Dec 1 to Jan 31
- Every end date gets an owner now
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The ABA Operator · Issue 6, late November 2026
Year-end sweep: authorizations, benefit caps and January 1
This issue: authorizations ending in December and January, plan-year resets to re-verify, and what changes for ABA codes and rates on January 1, 2027.
Sweep · Dec 1 to Jan 31
CPT 2027 · 453 changes
Jan 1, 2027 · API, BCBSM, Point32
Edition
6 · late Nov 2026
Focus
Year-end sweep
Audience
ABA operators
Window
Dec 1 to Jan 31
Codes
CPT 2027 · 453
Length
5 min
Authorizations that expire on leave
1
Pull every authorization ending Dec 1 to Jan 31this week
By payer and BCBA; a session after the end date is unpaid.
2
Open the reauthorization packet30 days ahead
Indiana: caregiver coaching hours and an FBA per BIP target [2].
3
Log request and decision dates72 h / 7 days
Impacted payers owe 72 hours expedited, 7 days standard, a specific denial reason [3].
4
Hold scheduling past the end dateuntil the ledger has a new one
From January 1, 2027 the payer API returns it [3].
Caps and resets
Plan years reset January 1. Re-verify every commercial member in week one; read the plan's ABA policy, not only the eligibility response.
| Rule | Detail | Source |
|---|---|---|
| Iowa group plans | Plans renewed on or after January 1, 2026 may not impose an aggregate annual or lifetime limit on autism benefits or limit outpatient ABA visits | [4] |
| BCBS Nebraska I.178 | Treatment plans of no more than 25 hours a week; only 97155 and 97156 payable by telehealth; effective November 15, 2026 | [5] |
| Indiana Medicaid | 4,000-hour lifetime allocation for comprehensive ABA, modifier UA; targeted ABA up to 15 hours a week; no coverage at 21 and older from October 1, 2026 | [2] |
| Point32Health | Center-based ABA providers in Massachusetts and Rhode Island accredited by January 1, 2027; all others by January 1, 2028 | [7] |
How we run itCorePulse, our eligibility and benefit verification engine, re-verifies January as one transaction per member; caps belong on the authorization row.
January 1 for ABA codes and rates
CPT 2027, released September 9, 2026, highlights maternity care, AI codes and sleep studies, not 97151 to 97158 [1].
CPT 2027 changes
299 new, 74 revised, 80 deleted [1]
299New · 66%
7416%
8018%
Indiana 97153 U1 maximum fee per unit
Phases [2]
$17.06Before
$16.04Apr 2026-6.0%
$15.39Apr 2027-9.8%
| Date | Change | Source |
|---|---|---|
| Dec 1, 2026 | Massachusetts 101 CMR 358.00 ABA rates, proposed unchanged, subject to federal approval | [6] |
| Jan 1, 2027 | CPT 2027 effective; no adaptive behavior changes named | [1] |
| Jan 1, 2027 | Blue Cross Behavioral Health applies updated ABA criteria to admissions, continued stays and discharge for BCBSM and BCN members | [8] |
| Jan 1, 2027 | Point32Health accreditation deadline for center-based ABA providers in Massachusetts and Rhode Island | [7] |
| Jan 1, 2027 | CMS-0057-F Prior Authorization API: Medicaid MCOs, FFS and MA plans | [3] |
| Apr 1, 2027 | Indiana's additional 4% reduction on all ABA codes; state documents in the Q4 rate tracker | [2] |
Three numbers
30 days
- Packet opens 30 days before the end date
72 h / 7 days
- Owed on each request [3]
This month
The 2027 margin playbook is out; our ABA billing team is running the December sweep for clients. The ABA payer matrix carries November's policy changes.
Export every authorization by end date
Sort by end dateAnything ending before January 31 gets an owner today.
Ledger templateABA RCM toolkit.
Send the API questions tooNovember issue.
Re-verify every commercial member in week one of JanuaryResets land on the authorization row.
Frequently asked questions
Are the ABA CPT codes changing on January 1, 2027?
The AMA's September 9, 2026 release lists 453 changes in maternity care, AI, sleep medicine and other areas; it does not name 97151 to 97158. Expect the same ABA codes in January.
Why sweep ABA authorizations in December?
Six-month authorizations from June and July end in December and January, when reviewers and families are hardest to reach. Pull everything ending by January 31, open packets 30 days ahead, log decisions against the clocks.
What benefit caps should ABA billing teams check at the plan-year turn?
Weekly, annual and lifetime limits, deductibles, visit counts: BCBS Nebraska's 25-hour weekly limit from November 15, 2026, Indiana's 4,000-hour lifetime allocation, Iowa's bar on aggregate autism limits for group plans renewed from January 1, 2026.
- American Medical Association press release, AMA releases CPT 2027 code set (September 9, 2026)
- Indiana IHCP bulletin BT202627, IHCP announces changes to applied behavior analysis (ABA) therapy services (February 26, 2026)
- CMS fact sheet, CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F), January 17, 2024
- Iowa Code 2026, section 514C.22, Biologically based mental illness coverage
- Blue Cross and Blue Shield of Nebraska, Medical Policy Update November 2026, Policy I.178 Autism Spectrum Disorders (effective November 15, 2026)
- Massachusetts EOHHS, Notice of Public Hearing, 101 CMR 358.00 Rates for Applied Behavior Analysis (hearing June 17, 2026)
- Point32Health, ABA accreditation requirements and deadlines (September 2026)
- Blue Cross Blue Shield of Michigan, The Record, October 2026: updated ABA utilization management criteria for dates of service on or after January 1, 2027
Checked October 27, 2026. Confirm against the source; proposed rules are marked proposed.
Want the December sweep run on your book?
We export the authorizations, assign owners, re-verify January benefits and load the dated rates.