Does Carelon Cover ABA Therapy?
Yes, when your health plan covers ABA. Carelon Behavioral Health runs the behavioral health network for plans such as Anthem Blue Cross and Blue Shield in Colorado, and your plan sets the coverage rules. Alpaca Health accepts Carelon, checks your benefits for free, handles the approval paperwork with your BCBA, and doesn't have a waitlist.
How Carelon covers ABA therapy
Your health plan pays for ABA when it's medically necessary (needed to treat autism), and Carelon runs that plan's behavioral health network.
- Who Carelon is: Carelon Behavioral Health is part of Elevance Health, Anthem's parent company, and it manages behavioral health care for health plans and employers.
- Its role in Colorado: BCBAs who treat members of Anthem's Colorado plans join the network through Carelon and sign their contracts with it.
- Your plan comes first: When your plan's documents and Carelon's provider rules differ, Carelon's handbook says your plan wins.
- Fully insured plans: In these plans the insurer pays the claims, and Colorado's autism law adds rules, shown in the table further down.
- Self-funded employer plans: Your employer pays the claims, and these plans are exempt from state insurance laws, so their own plan documents set the rules.
- Not sure which you have: Your HR team can tell you, or we check during your free benefits review.
What your child needs to qualify
1. An autism diagnosis
Colorado's autism law says a licensed doctor or psychologist must order the treatment. Carelon's ABA report guidelines also ask who made the diagnosis, their title, and the date. If your child doesn't have a diagnosis yet, Alpaca Health offers an autism evaluation and checks your coverage first.
2. A BCBA assessment
A BCBA tests your child's skills with tools such as the VB-MAPP or ABLLS-R. Carelon recommends that the BCBA watch your child directly at least twice. The BCBA also does a functional behavior assessment, a study of what sets off a behavior and why.
3. A treatment plan with measurable goals
The BCBA writes a treatment plan with starting data, measurable goals, and a target date for each skill. Carelon also asks for parent training goals and a crisis plan, and it wants goals that aren't schoolwork and don't overlap your child's IEP.
4. A qualified provider
Carelon's request form asks who leads the program, such as a BCBA or a licensed behavior analyst. Behavior technicians can then run sessions under that person's direction.
How prior authorization works with Carelon
This step means getting your health plan's approval before ABA starts. Your BCBA sends the request to your plan, online or through the number on your member ID card. Carelon's Colorado guide gives providers that same card number.
- Anthem plans: Anthem's Colorado approval list names Anthem as the reviewer for behavioral health care, and Anthem has judged ABA requests with an outside guideline, MCG B-806-T, since June 2024.
- When Carelon reviews: Plans that send ABA requests to Carelon use its ABA request form, which asks for a complete treatment plan and the hours wanted for each billing code.
- Separate requests: That form treats the first assessment, the start of therapy, and each renewal as their own requests.
- Renewals show progress: Carelon's report guidelines ask for a progress report between 30 days and two weeks before an approval ends, with a graph of the data for every goal.
- Some employer plans skip review: Self-funded Anthem plans that didn't buy Anthem's review program don't need this approval.
- Step 1DiagnosisA licensed clinician confirms your child's autism diagnosis.
- Step 2BCBA assessmentA BCBA in Carelon's network observes your child and tests skills.
- Step 3Treatment planThe BCBA sets measurable goals, parent goals, and a crisis plan.
- Step 4Plan approvalYour health plan, such as Anthem, reviews the request and approves hours.
- Step 5Therapy and renewalsTherapy starts, and progress reports go in before each approval ends.
What Carelon covers for ABA therapy
Carelon's ABA request form lists the billing codes below, and your plan decides which ones it pays for. You'll see these codes on your explanation of benefits.
- Assessments (97151, 97152): The BCBA tests your child and writes the plan, sometimes with a technician's help.
- One-to-one therapy (97153): A behavior technician works with your child, with 1 hour of BCBA supervision for every 5 to 10 hours of therapy.
- BCBA sessions (97155): The BCBA works with your child, adjusts the program, and can direct the technician.
- Caregiver training (97156, 97157): Coaching for parents and caregivers, for one family or a group of families.
- Group sessions (97154, 97158): Small-group therapy, such as a social skills group.
- Severe behavior (0362T, 0373T): Testing and treatment with two or more technicians, led on site by the BCBA, for severe or destructive behavior.
The form asks for weekly hours by code and for the setting, such as home, a clinic, or school. Your child's assessment shapes those numbers. Anthem plans approve a set number of hours each week, and since March 2026 Anthem pays only up to that weekly approved amount.
State limits on fully insured plans in Colorado
| State | What state law allows |
|---|---|
| Colorado | Plans must cover autism treatment for children, including ABA, and the law sets no dollar cap or specific age cutoff (C.R.S. 10-16-104). |
Self-funded employer plans follow their own plan documents. We checked these laws in October 2026.
What families pay with Carelon
What you pay depends on your plan's deductible, copay, and out-of-pocket maximum. Carelon's handbook says your plan sets what you owe. The deductible is what you pay each year before your plan starts to share costs. Coinsurance is the percent of each bill you pay after that.
- Same cost share as other care: Colorado's law says the fully insured plans it covers can't apply worse deductibles or coinsurance to autism care than to other physical illness.
- No extra bills in network: Carelon's handbook bars BCBAs in its network from billing you more than your plan's share for covered care.
- Self-funded plans vary: These plans set their own cost sharing, so two families with the same insurer can pay very different amounts.
- Plan a full year: Once you know your deductible and yearly limit, you can estimate a year of ABA therapy costs.
Where Alpaca Health accepts Carelon
Open the Colorado page below to see local BCBAs, in-home options, and the state rules that shape your coverage.
Independent BCBAs in Colorado Springs, Thornton, Erie, Pagosa Springs, and other parts of Colorado accept Carelon.
See Colorado options →How Alpaca Health handles your Carelon benefits
You don't have to sort out which company does what, because our team makes those calls for you. After you fill out our short intake form, we check your benefits. We follow up within one business day with what your plan covers and what you may owe.
- Benefits check: We confirm which plan pays for your child's care, plus your deductible, coinsurance, and out-of-pocket maximum.
- Approval paperwork: Your BCBA writes the assessment and treatment plan your plan reviews, and we handle the submission.
- A BCBA who takes your plan: We match you with an independent BCBA who accepts Carelon and has openings now.
Carelon BCBAs near you
Each clinician below accepts Carelon and works with Alpaca Health. Browse the full provider directory, or fill out the intake form and we'll match you.
Amber Moore, M.S., BCBA, is a Board Certified Behavior Analyst and the co-founder and clinical director of Love Forward ABA. She brings more than ten years of experience supporting children and families, blending play with learning in individualized, neuro-affirming ABA care.
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Dr. Anesa Doyle, PhD, BCBA, is a Board Certified Behavior Analyst with more than a decade of experience supporting autistic children, adolescents, and their families. She has also spent many years teaching and training future behavior analysts at the graduate level.
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Angelina Waterman is a Board Certified Behavior Analyst and wellness consultant who provides behavioral wellness services that combine evidence-based ABA with yoga, mindfulness, and personalized coaching.
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Asia Johnson, M.S., BCBA, LBA, is a Board Certified Behavior Analyst and the founder and CEO of Seizing 61:1. She began as a Behavior Technician and brings more than a decade of clinical and leadership experience to culturally responsive, trauma-informed care.
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Carol Potter, MA, BCBA, LBA, is a Board Certified Behavior Analyst with more than 20 years of experience working with children, adolescents, and young adults. Her specialties include autism, ADHD, behavioral sleep and feeding concerns, and Acceptance and Commitment Therapy.
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Christine Coffman, M.Ed., BCBA, is the founder of Training Wheels, a clinician-owned and clinician-operated ABA practice in Colorado. She built it around ethical practice, realistic caseloads, and genuine support for the clinicians and RBTs doing the work.
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Daniel Guglielmo is a Licensed and Board Certified Behavior Analyst and behavioral health executive with extensive experience building, leading, and overseeing high-quality Applied Behavior Analysis services in regulated healthcare environments.
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Elyanna Myer is a Board Certified Behavior Analyst and the founder of Sunrise Behavioral Consultants. She has extensive experience working with clients aged 18 months to 21 years across diverse settings, including in-home, school, clinic, telehealth, and youth centers.
Book a consultationView profileIs Carelon the same as Beacon Health Options?
Yes. Anthem bought Beacon Health Options in 2020. In 2022, Anthem's parent company, now called Elevance Health, said Beacon would take the new Carelon name. If a letter still says Beacon, it's the same company, and we check your insurance coverage the same way.
Does Carelon require prior authorization for ABA therapy?
Yes for Anthem plans in Colorado, unless a self-funded employer plan skipped Anthem's review program. Carelon's handbook says approval rules vary from plan to plan, so we check yours before the first ABA assessment. Alpaca Health prepares each request with your BCBA, so you don't have to.
How many hours of ABA therapy does Carelon cover?
Carelon's ABA request form doesn't set a fixed weekly number. Its handbook says each approval covers a set number of services for a set time, based on your child's needs. Your BCBA asks for the hours per week that the assessment supports. For fully insured plans, Colorado's law sets no dollar cap on ABA.
How do I find ABA therapy that accepts Carelon in Colorado?
Look for a BCBA in Carelon's network for your plan, since Carelon signs up behavioral health providers for Anthem's Colorado plans. Alpaca Health works with independent BCBAs across Colorado who take Carelon. Denver families can also choose in-home ABA therapy. Fill out our intake form and we'll match you with one who has openings.
Does Carelon cover autism testing?
Testing comes from your health plan's benefits, just like ABA. Colorado's law says fully insured plans must cover autism testing and diagnosis for a child, as well as treatment. Self-funded plans set their own rules, so we check your plan first, and you can compare typical autism diagnosis costs.
Check your Carelon coverage
Tell us about your child and the plan on your card. We'll confirm your benefits, handle the approval paperwork, and match you with a BCBA who takes your plan.