In most cases, yes. Pennsylvania's Autism Insurance Act (Act 62) requires state-regulated group health plans (51+ employees) to cover ABA therapy for autism, performed by a licensed BCBA, with no visit limits, for members up to age 21. Anthem Blue Cross Blue Shield covers ABA therapy when medically necessary. Confirm your specific plan with a Verification of Benefits before starting.
Pennsylvania's Autism Insurance Act (Act 62), signed into law in 2008, requires state-regulated group health insurance policies issued in Pennsylvania to groups of 51 or more employees to cover the diagnosis and treatment of autism spectrum disorder, including ABA therapy performed by a licensed BCBA. The law prohibits visit limits on autism services and covers members up to age 21. Fully-insured group plans of 51+ employees issued in PA are bound by Act 62. Self-funded employer plans are typically governed by federal ERISA law instead, and Act 62's state mandate does not apply to them — though many self-funded employers choose to cover ABA anyway. Anthem operates as Anthem Blue Cross Blue Shield in Pennsylvania and covers ABA therapy for autism spectrum disorder when medically necessary, with details varying by the specific plan.
Most Anthem plans in Pennsylvania require prior authorization before ABA services begin:
A formal ASD diagnosis from a licensed psychologist or developmental pediatrician is required before submitting a treatment plan.
Anthem typically requires a comprehensive treatment plan with measurable goals, assessment results, weekly therapy hours, and the BCBA's credentials before authorizing ABA services.
ABA services are billed under CPT codes 97151–97158, 0362T, and 0373T. Call the member services number on your Anthem card to confirm your plan's specific authorization process.
Families across the Philadelphia suburbs — including Montgomery County, Delaware County, Chester County, and Bucks County — and in the Pittsburgh metro — including Allegheny, Butler, and Westmoreland counties — frequently ask whether Anthem covers ABA in their area. Coverage follows Pennsylvania's statewide Act 62 rules regardless of which metro you are in; what varies is provider availability and network status. Harmony Care Finder's provider network spans both corridors, so one coverage check surfaces in-network Anthem options across whichever area is closest to you.
Call the member services number on your Anthem card and request a Verification of Benefits. Confirm: ABA coverage, prior authorization requirements, session caps, deductible, copay, and out-of-pocket maximum. Ask specifically whether your employer plan is fully-insured (covered by Act 62) or self-funded.
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This content is for informational purposes only and does not constitute medical, clinical, or therapeutic advice. Consult a licensed healthcare provider or Board Certified Behavior Analyst (BCBA) before making therapy decisions for your child.
Data current as of August 2026. Coverage terms and provider availability change frequently — verify directly with your insurance carrier and the provider before scheduling.