New Jersey
Notice to ABA providers treating NJ members
Effective March 24, 2020, as a result of a bulletin provided by New Jersey’s Department of Insurance, Magellan will allow the telehealth utilization of all applied behavior analysis (ABA) codes on your current reimbursement schedule. This applies to any member enrolled in their health plan in New Jersey, regardless of where the services are rendered. You are required to continue to utilize telehealth modifiers and POS codes.
It is your clinical responsibility to ensure your members are receiving the appropriate level of treatment. By providing telehealth services you are guaranteeing that the treatment recommendation is conducive to the member’s functioning level, cognitive capacity, and behavior/stimulus control to benefit from a virtual model. The request for telehealth services must be made individually to each member. Magellan will review requests for medical necessity and you are required to demonstrate in your treatment plan how the telehealth program will be utilized and benefit the member/family. You are required to continue to follow the standard pre-authorization requirements to receiving ABA services.
Telehealth for ABA codes will be provided while the pandemic is ongoing. Once we lift the telehealth option you will receive a notification from Magellan regarding the change in process.