In most cases, yes. Illinois law requires state-regulated health plans to cover ABA therapy for autism for individuals under 21, capped at roughly $36,000/year (inflation-adjusted). Blue Cross Blue Shield of Illinois covers ABA therapy when medically necessary, usually with prior authorization. Confirm your specific plan with a Verification of Benefits before starting.
Illinois's autism insurance mandate (215 ILCS 5/356z.15, 2011) requires state-regulated fully-insured commercial plans to cover autism diagnosis and treatment, including ABA, for individuals under 21, with benefits up to $36,000/year (inflation-adjusted) at parity with other medical benefits. Blue Cross Blue Shield of Illinois covers ABA therapy under this mandate for its state-regulated plans. If your BCBS plan is employer-based, it may be self-funded, in which case the state mandate may not apply — call BCBS Illinois directly to confirm your plan type. Note on Medicaid: BCBS Community Health Plan is BCBS Illinois's Medicaid managed care plan and covers Adaptive Behavior Support (ABS) services for individuals under 21 with an ASD diagnosis. This is a separate product from the commercial BCBS Illinois plans covered on this page.
Prior authorization is typically required before ABA services begin:
A DSM diagnosis of F84.0 (autism spectrum disorder) is a prerequisite — without it, ABA assessment or service authorizations cannot be granted.
Prior authorization typically involves a diagnosis, physician referral, and a BCBA-developed treatment plan. Approval commonly takes up to 14 business days for the initial assessment, plus another 14 days for authorization of ongoing direct services.
As of September 1, 2022, BCBS Illinois eliminated the prior authorization requirement for CPT codes 97151 and 97152 for some commercial members, depending on individual claim history.
Call the member services number on your BCBS Illinois card and request a Verification of Benefits. Confirm: ABA coverage, whether prior authorization is required for your specific plan and claim history, the F84.0 diagnosis requirement, deductible, copay, out-of-pocket maximum.
Use Our Free Coverage Check →Let us check your benefits and match you with Illinois providers who accept Blue Cross Blue Shield of Illinois. It's free.
Check My Coverage →This page is pending review by a named BCBA or BCBA-D. A working BACB Certificant Registry link will be added once a reviewer is confirmed.
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 July 2026. Coverage terms and provider availability change frequently — verify directly with your insurance carrier and the provider before scheduling.