Clinical UM Guideline


Subject:Applied Behavioral Analysis for Autism Spectrum Disorder
Guideline #:  CG-BEH-02Current Effective Date:  07/01/2014
Status:ReviewedLast Review Date:  02/13/2014

Description

This guideline addresses the use of Applied Behavioral Analysis (ABA) or similar services that utilize intensive behavioral intervention (collectively, ABA), when included in relevant state mandates, as treatment for Autism Spectrum Disorder (ASD) when a state mandate requires or benefit plan language explicitly provides coverage for ABA.

The diagnosis of ASD can be complex and difficult due to the diversity of the presentation of symptoms and their severity.  Due to the multitude of possible causes and potential confusion with other conditions, many tests exist to diagnose ASD that may or may not be appropriate.  It is vital that parents or guardians of children suspected of having an ASD seek early diagnosis and care for the child to increase any potential benefits of treatment.  The recommendations for evaluation and assessment of Autism Spectrum Disorders as published by the American Academy of Neurology (Filipek, 2000), the Child Neurology Society and the American Academy of Pediatrics (Johnson, 2007) and the American Academy of Child and Adolescent Psychiatry (Volkmar,1999) are good resources to utilize.

Autism spectrum disorder, as defined in the fifth edition of the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM-5), includes disorders previously referred to as:

Note: Benefits, state mandates and regulatory requirements should be verified prior to application of criteria listed below.

Note: For information regarding testing or treatment of ASD and other related conditions, please see:

Criteria for Coverage

An initial course of ABA treatment may be covered for an individual with ASD when a state mandate requires or a benefit plan explicitly provides coverage for ABA and ALL of the following selection criteria are met:

  1. A diagnosis of ASD has been made by a licensed medical professional or licensed psychologist; and
  2. ABA is considered an effective intervention for ASD based on consensus and evidence based practice guidelines from relevant professional societies and consistent with peer reviewed literature; and
  3. The goals of intervention are appropriate for the individual's age and impairments:
    1. Age 7 and under:  Social, communication, or  language skills or adaptive functioning that have been identified as deficient relative to age expected norms, which form the basis for an individualized treatment plan. The treatment plan should include treatment with a certified or licensed ABA provider (in accordance with state law and benefit plan requirements) for 40 hours per week or less. ABA services for more than 40 hours per week have not been shown to be more effective and documentation as to why more than 40 hours per week is planned must be provided; and
    2. Age 8 and over:  Behaviors or deficits that are interfering with social, communication or language skills or adaptive functioning form the basis for an individualized treatment plan; and
  4. Documentation is provided which describes the individual-specific treatment plan that includes all of the following:
    1. Addresses the identified behavioral, psychological, family, and medical concerns; and
    2. Has measurable goals in objective and measurable terms based on standardized assessments that address the behaviors and impairments for which the intervention is to be applied (Note: this should include, for each goal, baseline measurements, progress to date and anticipated timeline for achievement based on both the initial assessment and subsequent interim assessments over the duration of the intervention); and
    3. Documents that ABA services will be delivered by an appropriate provider who is licensed or certified according to the requirements of applicable state laws and benefit plan requirements
      Note:  Where such requirements apply, the provider of ABA should be within the requirements of the specific state law or as described by the benefit plan.

Continuation of ABA treatment may be covered for an individual with ASD when a state mandate requires or a benefit plan explicitly provides coverage for ABA and ALL of the following selection criteria are met:

  1. The individual has met criteria for an initial course of ABA; and
  2. The individual-specific treatment plan will be updated and submitted, in general, every 6 months or as required by a state mandate.  Note: treatment plans may be required more often than every 6 months when warranted by the individual circumstances; and
  3. For each goal in the individual-specific treatment plan, the following is documented:
    1. Developmental testing is done no later than 2 months after the initial course of ABA treatment has begun in order to establish a baseline in the areas of social skills, communication skills, language skills, and adaptive functioning; and
    2. Progress to date; and
    3. Anticipated timeline for achievement of the goal based on both the initial assessment and subsequent interim assessments over the duration of the intervention; and
  4. The individual-specific treatment plan includes age and impairment appropriate goals and measures of progress:
    1. Age 7and under:  The treatment plan should include measures of the progress made with social skills, communication skills, language skills and adaptive functioning.  Clinically significant progress in social skills, communication skills, language skills, and adaptive functioning must be documented as follows:
      1. Interim progress assessment at least every six months based on clinical progress toward treatment plan goals; and
      2. Developmental status as measured by standard scores using standardized assessments every 1 to 2 years.*
    2. Age 8 and over:  The treatment plan should include measures of the specific behaviors or deficits targeted and also include assessments of social skills, communication skills, language skills, and adaptive functioning that reflect progress in the areas that were identified as negatively affected by the targeted behaviors and deficits. Clinically significant progress in social skills, communication skills, language skills, and adaptive functioning must be documented as follows:
      1. Interim progress assessment at least every six months based on clinical progress toward treatment plan goals; and
      2. Developmental status as measured by standard scores using standardized assessments every 2 to 3 years.*

* During ABA treatment, an individual's progress should be measured using standardized assessment tools with known normative data. Such tests should have age-specific norms against which the individual's progress is measured. For example, using the Vineland, the results are reported in standard scores.  The results can be compared from two points in time to see if the standard scores showed improvement.

Supervision of behavior analysts providing ABA treatment may be covered for an individual with ASD when a state mandate requires or a benefit plan explicitly provides coverage for ABA and ALL of the following selection criteria are met:

  1. The individual has been approved for covered benefits based on criteria above; and
  2. The supervising professional is an appropriate provider who is licensed or certified according to the requirements of applicable state laws and benefit plan requirements to perform the supervisory services; and
  3. Generally, one (1) hour of supervision will be covered for every ten (10) to twenty (20) hours of direct ABA therapy.  Any greater frequency of supervision will require written documentation demonstrating the need for additional supervision.

ABA treatment will not be covered when the criteria above are not met or when there is no documentation of clinically significant developmental progress in any one of the following areas: social skills, communication skills, language skills, or adaptive functioning as measured by either a) interim progress assessment or b) developmental status as measured by standardized tests.

Coding

The following codes for treatments and procedures applicable to this document are included below for informational purposes. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member.

Note: There are no specific procedure codes for ABA therapy.  The following list of procedure codes are examples only and may not represent all codes being used for ABA therapy.  Please contact the member's plan for applicable coding conventions as these may vary. 

CPT 
0359TBehavior identification assessment, by the physician or other qualified health care professional, face-to-face with patient and caregiver(s), includes administration of standardized and non-standardized tests, detailed behavioral history, patient observation and caregiver interview, interpretation of test results, discussion of findings and recommendations with the primary guardian(s)/caregiver(s), and preparation of report
0360TObservational behavioral follow-up assessment, includes physician or other qualified health care professional direction with interpretation and report, administered by one technician; first 30 minutes of technician time, face-to-face with the patient
0361TObservational behavioral follow-up assessment, includes physician or other qualified health care professional direction with interpretation and report, administered by one technician; each additional 30 minutes of technician time, face-to-face with the patient
0362TExposure behavioral follow-up assessment, includes physician or other qualified health care professional direction with interpretation and report, administered by physician or other qualified health care professional with the assistance of one or more technicians; first 30 minutes of technician(s) time, face-to-face with the patient
0363TExposure behavioral follow-up assessment, includes physician or other qualified health care professional direction with interpretation and report, administered by physician or other qualified health care professional with the assistance of one or more technicians; each additional 30 minutes of technician(s) time, face-to-face with the patient
0364TAdaptive behavior treatment by protocol, administered by technician, face-to-face with one patient; first 30 minutes of technician time
0365TAdaptive behavior treatment by protocol, administered by technician, face-to-face with one patient; each additional 30 minutes of technician time
0366TGroup adaptive behavior treatment by protocol, administered by technician, face-to-face with two or more patients; first 30 minutes of technician time
0367TGroup adaptive behavior treatment by protocol, administered by technician, face-to-face with two or more patients; each additional 30 minutes of technician time
0368TAdaptive behavior treatment with protocol modification administered by physician or other qualified health care professional with one patient; first 30 minutes of patient face-to-face time
0369TAdaptive behavior treatment with protocol modification administered by physician or other qualified health care professional with one patient; each additional 30 minutes of patient face-to-face time
0370TFamily adaptive behavior treatment guidance, administered by physician or other qualified health care professional (without the patient present)
0371TMultiple-family group adaptive behavior treatment guidance, administered by physician or other qualified health care professional (without the patient present)
0372TAdaptive behavior treatment social skills group, administered by physician or other qualified health care professional face-to-face with multiple patients
0373TExposure adaptive behavior treatment with protocol modification requiring two or more technicians for severe maladaptive behavior(s); first 60 minutes of technicians' time, face-to-face with patient
0374TExposure adaptive behavior treatment with protocol modification requiring two or more technicians for severe maladaptive behavior(s); each additional 30 minutes of technicians' time, face-to-face with patient
  
HCPCS 
 For the following codes, when specified as ABA therapy:
H0031Mental health assessment by non-physician
[when specified as functional assessment and treatment plan developed for Applied Behavior Analysis (ABA) services by a Qualified Autism Service Provider (licensed clinician or Board Certified Behavioral Analyst (BCBA))
H0032Mental health service plan development by non-physician
[when specified as supervision of a Qualified Autism Service Professional or Paraprofessional by a Qualified Autism Service Provider]
H0046Mental health services, not otherwise specified
[when specified as direct ABA services by a Qualified Autism Service Professional]
H2012Behavioral health day treatment, per hour
[when specified as direct ABA services by a Qualified Autism Service Provider]
H2014Skills training and development, per 15 minutes
[when specified as skill development, social skills group activity]
H2019Therapeutic behavioral services, per 15 minutes
[when specified as direct ABA services by a Qualified Autism Service Paraprofessional]
  
ICD-9 Diagnosis[For dates of service prior to 10/01/2015]
299.00-299.01Autistic disorder
299.10-299.11Childhood disintegrative disorder
299.80-299.81Other specified pervasive developmental disorders (Asperger's disorder)
299.90-299.91Unspecified pervasive developmental disorder
  
ICD-10 Diagnosis[For dates of service on or after 10/01/2015]
F84.0Autistic disorder
F84.3Other childhood disintegrative disorder
F84.5Asperger's syndrome
F84.8Other pervasive developmental disorders
F84.9Pervasive developmental disorder, unspecified
  
Discussion/General Information

In May 2013, the American Psychiatric Association (APA) released the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).  This edition of the DSM includes several significant changes over the previous edition, including combining several previously separate diagnoses under the single diagnosis of "autism spectrum disorder" (ASD).  This diagnosis included the following disorders, previously referred to as: atypical autism, Asperger's disorder, childhood autism, childhood disintegrative disorder, early infantile autism, high-functioning autism, Kanner's autism, and pervasive developmental disorder not otherwise specified.  All of these conditions are now considered under one diagnosis, ASD. It should be noted that Rett Syndrome is not included in the new DSM-5 ASD diagnostic group.

The DSM-5 describes the essential diagnostic features of autism spectrum disorder as both a persistent impairment in reciprocal social communication and restricted and repetitive pattern of behavior, interest or activities.  These attributes are present from early childhood and limit or impair everyday functioning.  Parents may note symptoms as early as infancy, and the typical age of onset is before 3 years of age. Symptoms may include problems with using and understanding language; difficulty relating to or reciprocating with people, objects, and events; lack of mutual gaze or inability to attend events conjointly; unusual play with toys and other objects; difficulty with changes in routine or familiar surroundings, and repetitive body movements or behavior patterns.  There are some exceptions to this, where in some circumstances a child may exhibit normal development for approximately 2 years followed by a marked regression in multiple areas of function. 

Children with ASD vary widely in abilities, intelligence, and behaviors. Some children do not speak at all, others speak in limited phrases or conversations, and some have relatively normal language development.  Repetitive play skills, resistance to change in routine and inability to share experiences with others, and limited social and motor skills are generally evident. Unusual responses to sensory information, such as loud noises and lights, are also common. Affected children can exhibit unusual behaviors occasionally or seem shy around others sometimes without having ASD.  What sets children with ASD apart is the consistency of their unusual behaviors.  Symptoms of the disorder have to be present in all settings, not just at home or at school, and over considerable periods of time. With ASD, there is a lack of social interaction, impairment in nonverbal behaviors, and a failure to develop normal peer relations. A child with an ASD tends to ignore facial expressions and may not look at others; other children may fail to respect interpersonal boundaries and come too close and stare fixedly at another person.

ASDs, under the new DSM-5 paradigm, are now classified by Severity Level (see Table 2 below).  Level 1, "Requiring support," is considered the least severe classification and includes individuals with mild deficits in social communications (as seen in individuals formerly diagnosed with Asperger's syndrome).  Level 3, "Requiring very substantial support," is considered the most severe classification and includes individuals with no or extremely limited communication abilities.

The exact causes of autism are unknown, although genetic factors are strongly implicated.  A study released by the Centers for Disease Control and Prevention (2012) indicates that the incidence of ASD was as high as 1 in 88 children. 

The specific DSM-5 diagnostic criteria for ASD are provided below:

DSM-5 Criteria for Autism Spectrum Disorder*

Diagnostic criteria

  1. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive; see text);
    1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
    2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication, to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communications.
    3. Deficits in developing, maintaining and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social context; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.
      Specify current severity:
      Severity is based on social communication impairments and restricted, repetitive patterns of behavior (See table 2).
  2. Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the  following, currently or by history (examples are illustrative, not exhaustive; see text)
    1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypes, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
    2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food everyday).
    3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).
    4. Hyper- or hypoactivity to sensory inputs or unusual interest in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching or objects, visual fascination with lights or movement).
      Specify current severity:
      Severity is based on social communication impairments and restricted, repetitive patterns of behavior (See table 2).
  3. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learning strategies in later life).
  4. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
  5. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.

Note: Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger's disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder. Individuals who have marked deficits in social communication, but whose symptoms do not otherwise meet criteria for autism spectrum disorder, should be evaluated for social (pragmatic) communication disorder.
Specify current severity:

With or without accompanying intellectual impairment
With or without accompanying language impairment
Associated with a known medical or genetic condition or environmental factor (Coding note: Use additional code to identify the associated medical or genetic condition)
Associated with another neurodevelopmental, mental, or behavioral disorder. (Coding note: Use additional code[s] to identify the associated neurodevelopmental, mental, or behavioral disorder)
With catatonia (refer to the criteria for catatonia associated with another mental disorder, pp. 119-120 for definition). (Coding note: Use additional code 293.89 [F06.1] catatonia associated with autism spectrum disorder to indicate the presence of the comorbid catatonia).

* From: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.  DSM-5.  American Psychiatric Association. Washington, DC.  May 2013. Pages 50-51.

Table 2 Severity levels for autism spectrum disorders*
Severity LevelSocial CommunicationRestricted, repetitive behaviors

Level 3

"Requiring very substantial support"

Severe deficits in verbal and nonverbal social communications skills cause severe impairments in functioning, very limited initiation of social interactions, and minimal response to social overtures from others.  For example, a person with few words of intelligible speech who rarely initiates interaction and, when he or she does, makes unusual approaches to meet needs only and responds to only very direct social approaches.Inflexibility of behavior, extreme difficulty coping with change, or other restricted / repetitive behaviors markedly interfere with functioning in all spheres. Great distress / difficulty changing focus or action.

Level 2

"Requiring substantial support"

Marked deficits in verbal and nonverbal communication skills; social impairments apparent even with supports in place; limited initiation of social interactions; and reduced or abnormal responses from others.  For example, a person who speaks simple sentences, whose interaction is limited to narrow special interests, and who has markedly odd nonverbal communication.Inflexibility of behavior, difficulty coping with change, or other restricted / repetitive behaviors appear frequently enough to be obvious to the casual observer in a variety of context. Distress and or difficulty changing focus or action.

Level 1

"Requiring support"

Without supports in place, deficits in social communication cause noticeable impairments. Difficulty initiating social interactions, and clear examples of atypical or unsuccessful responses to social overtures of others. May appear to have decreased interest in social interactions. For example, a person who is able to speak in full sentences and engages in communications but whose to-and-fro conversation with others fails, and whose attempts to make friends are odd and typically unsuccessful.Inflexibility of behavior cases significant interference with functioning in one or more context. Difficulty switching between activities. Problems of organization and planning hamper independence.

* From: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.  DSM-5.  American Psychiatric Association. Washington, DC.  May 2013. Page 52.

The treatment of ASD may take many different approaches, focusing on one or more aspects of the condition being treated.  There is no single treatment that has consistently demonstrated benefit at the core symptoms of these disorders.  Family therapy is generally supported as a valuable treatment because it offers emotional support and guidance to parents who will contend with a myriad of services to assist their child.  Individual therapy using social story technique and behavioral cue coaching are very useful for the older child/adolescent with Asperger's syndrome and can make a difference in that child's acceptance by others.  Educational therapy includes intensive one-on-one therapy involving a wide array of techniques focusing on improvement in social, communication, and language skills, and may include ABA.

When ABA is used, it may focus on the treatment of multiple behavioral targets across all developmental domains (Comprehensive ABA) or may focus on a limited number of behavioral targets in a select number of domains (Focused ABA).  Comprehensive ABA may range from 26-40 hours per week, including supervision, in a one-to-one setting with the treated individual and an ABA Analyst.  As treatment progresses, treatment in group settings may also be appropriate.  One example of this type of treatment is early treatment where the goal is to close the gap between an individual and their typically developing peers.  These goals may focus on cognitive communication, social, and emotional domains as well as on the symptoms of co-occurring behavior disorders such as aggression or self injury.  Older individuals with ASDs may be reasonable candidates for Comprehensive ABA, especially if they engage in severe or dangerous behaviors across environments.  Focused ABA involves one-on-one treatment and is not restricted by age or other factors.  It is used to attain specific goals where an individual is lacking functional skills, such as are needed in establishing compliance with medical and dental procedures, sleep hygiene, self care, or safe and independent leisure skills.  Focused ABA treatment is usually 10 to 25 hours weekly.

With regard to the hours of supervision of behavior analysts providing ABA treatment, the Behavior Analyst Certification Board guidelines for Health Plan Coverage of Applied Behavior Analysis Treatment for Autism Spectrum Disorder (2012) states the following:

Although the amount of supervision for each case must be responsive to individual client needs, 1-2 hours for every 10 hours of direct treatment is the general standard of care. When direct treatment is 10 hours per week or less, a minimum of 2 hours per week of clinical management and case supervision is generally required. Clinical management and case supervision may need to be temporarily increased to meet the needs of individual clients at specific time periods in treatment (e.g., intake, assessment, significant change in response to treatment).

Definitions

Note: State mandates or certificate language may define these terms more or less broadly than below; consult applicable mandates and certificates when applying this guideline.

Applied Behavior Analysis (ABA): ABA refers to the process of applying interventions that are based on the principles of learning derived from experimental psychology research to systematically change behavior and to demonstrate that the interventions used are responsible for the observable improvement in behavior. ABA methods are used to increase and maintain desirable adaptive behaviors, reduce interfering maladaptive behaviors or narrow the conditions under which they occur, teach new skills, and generalize behaviors to new environments or situations.  ABA focuses on the reliable measurement and objective evaluation of observable behavior within relevant settings including the home, school, and community (Meyers, 2007).

Assessment instruments: Specialized and standardized diagnostic test used to evaluate an individual's performance in specific areas of functioning such as those recommended in the guidelines of the AAP, AAN and the AACAP (e.g., learning and communications skills, social interaction, etc.).

Autism Spectrum Disorder: A collection of associated developmental disorder that affect the parts of the brain that control social interaction and verbal and non-verbal communication.

Behavior modification: A therapy type that is designed to create new behavior patterns in people through intensive and frequent feedback using a reward, non-reward system.

Educational interventions: Learning interventions that assist children with obtaining knowledge, communication through speech, sign language, writing and other methods and social skills. Note: Many benefit contracts exclude coverage for services that are educational in nature.

Oversight/supervision of treatment: ABA is usually conducted by many different individuals, all of whom are tasked with implementing a treatment plan created by a licensed or certified behavioral analyst.  To assure that the treatment plan is being properly and effectively implemented, the licensed or certified provider is required to conduct regular direct supervision sessions of the individuals conducting the ABA treatments specified by the treatment plan for the individual with an autism spectrum disorder. 

Rett Syndrome: A developmental disorder that affects the parts of the brain that control social interaction, communications and motor function.

References

Peer Reviewed Publications:

  1. Cohen H, Amerine-Dickens M, Smith T. Early intensive behavioral treatment: replication of the UCLA model in a community setting. J Dev Behav Pediatr. 2006; 27(2 Suppl):S145-155.
  2. Dawson G, Rogers S, Munson J, et al.  Randomized, controlled trial of an intervention for toddlers with autism: the Early Start Denver Model. Pediatrics. 2010; 125(1):e17-e23.
  3. Eikeseth S, Smith T, Jahr E, Eldevik S. Intensive behavioral treatment at school for 4- to 7-year-old children with autism. A 1-year comparison controlled study. Behav Modif. 2002; 26(1):49-68.
  4. Eldevik S, Eikeseth S, Jahr E, Smith T. Effects of low-intensity behavioral treatment for children with autism and mental retardation. J Autism Dev Disord. 2006; 36(2):211-224.
  5. Gutstein, SE, Burgess AF, Montfort K. Evaluation of the relationship development intervention program. Autism. 2007; 11(5):397-411.
  6. Howard JS, Sparkman CR, Cohen HG, et al. Comparison of intensive behavior analytic and eclectic treatments for young children with autism. Res Dev Disabil. 2005; 26(4):359-383.
  7. McEachin JJ, Smith T, Lovaas OI. Long-term outcome for children with autism who received early intensive behavioral treatment. Am J Mental Retard. 1993; 97(4):359-372.
  8. Sallows GO, Graupner TD. Intensive behavioral treatment for children with autism: four-year outcome and predictors. Am J Ment Retard. 2005; 110(6):417-438.
  9. Sheinkopf SJ, Siegel B.  Home-based behavioral treatment of young children with autism. J Autism Dev Disord. 1998; 28(1):15-23.
  10. Simpson RL. ABA and students with autism spectrum disorders: issues and considerations for effective practice. Focus on Autism and Other Dev Disabil. 2001; 16(2):68-71.
  11. Smith T, Groen AD, Wynn JW.  Randomized trial of intensive early intervention for children with pervasive developmental disorder. Am J Ment Retard. 2000; 105(4):269-285.
  12. Strain PS, Schwartz, I. ABA and the development of meaningful social relations for young children with autism. Focus on Autism and Other Dev Disabil. 2001; 16(2):120-128.

Government Agency, Medical Society, and Other Authoritative Publications:

  1. American Academy of Child and Adolescent Psychiatry.  Practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder. September 2013.  Available at: http://www.aacap.org/App_Themes/AACAP/Docs/practice_parameters/autism.pdf. Accessed on February 7, 2014.
  2. American Academy of Pediatrics, Committee on Children with Disabilities. The pediatrician's role in the diagnosis and management of autistic spectrum disorder in children, Pediatrics. 2001; 107(5):1221-1226.
  3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.  DSM-5.  American Psychiatric Association. Washington, DC.  May 2013.
  4. Autism and Developmental Disabilities Monitoring Network Surveillance Year 2002 Principal Investigators; Centers for Disease Control and Prevention. Prevalence of autism spectrum disorders--autism and developmental disabilities monitoring network, 14 sites, United States, 2002. MMWR Surveill Summ. 2007; 56(1):12-28.
  5. Behavior Analyst Certification Board, Inc.  Guidelines: Health plan coverage of applied behavior analysis treatment for Autism Spectrum Disorder. 2012. Available at: http://www.bacb.com/index.php?page=100772.  Accessed on February 7, 2014.
  6. Burrows K. The Canadian Paediatric Society Mental Health and Developmental Disabilities Committee. Position statement: Early intervention for children with autism.  Paediatr Child Health. 2004; 9(4):267-270. Available at: http://www.cps.ca/documents/position/early-intervention-autism. Accessed on February 7, 2014.  
  7. Center for Health Services and Policy Research, British Columbia Office of Health Technology Assessment, Autism and Lovaas treatment:  A systematic review of effectiveness evidence, July 2000.
  8. Filipek PS, Accardo PJ, Ashwal S, et al. American Academy of Neurology and the Child Neurology Society. Practice parameter: screening and diagnosis of autism: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Child Neurology Society. Neurology. 2000; 55(4):468-479. Guideline-reaffirmed 07/28/2006. Available at: http://www.neurology.org/content/55/4/468.full.pdf. Accessed on February 7, 2014.
  9. Greenspan SI, Brazelton TB, Solomon R, et al. Guidelines for early identification, screening, and clinical management of children with autism spectrum disorders. Pediatrics. 2008; 121(4):828-830.
  10. Johnson CP, Myers SM; American Academy of Pediatrics Council on Children with Disabilities. Identification and evaluation of children with autism spectrum disorders. Pediatrics. 2007; 120(5):1183-1215.
  11. Myer SM, Johnson CP; American Academy of Pediatrics Council on Children with Disabilities. Management of children with autism spectrum disorders. Pediatrics. 2007; 120(5):1162-1182. Available at: http://www.pediatrics.org/cgi/content/full/120/5/1162. Accessed on February 7, 2014.
  12. Reichow B, Barton EE, Boyd BA, Hume K. Early intensive behavioral intervention (EIBI) for young children with autism spectrum disorders (ASD). Cochrane Database Syst Rev. 2012; (10):CD009260.
  13. Volkmar F, Cook EH Jr, Pomeroy J, et al. Practice parameters for the assessment and treatment of children, adolescents, and adults with autism and other pervasive developmental disorders. American Academy of Child and Adolescent Psychiatry Working Group on Quality Issues. J Am Acad Child Adolesc Psychiatry. 1999; 38(12 Supp):32S-54S.
Websites for Additional Information
  1. National Institute of Neurological Disorders and Stroke. Asperger's Syndrome - Short Summary. Available at: http://www.ninds.nih.gov/disorders/Asperger/Asperger.htm. Accessed February 7, 2014.
  2. National Institute of Neurological Disorders and Stroke. Pervasive Developmental Disorders Available at: http://www.ninds.nih.gov/disorders/pdd/pdd.htm.  Accessed on February 7, 2014.
  3. National Library of Medicine. Medical Encyclopedia, Autism. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/001526.htm. Accessed on February 7, 2014.
  4. The Nemours Foundation. Autism. Available at: http://kidshealth.org/parent/medical/learning/pervasive_develop_disorders.html. Accessed on February 7, 2014.
Index

Applied Behavioral Analysis (ABA)
Asperger's Syndrome
Autism
Early Intensive Behavior Intervention (EIBI)
Intensive Behavior Intervention (IBI)
Lovaas Therapy
Pervasive Developmental Disorder (PDD)

History
StatusDateAction
 07/01/2014Updated Coding section with 07/01/2014 CPT changes.
Reviewed02/13/2014Medical Policy & Technology Assessment Committee (MPTAC) review.
Reviewed02/07/2014Behavioral Health Subcommittee review.  No change to Clinical Indications.
New11/14/2013MPTAC review.
New10/18/2013Behavioral Health Subcommittee review.  Initial document development.