Regence's ABA Policy Changes November 1: One Provider at a Time, No 0373T Stacking

The revised BH18 applies to Regence members in Washington, Oregon, Idaho and Utah whose plans require ABA preauthorization. Most of the change is to billing, not to medical necessity.

Regence has published a revised version of its ABA medical policy, BH18, that takes effect November 1, 2026, about four weeks from now. The current version, effective since August 1, 2025, carries a banner saying so. It applies to Regence member contracts that require preauthorization for ABA, and it cites the autism and parity laws of Washington, Oregon, Idaho and Utah.

The turn: the criteria barely moved. The billing did.

Set the two versions side by side and the medical-necessity tests read almost the same. The initial-assessment criteria that used to sit in a separate policy, BH33, are now Criterion I of BH18, and the cross-reference to BH33 reads "None." The changes that will show up in claims and authorizations are elsewhere:

  • One provider. A new note: "Members are limited to ABA treatment by one authorized ABA provider at any given time."
  • 0373T. "Code 0373T may not be billed concurrently with 97153 or 97155. Activities typically reported under these codes are considered part of the 0373T service and are not separately reimbursable." The policy cites the ABA Coding Coalition's supplemental guidance.
  • Group treatment. "Clinical justification is required for the use of intensive group adaptive behavior treatment demonstrating why a group treatment format is necessary to address the member's identified deficits and why the requested frequency and duration are medically necessary."
  • Hours by modality. The treatment plan must now justify "the hours per week of each modality (e.g., face-to-face supervision, intensive group therapy)," where the old text asked only about face-to-face supervision. Requests must list services "(including modality)."

One wording change to read carefully: "Behavior Technicians (BTs) and Registered Behavior Technicians (RBTs)" now reads just "Registered Behavior Technicians (RBTs)." The policy doesn't say non-RBT technicians are excluded, so don't assume it either way.

What didn't change

Continuation documentation is still due at least five business days before an authorization ends and no more than 30 days before. Objective measurement of goals is still required at least every six months, with the same tool used at baseline.

The limits

We found no Regence provider notice announcing the revision. The policy doesn't define "concurrently" for 0373T, so it doesn't say whether the bar covers only overlapping time or any 97153 or 97155 on the same date. It also doesn't say how the one-provider limit handles a transfer between agencies.

What you must know or do

  • Billers: pull Regence claims from the last 90 days where 0373T and 97153 or 97155 appear on the same date of service. Ask Regence in writing, before November 1, whether "concurrently" means overlapping time or the same date.
  • Intake: for every Regence member, ask whether another ABA agency also holds an authorization, such as a separate home or school program. Flag each one before its next renewal.
  • Clinical directors: for any Regence plan that includes 97154 or 97158, write the group-format justification and the weekly hours for each modality into the treatment plan now, so renewals dated after November 1 already carry it.