health care professional (without the patient present), face-to-face with multiple sets of guardians/caregivers, each 15 minutes 97158 Group adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional, face-to-face with multiple patients, each 15 minutes 0373T Adaptive behavior treatment with protocol modification, each 15 minutes of technicians' time face-to-face with a patient, requiring the following components: administration by the physician or other qualified health care professional who is on site; with the assistance of two or more technicians; for a patient who exhibits destructive behavior; completion in an environment that is customized to the patient's behavior. 0362T Behavior identification supporting assessment, each 15 minutes of technicians' time face-to-face with a patient, requiring the following components: administration by the physician or other qualified health care professional who is on site; with the assistance of

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two or more technicians; for a patient who exhibits destructive behavior; completion in an environment that is customized to the patient's behavior. ICD-10 Diagnosis Codes ICD-10-CM diagnosis codes: Code Description F84.0 Autism Spectrum Disorder Q90.0 Trisomy 21, nonmosaicism (meiotic nondisjunction) Q90.1 Trisomy 21, mosaicism (mitotic nondisjunction) Q90.2 Trisomy 21, translocation Q90.9 Down syndrome, unspecified

Description Applied Behavior Analysis (ABA) services include “the design, implementation, and evaluation of environmental modifications, using behavioral stimuli and consequences, to produce socially significant improvements in human behavior, including the use of direct observation, measurement, and functional analysis of the relationship between environment and behavior.” (Chapter 207 of the Acts of 2010). ABA procedures and interventions are based on the principles of behavior analysis identified through scientific research. ABA procedures and interventions are used to support skill acquisition and behavior reduction. Programmatic changes are based on direct observation, data collection, and analysis of graphed data.

ABA is a therapeutic treatment provided by a licensed applied behavior analyst (LABA)/Board Certified Behavior Analyst (BCBA) or appropriately trained, licensed psychologist. ABA is standardly used for the treatment of social, communication, behavioral, and adaptive skills to treat autism spectrum disorder, Down Syndrome, and in some cases other neurodevelopmental disorders. ABA is recognized as an evidence-based standard of care (National Research Council, 2001, American Academy of Pediatrics, 2001, National Standards Project, 2009).

Summary
The purpose of this medical policy is to describe covered/non-covered applied behavior analysis services. The procedure protocols are based on published research, society guidelines and expert opinion and are designed to promote safe and effective treatments for autism spectrum disorder and Down Syndrome. ABA protocols may focus on skill acquisition or behavior reduction and are developed following a behavioral assessment, development of a treatment plan and written treatment protocols. Information gained through various methods of assessment is used to develop an individualized treatment plan by the appropriately trained, licensed psychologist or a licensed applied behavior analyst (LABA)/ board certified behavior analyst (BCBA). ABA services allow for multiple practice opportunities within sessions and include a protocol for generalization of skills and behaviors across people and settings as well as training and guidance for families and caregivers to provide environmental supports that allow for skill maintenance. ABA services may be provided across age and severity levels and should be individualized. ABA services should be provided in consideration of symptom severity and the benefit of other therapeutic services should be considered when engaging in treatment planning. Comprehensive ABA treatment is the treatment of multiple affected developmental domains (social, behavior, communication, adaptive, and emotional functioning) and occurs at a high intensity (30 to 40 hours per week of direct, individualized treatment). Focused ABA treatment addresses a small number of adaptive or maladaptive behaviors targeted for increase or decrease and occurs at lower intensity, dependent upon individual factors. ABA services should be individualized and provided with a high degree of fidelity. ABA services should include ongoing risk assessment and referral to qualified providers for comorbid conditions.

Policy History Date Action

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10/1/2025 Annual policy reviewed. Medically necessary indications revised to include ABA services for individuals with down syndrome. Criteria clarified. References reviewed and added. 10/1/2025.
9/2023 Policy clarified to include prior authorization requests using Authorization Manager.
12/1/2022 Adaptive behavior assessment services, adaptive behavior treatment services, and clinician directed treatment sections reformatted. References and added. 12/1/22.
7/1/2022 Updated criteria to include evidenced based guidelines for typical courses of treatment for ABA services. References updated. Effective 7/1/2022.
3/1/2022 New policy describing medically necessary indications and prior authorization information. Reorganized and clarified InterQual criteria into policy #091. Effective 3/1/2022. Information Pertaining to All Blue Cross Blue Shield Medical Policies Click on any of the following terms to access the relevant information: Medical Policy Terms of Use Managed Care Guidelines Indemnity/PPO Guidelines Clinical Exception Process Medical Technology Assessment Guidelines References

1. ABA Coding Coalition. Model Coverage Policy for Adaptive Behavior Services. September 2020, Second edition January 2022. Accessed June 2025. Available at URL address: https://abacodes.org/wpcontent/uploads/2022/01/Model-Coverage-Policy-for-ABA-01.25.2022.pdf https://abacodes.org/coalitionupdates-its-model-coverage-policy/
2. ABA Coding Coalition. Reporting CPT® Codes for Telehealth Delivery of Adaptive Behavior (ABA) Services. April 2020. Accessed June 2025. Available at URL address: https://abacodes.org/wpcontent/uploads/2020/05/ABACC-Reporting-CPT-Telehealth-Delivery.pdf
3. ABA Coding Coalition. Frequently Asked Questions. Accessed June 2025. Available at URL address: https://abacodes.org/frequently-asked-questions/
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5. American Academy of Child and Adolescent Psychiatry. Practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder. Revised 2014. Available at: https://www.aacap.org/aacap/Resources_for_Primary_Care/Practice_Parameters_and_Resource Centers/PracticeParameters.aspx. Accessed on January 1, 2022
6. American Medical Association (2019). AMA CPT® Professional 2020. Chicago: Author.
7. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. DSM-5. American Psychiatric Association. Washington, DC. May 2013.
8. Association of Professional Behavior Analysts. Identifying Applied Behavior Analysis Interventions.
9. Accessed June 2025. Available at URL address: https://abacodes.org/wpcontent/uploads/2019/06/APBAwhitepaperABAinterventions.pdf
10. Baer DM, Wolf MM, Risley TR. Some current dimensions of applied behavior analysis. J Appl Behav Anal. 1968 Spring;1(1):91-7.
11. Behavior Analyst Certification Board (2022). BCBA® Ethics https://www.bacb.com/wp- content/uploads/2022/01/Ethics-Code-for-Behavior-Analysts-220316-2.pdf
12. Behavioral Health Center of Excellence (BHCOE). (2020). Standard for the documentation of clinical records for applied behavior analysis services. American National Standards Institute Publishing. BHCOE website: https://www.bhcoe.org/.
13. Council of Autism Service Providers [CASP] (2024). Applied behavior analysis practice guidelines for the treatment of Autism Spectrum Disorder: Guidance for healthcare funders, regulatory bodies,

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service providers, and consumers [Clinical practice guidelines]. https://www.casproviders.org/asd- guidelines.

13. Afsharnejad B, Black MH, Falkmer M, Bölte S, Girdler S. The Methodological Quality and Intervention Fidelity of Randomised Controlled Trials Evaluating Social Skills Group Programs in Autistic Adolescents: A Systematic Review and Meta-analysis. J Autism Dev Disord. 2024;54(4):1281-1316. doi:10.1007/s10803-023-05893-z
14. Council of Autism Service Providers (2020). Practice Parameters for Telehealth-Implementation of Applied Behavior Analysis: Continuity of Care during COVID-19 Pandemic. Wakefield, MA: Author.
15. Hyman, S.L., Levy, S.E., Myers, S.M., AAP Council on Children with Disabilities, Section on Developmental and Behavioral Pediatrics (2020). Identification, evaluation, and management of children with autism spectrum disorder. Pediatrics, 145(1). doi.org/10.1542/peds.2019-3447
16. Ivy, J.W., & Schreck, K.A. (2016). The efficacy of ABA for individuals with autism across the lifespan. Current Developmental Disorders Reports, 3, 57-66. doi.org/10.1007/s40474-016-0070-1
17. Leaf, J. B., Leaf, J. A., Milne, C., Taubman, M., Oppenheim-Leaf, M., Torres, N., Townley-Cochran, D., Leaf, R., McEachin, J., & Yoder, P. (2017). An evaluation of a behaviorally based social skills group for individuals diagnosed with autism spectrum disorder. Journal of Autism and Developmental Disorders, 47(2), 243-259. doi.org/10.1007/s10803-016-2949-4
18. Ninci, J., Neely, L.C., Hong, E. R., Boles, M., Gilliland, W.D., Ganz, J.B., Davis, J.L., & Vannest, K.J. (2015). Meta-analysis of single-case research teaching functional living skills to individuals with ASD. Review Journal of Autism and Developmental Disorders, 2, 184-198. doi.org/10.1007/s40489-014- 0046-1
19. Smith, T. & Iadarola, S. (2015). Evidence base update for autism spectrum disorder. Journal of Clinical Child & Adolescent Psychology, 44, 897-922. doi.org/10.1080/15374416.2015.1077448
20. Steinbrenner, J.R., Hume, K., Odom, S.L., Morin, K.L., Nowell, S.W., Tomaszewski, B., Szendrey, S., McIntyre, N.S., Yucesory- Ozkan, S., & Savage, M.N. (2020). Evidence-based practices for children, youth, and young adults with autism. The University of North Carolina at Chapel Hill, Frank Porter Graham Child Development Institute, National Clearinghouse on Autism Evidence and Practice Review Team.

21. Reichow, B. Steiner, AM, & Volkmar, F.R. (2012). Social skills groups for people aged 6 to 21 with autism spectrum disorders (ASD) Cochrane Database of Systematic Reviews, 7 Art. No.: CD008511. DOI: 10.1002/14651858.CD008511.pub2

    Endnotes

    1 Based on expert opinion