The short version
- It depends on who pays. Health First Colorado's published criteria list an autism diagnosis as one of several ways to qualify. Private plans under Colorado's mandate cover treatment of autism spectrum disorders, so they look for that diagnosis. TRICARE requires an ASD diagnosis from an approved provider.
- Even when Medicaid's criteria do not require an autism label, the prior authorization request asks for an ICD-10 diagnosis code and a prescription from a physician, physician assistant, nurse practitioner or psychologist.
- Colorado's private-plan mandate covers assessment and diagnosis as well as treatment, so the evaluation itself should be a covered benefit.
- Under age 3, anyone can refer your child to Early Intervention Colorado at 833-733-3734. From age 3, Aurora Public Schools and Cherry Creek School District run free Child Find evaluations.
- Health First Colorado is rewriting its pediatric behavioral therapy rules. The state plans an initial reading before the Medical Services Board on December 11, 2026, so check the current rules before you plan around them.
ABA without an autism diagnosis in Aurora is possible for some families and not for others, and the deciding factor is the payer. Health First Colorado, a private plan and TRICARE each set different rules. This guide lays them out, then covers what you can start while you wait for an evaluation.
Information current as of October 2026. Coverage rules change, so confirm with your plan and your provider.
Does the payer require an autism diagnosis?
| Payer | What it asks for | Autism diagnosis required? |
|---|---|---|
| Health First Colorado (Medicaid) | Two or more listed factors, a prescription and a standardized assessment | Not by the published criteria, but a diagnosis is one of the factors and the request carries an ICD-10 code |
| Fully insured private plan | Coverage of autism spectrum disorder assessment, diagnosis and treatment | In practice yes, because the mandate is written for ASD |
| Self-funded employer plan | Whatever the employer’s plan document says | Ask HR |
| TRICARE | Referral and pre-authorization | Yes, a diagnosis from an approved provider |
What does Health First Colorado actually require?
The state’s behavioral therapy criteria apply to members age 20 and younger. They call for the presence of two or more of the following:
- a diagnosis of a condition for which behavioral therapy is recognized as therapeutically appropriate, including autism spectrum disorder;
- a quality of life affected by persistent challenges in social communication or social-emotional reciprocity across home, school or community;
- a safety risk to self or others, with self-injury, aggression, property destruction, repetitive behaviors and elopement given as examples;
- a need for evidence-based support in behavior and self-regulation, cognition, learning and play, safety, or self-care.
A standardized assessment of maladaptive behaviors showing an inability to function in those activities is also required. So is a prescription from a physician, physician assistant, nurse practitioner or psychologist, and the child must be medically stable. (HCPF criteria) The state repeated the same criteria in a January 2026 provider review. (HCPF)
An autism diagnosis is one way to meet the test, not the only way. But the request still has to name a diagnosis: the state’s PAR checklist asks for an ICD-10 code, and the ordering prescription should include the diagnosis, preferably with that code. The provider also submits a referral, a plan of care and an adaptive-behavior assessment. (HCPF providers page, HCPF January 2026 review) Reviewers apply federal EPSDT medical necessity criteria, which call for an individualized, child-specific clinical review.
The rules are in motion. HCPF is drafting a full rule for pediatric behavioral therapy and plans an initial reading before the Medical Services Board on December 11, 2026. (HCPF) Our Health First Colorado guide covers Medicaid ABA in more detail.
What do private plans and TRICARE require?
Private plans. C.R.S. 10-16-104(1.4) requires health benefit plans issued or renewed in Colorado to cover “assessment, diagnosis, and treatment of autism spectrum disorders” for a child, including behavior training, behavior management and applied behavior analysis. Treatment must be prescribed by a licensed physician or psychologist. (C.R.S. 10-16-104) Because the benefit is built around that diagnosis, a plan will usually want it before approving ABA. The same statute covers the evaluation. Self-funded employer plans are generally outside the state mandate, so see our private insurance guide.
TRICARE. Your child must have a diagnosis of autism from an approved provider, plus a referral and pre-authorization. The approved list includes pediatricians, family practice physicians, developmental behavioral pediatricians, pediatric neurologists, psychiatrists and licensed doctoral-level clinical psychologists. (TRICARE)
Who can evaluate my child in Aurora?
Start with your pediatrician and ask for a referral. Children’s Hospital Colorado’s developmental pediatrics program evaluates social communication and autism spectrum disorders in children from infancy through adolescence. The line is 720-777-6630. The page does not say whether you need a referral, so ask when you call. (Children’s Hospital Colorado) Our guide to autism evaluations and early intervention in Aurora covers the evaluation process.
While you wait for an appointment, ask the clinic if it keeps a cancellation list, and ask the pediatrician what they can document today.
What can we do while we wait?
Under age 3: Early Intervention Colorado. The state says anyone can refer a family to Early Intervention, including a parent. The referral line is 833-733-3734. (EI Colorado) Aurora Public Schools tells families of children under 3 in Arapahoe or Adams counties to use the Early Intervention referral form. (Aurora Public Schools)
Ages 3 to 5: Child Find. From age 3, school districts run the process. Colorado says referrals can come from any source, including medical providers, family and preschools. Parental consent is not required to refer, though you take part throughout the evaluation. It is free. (CDE)
- Aurora Public Schools. Its Child Find is a free service for children 3 to 5 not yet in school. A team meets your child for a screening of play and conversation, then you decide together whether to evaluate further. The text line is 303-653-1689. (Aurora Public Schools)
- Cherry Creek School District. Its Child Find is free and uses a play-based assessment. If it finds your child needs support, it writes an IEP and offers a preschool classroom spot at no cost. The main line is 720-554-4001. (Cherry Creek)
Child Find looks for an educational disability that requires special education, so a “not eligible” result does not settle the medical question. Our guide to Aurora Public Schools and Cherry Creek supports goes further.
Can a clinic start before the diagnosis?
That depends on who pays and on the clinic. Ask on your first call: can you begin a behavior assessment while the diagnosis is pending, what would insurance cover, and what would you owe? Our early intervention ABA and comprehensive assessment pages describe our services. After an evaluation, our guide to what comes after a diagnosis covers next steps, and in-home ABA is one way care begins. We take all major insurance including Medicaid, have no waitlist and start families within two weeks of approval. Contact us.
Sources
- Colorado HCPF, Health First Colorado Criteria for Behavioral Therapies (November 2024)
- Colorado HCPF, Pediatric Behavioral Therapy (PBT) Review, January 2026
- Colorado HCPF, Pediatric Behavioral Therapies Information for Providers
- Colorado HCPF, Complete Rules: Pediatric Behavioral Therapy (PBT) rulemaking meetings
- Colorado Revised Statutes 10-16-104 (autism spectrum disorders, subsection 1.4)
- TRICARE, Autism Care Demonstration
- Early Intervention Colorado
- Aurora Public Schools, Child Find
- Cherry Creek School District, Child Find
- Colorado Department of Education, Child Find for children ages 3 through 5
- Children's Hospital Colorado, Developmental Pediatrics