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Coverage criteria policies

Intensive Early Intervention Behavioral Therapy (IEIBT)

These services may or may not be covered by your HealthPartners plans. Please see your plan documents for your specific coverage information. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.

Administrative Process

Prior authorization is not applicable to Intensive early intervention behavioral therapy (IEIBT) because it is a non-covered service.

This coverage policy does not apply to Minnesota commercial large group fully insured benefit plans that are subject to the Minnesota statues 62A.3094. Please see the policy for Early Intensive Intervention Services (EIIS) for those groups subject to the Minnesota mandate.

This coverage policy does not apply to Minnesota Medicaid plans or other plans sponsored by the Minnesota Department of Human Services. Please see the policy for Early Intensive Developmental and Behavioral Intervention (EIDBI) - Minnesota Health Care Programs.

This coverage policy does not apply to Wisconsin plans that are subject to Wis. Stat. Chapter 632.895 (12m) Please see the policy for Intensive Behavioral Therapy For Autism – Wisconsin.

Coverage

Intensive Early Intervention Behavioral therapy (Lovaas or Discrete Applied behavioral therapy) is not a covered service, as the evidence does not exist to prove or disprove its effectiveness in improving the functioning of children with autism.

Definitions

Intensive Early Intervention Behavioral therapy (IEIBT or Lovaas, or Discrete Trial Applied behavioral therapy) uses time-intensive behavioral intervention techniques to address symptoms that characterize autism. The goal of this staged-approach therapy is to reduce the level of disability associated with long-term outcomes in children with autism.

Autism Spectrum Disorder is a complex, life-long, developmental disability that results in social interaction problems, communication difficulties, and restrictive or repetitive behaviors. There are several programs that use a combination of methods that may include IEIB therapy. Although frequently used, the effectiveness of Intense Early Intervention Behavioral Therapy (a.k.a. Lovaas) is not supported in the medical literature.

If available, codes are listed below for informational purposes only, and do not guarantee member coverage or provider reimbursement. The list may not be all-inclusive.

Codes

Description

H2014

Skills training and development, per 15 minutes – Lay description: Skills training and development provides the patient with necessary abilities that will enable the individual to live independently and manage his/her illness and treatment. Training focuses on skills for daily living and community integration for patients with functional limitations due to psychiatric disorders, per 15 minutes.

F84.0

Autistic Disorder

CPT Copyright American Medical Association. All rights reserved.  CPT is a registered trademark of the American Medical Association.

Products

This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy, contact Member Services at 952-883-7979 or 1-800-233-9645.