When referring a patient please provide the following if available: 

• Diagnosing psychological evaluation listing one of the approved diagnosis codes listed below 
• Script stating “ABA Evaluate and Treat- Autism F84.0” with doctor’s signature 
• Copy of IEP (if available)

The psychological evaluation should meet the following: 

(This information was pulled from the ASD provider manual for providers in the GAMMIS portal)

• Minimum of two (2) assessment tools (1 clinician observational assessment, 1 caregiver assessment)
• Summary of each individual assessment.
• Include the date it was completed and include the tests administered with scores.
• Include the evaluators name and credentials

Approved caregiver tools: 

• ADI-R (Autism Diagnostic Interview) 
• DISCO (Diagnostic Interview for Social and Communication Disorders) 
• CARS QPC (Childhood Autism Rating Scale) 
• GARS-3 (Gilliam Autism Rating Scale) 3-22 years 
• SCQ (Social Communication Questionnaire) 
• MCHAT (Modified Checklist for Autism in Toddlers) 16-30 months 
• SRS-2 (Social Responsiveness Scale) 2.5 and up 
• ASRS (Autism Spectrum Rating Scale) 2 – 18 years 
• Autism Behavior Checklist (ABC) 3 years and older

Approved clinician tools: 

• ADOS2 (Autism Diagnostic Observation Schedule) 12 months through adulthood 
• GARS-3 (Gilliam Autism Rating Scale) 3-22 years 
• CARS2 ST/HF (Childhood Autism Rating Scale) 2 years and up 
• STAT (Screening Tool for Autism in Toddlers and Young Children) 24 – 35 months 
• CSBS (Communication and Symbolic Behavior Scales) 6-24 months 
• TELE-ASD-PEDS Children under 3 years 
• NODA (Naturalistic Observational Diagnostic Assessment) 18 months – 6 years
• DISCO (Diagnostic Interview for Social and Communication Disorders) any age 
• Rapid Interactive Screening Test for Autism in Toddlers (RITA-T) 18 – 36 months 
• Autism Detection in Early Childhood (ADEC) children under 3 years 
• BASC (Behavior Assessment System for Children) 2 – 21 years, 11 months 
• PDD-BI (PDD-Behavior Inventory) 18 months – 18 years, 5 months 
• PEDS:DM (Parents’ Evaluation of Developmental Status) birth – 7 years, 11 months 
• ASQ-3 (Ages and Stages Questionnaire) 1 – 66 months
• ASQ:SE2 (Ages and Stages Questionnaire: Social Emotional) 6 – 60 months
• CBRS (Conners Behavior Rating Scale) 6 – 18 years 
• CDI (Child Development Inventory) 0-6 years 
• CSBS DP Infant-Toddler Checklist 6-24 months