In most cases, yes. North Carolina law requires most state-regulated health plans to cover ABA therapy for autism for individuals under 19, capped at $40,000/year. Blue Cross NC covers ABA therapy when medically necessary, usually with prior authorization. Confirm your specific plan with a Verification of Benefits before starting.
North Carolina's autism insurance mandate (SB 676), signed into law October 15, 2015 and effective July 1, 2016, requires state-regulated plans — individual grandfathered plans, fully-insured large-group plans (51+ employees), and fully-insured small-group grandfathered plans (50 or fewer employees) — to cover screening, diagnosis, and treatment of autism spectrum disorder, including ABA therapy. Coverage for adaptive behavior treatment is limited to individuals under 19 and capped at $40,000 per year. ABA must be provided by a licensed BCBA. North Carolina Medicaid has separately covered ABA therapy since 2014. If your Blue Cross NC plan is employer-based and self-funded, it may fall outside this state mandate under federal ERISA instead.
Prior authorization is required before ABA services begin:
A documented autism spectrum disorder diagnosis is required.
A functional behavior assessment (FBA) completed by a BCBA is required.
An individualized treatment plan demonstrating baseline levels and measurable progress criteria must be submitted. Approval commonly takes 10–14 business days. Reauthorization is required approximately every 6 months to continue services.
Call the member services number on your Blue Cross NC card and request a Verification of Benefits. Confirm: ABA coverage, whether the $40,000 annual cap and age-19 limit apply to your specific plan, prior authorization and reauthorization requirements, deductible, copay, out-of-pocket maximum.
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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 July 2026. Coverage terms and provider availability change frequently — verify directly with your insurance carrier and the provider before scheduling.