---
title: "MO HealthNet (Missouri Medicaid) ABA coverage: the intake guide."
url: "https://carelu.com/payers/missouri-medicaid"
markdown_url: "https://carelu.com/payers/missouri-medicaid.md"
state: MO (Missouri)
payer: MO HealthNet (Missouri Medicaid)
kind: State Medicaid program
description: "How MO HealthNet covers ABA — the full fee-for-service carve-out from managed care, the single fax precertification (form 2575-045), EPSDT coverage beyond autism, the RBT/BCBA modifier rate split, 6-month auth periods, and the mandatory RBT credential rule."
last_reviewed: September 2026
vob_data_updated: 2026-07-23
---

# MO HealthNet (Missouri Medicaid) ABA coverage: the intake guide.

_Payer Guide · MO HealthNet · Last updated September 2026 · 17 primary sources_

> Full FFS carve-out: one payer, one fax precert (form 2575-045), no MCO contracting.

Missouri runs statewide Medicaid managed care — Healthy Blue, Home State Health, UnitedHealthcare, and the Show Me Healthy Kids specialty plan — but for ABA, none of that matters: the benefit is fully carved out of managed care, and every MO HealthNet member receives ABA on a fee-for-service basis directly from the state. The Behavioral Health Services Manual says it plainly, and the plans' own manuals confirm it. For an ABA practice, MO HealthNet is effectively a single-payer state: one precertification pathway (a form faxed to the state help desk — no UM vendor, no portal), one fee schedule, and zero MCO contracting or credentialing for ABA. The whole intake playbook below is about working that one pathway well.

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Required — all ABA needs precertification (sole exception: school-based ABA in an IEP); form 2575-045 faxed to (573) 635-6516 with the diagnostic evaluation [1][3]
- **Prior auth for treatment**: Required — precertified up to 6 months; continuation needs the current plan, progress graphs, and barriers if progress isn't evident [1][3]
- **Autism diagnosis required?**: ASD (F84.0, F84.3, F84.5, F84.8) by a licensed physician or psychologist for the standard benefit — but under EPSDT/HCY, ABA is also covered for other diagnoses when medically necessary [1]

## At a glance

- **Covers ABA?:** Yes — under 21; ASD standard benefit, plus other diagnoses under EPSDT/HCY when medically necessary
- **Structure:** Full FFS carve-out — MCO enrollees included; no MCO ever touches ABA
- **Precert:** Required for everything except IEP school-based ABA — form 2575-045 by fax to (573) 635-6516
- **Auth periods:** Up to 6 months; approved hours and dates come back by fax
- **Rates (per 15 min):** 97153: $20.13 (HO/HN) vs. $16.37 (HM technician/RBT); 97151/97155/97156: $25.26 (HO)
- **RBT rule:** National RBT credential mandatory — 90-day grace from passing the competency assessment
- **Licensure:** Missouri LBA (RSMo 337.315); psychologists need MHD ABA-specialty approval
- **Staff screening:** RBTs: BACB background + abuse-registry check; LBA/LaBA: MSHP + FBI fingerprints; FCSR not automatic for ABA

## The carve-out: why there are no MCO guides for Missouri

The Behavioral Health Services Manual states that participants enrolled in a MO HealthNet Managed Care health plan receive ABA services on a FFS basis, outside the managed-care benefit package — and the plans corroborate it in their own documents. Healthy Blue's provider manual lists ABA among services "reimbursed by the state agency on a fee-for-service basis," and the Show Me Healthy Kids manual's benefit grid routes ABA to "MO HealthNet Fee For Service." So whichever card a family shows — Healthy Blue, Home State Health, UnitedHealthcare Community Plan, or Show Me Healthy Kids (the statewide specialty plan for foster-care and adoption-subsidy children, a population with elevated behavioral needs) — the ABA answer is identical: state FFS, state precert, state fee schedule. MCO case managers are a referral source, not a payer; note that OT/PT/speech remain plan-covered with the MCO, which makes multi-service kids a coordination point, not a contracting one. The state's own MO HealthNet Managed Care Policy Statements (revised 7/2023 — confirmed as of this review still the current edition; no newer version was found) directly corroborates the carve-out: it lists ABA among services managed-care plans are not required to provide, states ABA is covered "when provided by MO HealthNet enrolled providers" (i.e., FFS), and confirms "All ABA services require precertification." [1][17][5][6]

## Precertification: one form, one fax number

All ABA services require precertification — the manual's sole exception is school-based ABA delivered under an IEP. The mechanics are refreshingly analog: complete the "Applied Behavior Analysis Request for Precertification" form (form 2575-045) and fax it to the MHD Behavioral Health Services help desk at (573) 635-6516. The state reviews in-house and faxes back the approved hours and the precert start and end dates. The initial "ABA Assessment for Intervention Planning" precert requires the diagnostic evaluation attached; the initial intervention precert requires that assessment plus the intervention plan; and continued intervention requires the current plan, progress data and graphs, and — where progress isn't evident — identified barriers and strategies. Intervention may be precertified for up to six months from the start date, with a new precert required to continue beyond it. [1][3][4]

Eligibility is diagnosis-flexible in a way intake teams should not miss: the standard benefit requires a participant under 21 with a diagnostic evaluation by a licensed physician or licensed psychologist producing an ASD diagnosis (precertifiable ICD-10 codes F84.0, F84.3, F84.5, F84.8) and recommending ABA as medically necessary — with evaluations expected to follow the Missouri Autism Guidelines Initiative's best-practice guidelines. But under the Healthy Children and Youth (EPSDT) program, ABA is also covered for participants under 21 with other diagnoses when medically necessary. An autism diagnosis is not an absolute gate — don't turn a non-ASD family away before the EPSDT analysis. [1][3][4]

## Rates: the modifier scheme is the revenue model

Missouri pays by rendering-practitioner tier, flagged with modifiers: HO = behavior analyst or psychologist, HN = assistant behavior analyst, HM = behavior technician/RBT (billed by the licensed supervisor), U8 = home or other place of service, TM = telemedicine. Per 15-minute unit from the official fee schedule: 97151 assessment pays $25.26 (max 32 units); 97153 direct treatment pays $20.13 at both the HO and HN tiers but $16.37 with the HM technician modifier (raised effective 7/1/2024 from $17.73; max 32 units — 8 hours/day); 97155 pays $25.26 HO ($27.46 with U8 in-home, $17.73 HN; max 24 units); 97156 family training pays $25.26 HO / $20.13 HN (max 16 units). Two quirks worth wiring into billing: the fee file marks the TM telemedicine rows as NOT requiring prior authorization, and technicians' claims must never carry the U8 modifier. The daily unit maximums are real — an October 2022 hot tip confirmed a system fix after 97153/97155 claims wrongly denied on limit restrictions. [2]

## Staffing rules: the RBT mandate and enrollment structure

Missouri made the national RBT credential mandatory with a 90-day grace period: a behavior technician (18+, high-school diploma, 40-hour RBT training, passed initial competency assessment) may render services for up to 90 calendar days from passing the competency assessment, but must pass the national RBT exam and hold the BACB credential by day 90 to continue — effective April 1, 2024 and reiterated in MHD's June 2026 billing-compliance bulletin. Technicians and RBTs cannot enroll as MHD providers; their services are billed by the licensed supervisor with the HM modifier plus the supervisor's specialty modifier. Enrolled behavior analysts hold the Missouri (or home-state) LBA license, and psychologists may only bill ABA once MHD approves them for the ABA specialty (credential documents fax to MMAC Provider Enrollment, (573) 634-3105). One structural recommendation from the state's own training: group practices with two or more licensed behavior analysts should enroll as an "Autism Clinic" (Provider Type 50 – Clinic/Group, specialty AC), which parks precerts at the clinic level so any performing provider in the clinic can serve the client — a genuine continuity-of-care advantage when supervisors change. [3][4][1]

## Staffing & credentialing: who you can hire, and what they must clear

At the technician level, Missouri layers almost nothing on the BACB — because it delegated the whole credential: 13 CSR 70-98.030 requires technicians to be "credentialed by the Behavior Analyst Certification Board (BACB) as a Registered Behavior Technician," with no state-registry alternative, and the April 1, 2024 policy adds the age/education floor (18+, high-school diploma or national equivalent, the 40-hour training and competency assessment) alongside the 90-day exam runway covered above. That makes the BACB's own screening rules the binding check for every technician hire: within 180 days of paying for the RBT application, the applicant must pass a criminal background check and an abuse-registry check "comparable to those required of home health aides, child care professionals, and teachers" — an employer-run check inside that window satisfies it if you keep the documentation for audit. One pipeline wrinkle: applicants on or after January 1, 2026 need the updated 2026 40-hour training (certificate carrying the 2026 approval statement, trainer an active BCBA/BCaBA with supervision training) and the updated competency assessment. [7][8][9][10][11][12][13][14][15][16]

Supervisors carry the state's only individual-level fingerprint mandate. LBA and LaBA licensure under RSMo 337.315 (Behavior Analyst Advisory Board, Division of Professional Registration — applications now run through the MOPRO portal, launched January 14, 2025) requires two classified fingerprint sets: one processed by the Missouri State Highway Patrol against the state repository, the second forwarded to the FBI. Missouri also adds a training mandate found nowhere in the ABA payment rules: at least two hours of suicide assessment, referral, treatment, and management training at initial licensure and at every renewal (HB 1719, effective August 28, 2018). Useful for hiring pre-certification talent: the statute provides provisional licenses allowing practice under licensed supervision before BCBA/BCaBA certification — terminating automatically after one year, renewable once for a two-year maximum — plus 90-day temporary licenses (one extension) for practitioners licensed elsewhere. On structure, 13 CSR 70-98.030 requires each technician to work under an LBA, an LaBA, or a licensed psychologist officially granted supervisory privileges by the BACB, with the supervisory relationship documented in writing; the rule sets no numeric ratio of its own, so the BACB's 5%-of-monthly-hours RBT supervision minimum (two monthly face-to-face contacts, at least one individual) is the operative floor. [7][8][9][10][11][12][13][14][15][16]

At the agency level, screening runs through Missouri Medicaid Audit & Compliance: under 13 CSR 65-2 and 42 CFR 455.450, MMAC screens every provider at initial enrollment and revalidation by federal risk category — limited-risk screening covers cross-state license verification, identity confirmation, and database checks (SSA Death Master File, NPPES, OIG exclusions, Medicare enrollment, National Sex Offender Public Website); moderate risk (the default for any provider type not otherwise categorized) adds pre-enrollment and unannounced post-enrollment site visits; high risk adds fingerprint-based FBI and MSHP checks of every 5%-or-greater owner, submitted via the MACHS system through the state vendor IDEMIA, with an exemption for owners fingerprinted for Medicare or another state Medicaid within the last two years. Two honest caveats close the picture. First, Missouri's Family Care Safety Registry is not automatic for ABA agencies: RSMo 210.900 ties the "mental health worker" registration duty to personal-care staff of DD facilities and group homes, so a standard outpatient/in-home ABA clinic isn't covered by definition — though agencies operating DD facilities or group homes or employing personal-care workers are (registration within 15 days of hire), and many providers use the FCSR voluntarily as an inexpensive screening tool. Second, the MO HealthNet ABA rule itself contains no employee background-check provision, so the binding individual-level checks are exactly the BACB RBT check and the licensure fingerprinting above — confirm any employer-level extras with MMAC provider enrollment rather than assuming them. [7][8][9][10][11][12][13][14][15][16]

## Intake gates

The questions that decide whether a family can start with MO HealthNet (Missouri Medicaid), and what they have to bring.

- **Age limit**: Under 21, on both pathways. “To be eligible for ABA services, participants must be under 21 and have a diagnostic evaluation performed by a licensed physician or licensed psychologist, resulting in a diagnosis of ASD, and recommending ABA services as medically necessary.” The Healthy Children and Youth (HCY) program — Missouri's EPSDT — keeps the same upper bound while widening the diagnosis: ABA is also covered for participants under 21 with other diagnoses if medically necessary. No lower age bound, no hour cap and no dollar cap are published. [1]
- **Who may diagnose**: A short list: a licensed physician or a licensed psychologist. The diagnostic evaluation must be performed by one of those two, must result in an ASD diagnosis, and must recommend ABA as medically necessary. Under the HCY/EPSDT pathway the diagnosis need not be ASD at all, but the evaluation requirement stands. Note that the person who may diagnose and the person who may bill ABA are different populations in Missouri: psychologists may only bill ABA once MHD has approved them for the ABA specialty. [1]
- **Diagnostic tools required**: Missouri names no instrument but names a standard. “The diagnostic evaluation should be performed in accordance with Autism Spectrum Disorders: Missouri Best Practice Guidelines for Screening, Diagnosis, and Assessment, published by the Missouri Autism Guidelines Initiative.” The precertification table treats instruments as a reassessment trigger rather than an entry requirement — re-administration of tools is listed among the clinical rationales for a periodic ABA Assessment for Intervention Planning. So collect the full evaluation report and whatever tools it used; do not expect a closed list to check it against. [1]
- **Referral required?**: There is no separate referral document — the recommendation lives inside the diagnostic evaluation, which must result in an ASD diagnosis “and recommending ABA services as medically necessary.” What sits in a referral's place is precertification, and it is universal: “all ABA services (except for school-based ABA services included in an IEP) require precertification.” Fax form 2575-045 with the required clinicals to the Behavioral Health Services help desk at (573) 635-6516; there is no portal and no UM vendor. The initial assessment precert needs the diagnostic evaluation attached; the initial intervention precert needs that assessment plus the intervention plan; continuation needs the current plan, progress data and graphs, and — where progress is not evident — identified barriers and strategies. [1][3]
- **Telehealth**: Permissive, and unusually explicit that technicians count. “Any licensed health care provider may provide telemedicine services if such services are within the scope of practice for which the health care provider is licensed… This includes applied behavior analysis services rendered by a behavior technician or RBT under the supervision of a licensed behavior analyst or licensed psychologist” (13 CSR 70-3.330(2)(A)). Services must meet the same standard of care as in person, and the provider must be fully licensed in Missouri and enrolled with MO HealthNet. Bill POS 02 (telemedicine not in home) or POS 10 (telemedicine in home); distant-site services on school grounds bill POS 03 with a GT modifier, and for a participant in a residential or inpatient place of service the claim carries the GT modifier and the POS where the participant physically is, never POS 02. Telemedicine in a school needs the parent or guardian's authorization first, which may cover the remainder of the school year. One billing quirk: the fee file marks the TM telemedicine rows as not requiring prior authorization, but a service delivered by telemedicine is otherwise subject to exactly the same precertification and utilization review as in person. [1][2]
- **Prior-auth decision time**: MO HealthNet decides ABA precertification itself (fee-for-service, faxed form 2575-045), and neither the Behavioral Health Services Manual nor the General Sections Manual publishes a decision timeframe. The federal fee-for-service floor therefore governs: since January 1, 2026 the state agency must decide a standard prior-authorization request "in no case later than 7 calendar days after receiving the request," extendable by up to 14 calendar days when the provider or participant asks or the agency needs more information, and an expedited request "in no case later than 72 hours after receiving the request." The clock starts on receipt, so send the complete package the ABA section lists with the form. Approvals come back by fax: "Providers will receive a faxed response indicating the number of hours allowed, as well as precertification start and end dates." ABA intervention is precertified "for a period of up to six (6) months from the start date," and nothing is backdated: "If services are initiated before the approval date on the Prior Authorization (PA) Request or after the authorization deadline, payment will not be made." Reauthorization lead time: "For services to continue after the expiration date of an existing PA Request, a new PA Request must be completed and submitted prior to the end of the current PA." No fixed number of days ahead is published. [18][1][19]
- **Other insurance (who pays first)**: MO HealthNet pays last. "MHD does not and should not pay a claim for medical expenses until the provider submits documentation that all available TPRs have considered the claim for payment." Bill the child's commercial plan (or TRICARE, CHAMPVA, a non-custodial parent's court-ordered plan) first; MO HealthNet then pays only "the difference between the MHD allowable and the TPR benefit amount." If the commercial plan denies, attach a "legitimate denial" — an EOB stating the service is not payable "for reasons other than failure to meet claim filing requirements." MHD will not pay behind an administrative denial: "TPR's claim filing instructions were not followed" or "Any other payment precondition was not met," so get the commercial plan's own prior auth and network status right. An out-of-network commercial provider is paid only if that plan "has paid primary or there is a legitimate denial." Get the MO HealthNet precert too: the ABA rule has no other-insurance exception ("All ABA services (except for school-based ABA services included in an IEP) require precertification"), and the same manual states for behavioral-health precert that "Precertification is required when third party insurance coverage exists." The TPL bypass list (pay first, recover later) covers claims "Related to preventative pediatric care," personal care and ID/DD waiver services; ABA is not on it. Difficulty getting a primary EOB does not extend MO HealthNet's 12-month filing limit. [19][1][20]
- **Diagnosis recency** _(ask the plan)_: No recency rule is published. §1.16 requires a diagnostic evaluation by a licensed physician or licensed psychologist but does not state how recent it must be, and the precertification table asks for the diagnostic evaluation on the initial assessment request without a date test. The only currency requirement sits on the assessment rather than the diagnosis: a periodic re-assessment precertification must carry a clinical rationale — re-administration of tools, a new behavior observed, a new environment where the participant is responding differently, or a lack of adequate progress. [1]
  - Ask the plan: MHD Behavioral Health Services help desk at (573) 635-6516 when faxing form 2575-045 — ask whether an evaluation of this age will be accepted before you book the assessment.

## Delivery and billing rules

Coverage decides whether MO HealthNet (Missouri Medicaid) pays. These decide whether the claim survives: staffing and supervision, concurrent billing, per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.

- **Supervision**: Missouri delegates the ratio and keeps the accountability. 13 CSR 70-98.030 requires each technician to work under an LBA, an LaBA, or a licensed psychologist granted supervisory privileges by the BACB, “the supervisory relationship with a licensed ABA practitioner must be documented in writing, and the licensed supervisor is responsible for the work performed by unlicensed individuals.” The rule sets no numeric ratio of its own, so the BACB's 5-percent-of-monthly-hours RBT supervision minimum (two monthly face-to-face contacts, at least one individual) is the operative floor. Technicians have 90 calendar days from passing the initial competency assessment to hold the national RBT credential, and the grace period attaches to the person, not to your company. [1][7][8]
- **Daily limits / MUEs**: Real, published and worth wiring into scheduling: per 15-minute unit, 97151 is capped at 32 units a day, 97153 at 32 units (8 hours) a day, 97155 at 24 units, and 97156 family training at 16 units. The precertification itself sets the other ceiling — ABA intervention may be precertified for up to six months from the start date, and the faxed response comes back with the number of hours allowed plus the start and end dates. The daily maximums bite: an October 2022 hot tip confirmed a system fix after 97153 and 97155 claims wrongly denied on limit restrictions. [2][1]
- **Session-note signature**: Missouri puts the signature on the supervisor, explicitly. For behavior technicians and RBTs, “the licensed supervisor is responsible for the work performed by unlicensed individuals, including reviewing and signing documentation for services provided by the behavior technicians and RBTs they supervise.” Beyond that, “all services provided must be adequately documented in the medical record” under 13 CSR 70-3.030 and the Title XIX Provider Participation Agreement — see the manual's own definitions of adequate documentation and adequate medical records. No signing deadline is published. [1][7]
- **Place of service**: Four settings, and the modifier follows the setting. “Services may be provided in POS 11 (office), 12 (home), 03 (school) or 99 (other). The U8 modifier should be used for services billed with a POS 12 (home) or 99 (other)” — and the U8 modifier must never be used on a behavior technician or RBT line. School-based ABA delivered under an IEP is the single precertification exemption in the whole benefit. Telemedicine uses POS 02 (not in home) or POS 10 (in home), except that distant-site services delivered on school grounds bill POS 03 with a GT modifier. [1]
- **Bill as provider**: The supervisor bills; the technician cannot. “Services provided by a behavior technician or RBT must be billed by the licensed supervisor using the codes and modifiers specified… Behavior technicians and RBTs are not allowed to enroll as MHD providers.” The HM modifier flags technician delivery and the supervisor adds their own specialty modifier (HO for behavior analyst or psychologist, HN for assistant behavior analyst). Psychologists may bill ABA only once MHD approves them for the ABA specialty, and should not use the AH modifier with these codes. MHD recommends that group practices with two or more licensed behavior analysts enroll as an Autism Clinic (Provider Type 50 — Clinic/Group, specialty AC), which parks the precertification at the clinic level so any performing provider in the clinic can serve the client. [1][4]
- **Concurrent billing (97153 + 97155)** _(ask the plan)_: Not addressed. Neither §1.16 of the Behavioral Health Services Manual nor 13 CSR 70-98.030 states whether 97155 and 97153 may be billed for the same clock time. The manual does carry a general non-covered line — “travel time is not reimbursed and must not be included as part of the scheduled appointment time” — and the daily unit maximums on the fee schedule bound the day, but neither settles same-time code pairs. A 2022 hot tip confirming a system fix after 97153/97155 claims wrongly denied on limit restrictions suggests the pair does pay in practice, which is a claims-history observation rather than a published rule. [1][2]
  - Ask the plan: MHD Behavioral Health Services help desk — the same line that takes the precertification fax, (573) 635-6516 — or Provider Communications. Ask whether 97155 pays alongside 97153 for the same clock time and request the answer in writing.

## What intake should collect for MO HealthNet (Missouri Medicaid)

- **MO HealthNet eligibility — not the plan card:** Whichever MCO card the family shows, ABA is state FFS. Verify MO HealthNet eligibility; skip the MCO analysis entirely.
- **Diagnostic evaluation:** By a licensed physician or psychologist — required with the assessment precert. ASD codes F84.0/F84.3/F84.5/F84.8, or frame the EPSDT case for other diagnoses.
- **Age (under 21):** The benefit is under-21 in both the standard and EPSDT pathways.
- **School services / IEP status:** IEP-based school ABA is precert-exempt — and a coordination fact for the intervention plan.
- **Rendering-tier plan:** HO vs. HN vs. HM decides the rate on every hour — staffing mix is a first-order revenue variable.

Free verification-call checklist (PDF): https://carelu.com/downloads/aba-verification-call-checklist.pdf

## Verification of benefits (VOB) data

How MO HealthNet (Missouri Medicaid) ABA benefits route and read on an eligibility check. Data last updated 2026-07-23.

### EDI routing

- **Payer ID (pVerify):** 00146
- **Supports 270/271 eligibility:** Yes
- **Real-time eligibility:** Yes
- **Behavioral health administrator:** none (ABA is a MO HealthNet FFS carve-out from managed care — billed to the state, never to the MCO)
- **ABA rides on:** medical benefit
- **Two-hop verification required:** No
- **Where the 271 carries MCO enrollment:** Loop 2110C EB segment: EB04='MC' (X12 Managed Care code) flags managed-care enrollment; the ME (eligibility) code rides EB05, and 2110C REF02 when REF01='M7'. The MCO's plan hotline surfaces in Loop 2120C PER04. The ABA FFS carve-out is NOT exposed as a discrete 271 field — it must be inferred from the coverage category, not read off the wire.
- **Eligibility span granularity:** Real-time (1) or batch (99); DTP date-range spans keyed to calendar-month boundaries, with day-specific eligibility also supported. Monthly ME-segment coverage is the default granularity.

### Code-level coverage

| Code | Covered | Prior auth | Unit cap | Place of service | Telehealth | Modifiers |
| --- | --- | --- | --- | --- | --- | --- |
| 97151 | Yes | Required — precertification via the faxed ABA precertification request form (form 2575-045 per missouri.ts prose) to the MHD Behavioral Health Services help desk, (573) 635-6516; the sole exception is school-based ABA delivered under an IEP. Precertified for up to 6 months. Telehealth (TM) rows are marked no-precert on the fee schedule. | 32 units/day per day | 11 = office, 12 = home (U8 modifier required), 03 = school, 99 = other (U8 modifier required), telehealth (TM modifier) | Yes — TM modifier. The ABA fee schedule marks every TM (telemedicine) row as NOT requiring precertification, unlike in-person rows. Delivered only by the tiers each code allows (LaBAs and technicians are limited per the manual). | HO, U8 (in-home), TM (telehealth) |
| 97152 | Yes | Required — precertification via the faxed ABA precertification request form (form 2575-045 per missouri.ts prose) to the MHD Behavioral Health Services help desk, (573) 635-6516; the sole exception is school-based ABA delivered under an IEP. Precertified for up to 6 months. Telehealth (TM) rows are marked no-precert on the fee schedule. | 16 units/day per day | 11 = office, 12 = home (U8 modifier required), 03 = school, 99 = other (U8 modifier required), telehealth (TM modifier) | Yes — TM modifier. The ABA fee schedule marks every TM (telemedicine) row as NOT requiring precertification, unlike in-person rows. Delivered only by the tiers each code allows (LaBAs and technicians are limited per the manual). | HO, HN, HM (RBT, billed by supervisor), U8 (HO/HN in-home), TM |
| 97153 | Yes | Required — precertification via the faxed ABA precertification request form (form 2575-045 per missouri.ts prose) to the MHD Behavioral Health Services help desk, (573) 635-6516; the sole exception is school-based ABA delivered under an IEP. Precertified for up to 6 months. Telehealth (TM) rows are marked no-precert on the fee schedule. | 32 units/day per day | 11 = office, 12 = home (U8 modifier required), 03 = school, 99 = other (U8 modifier required), telehealth (TM modifier) | Yes — TM modifier. The ABA fee schedule marks every TM (telemedicine) row as NOT requiring precertification, unlike in-person rows. Delivered only by the tiers each code allows (LaBAs and technicians are limited per the manual). | HO, HN, HM (RBT, billed by supervisor), U8 (HO/HN in-home), TM |
| 97154 | Yes | Required — precertification via the faxed ABA precertification request form (form 2575-045 per missouri.ts prose) to the MHD Behavioral Health Services help desk, (573) 635-6516; the sole exception is school-based ABA delivered under an IEP. Precertified for up to 6 months. Telehealth (TM) rows are marked no-precert on the fee schedule. | 8 units/day per day | 11 = office, 12 = home (U8 modifier required), 03 = school, 99 = other (U8 modifier required), telehealth (TM modifier) | Yes — TM modifier. The ABA fee schedule marks every TM (telemedicine) row as NOT requiring precertification, unlike in-person rows. Delivered only by the tiers each code allows (LaBAs and technicians are limited per the manual). | HM (RBT, billed by supervisor), TM |
| 97155 | Yes | Required — precertification via the faxed ABA precertification request form (form 2575-045 per missouri.ts prose) to the MHD Behavioral Health Services help desk, (573) 635-6516; the sole exception is school-based ABA delivered under an IEP. Precertified for up to 6 months. Telehealth (TM) rows are marked no-precert on the fee schedule. | 24 units/day per day | 11 = office, 12 = home (U8 modifier required), 03 = school, 99 = other (U8 modifier required), telehealth (TM modifier) | Yes — TM modifier. The ABA fee schedule marks every TM (telemedicine) row as NOT requiring precertification, unlike in-person rows. Delivered only by the tiers each code allows (LaBAs and technicians are limited per the manual). | HO, HN, U8 (HO in-home, higher rate), TM |
| 97156 | Yes | Required — precertification via the faxed ABA precertification request form (form 2575-045 per missouri.ts prose) to the MHD Behavioral Health Services help desk, (573) 635-6516; the sole exception is school-based ABA delivered under an IEP. Precertified for up to 6 months. Telehealth (TM) rows are marked no-precert on the fee schedule. | 16 units/day per day | 11 = office, 12 = home (U8 modifier required), 03 = school, 99 = other (U8 modifier required), telehealth (TM modifier) | Yes — TM modifier. The ABA fee schedule marks every TM (telemedicine) row as NOT requiring precertification, unlike in-person rows. Delivered only by the tiers each code allows (LaBAs and technicians are limited per the manual). | HO, HN, U8 (HO/HN in-home), TM |
| 97157 | Yes | Required — precertification via the faxed ABA precertification request form (form 2575-045 per missouri.ts prose) to the MHD Behavioral Health Services help desk, (573) 635-6516; the sole exception is school-based ABA delivered under an IEP. Precertified for up to 6 months. Telehealth (TM) rows are marked no-precert on the fee schedule. | 8 units/day per day | 11 = office, 12 = home (U8 modifier required), 03 = school, 99 = other (U8 modifier required), telehealth (TM modifier) | Yes — TM modifier. The ABA fee schedule marks every TM (telemedicine) row as NOT requiring precertification, unlike in-person rows. Delivered only by the tiers each code allows (LaBAs and technicians are limited per the manual). | HO, HN, U8 (HO/HN in-home), TM |
| 97158 | Yes | Required — precertification via the faxed ABA precertification request form (form 2575-045 per missouri.ts prose) to the MHD Behavioral Health Services help desk, (573) 635-6516; the sole exception is school-based ABA delivered under an IEP. Precertified for up to 6 months. Telehealth (TM) rows are marked no-precert on the fee schedule. | 6 units/day per day | 11 = office, 12 = home (U8 modifier required), 03 = school, 99 = other (U8 modifier required), telehealth (TM modifier) | Yes — TM modifier. The ABA fee schedule marks every TM (telemedicine) row as NOT requiring precertification, unlike in-person rows. Delivered only by the tiers each code allows (LaBAs and technicians are limited per the manual). | HO, HN, TM |
| 0362T | Yes | Required — precertification via the faxed ABA precertification request form (form 2575-045 per missouri.ts prose) to the MHD Behavioral Health Services help desk, (573) 635-6516; the sole exception is school-based ABA delivered under an IEP. Precertified for up to 6 months. Telehealth (TM) rows are marked no-precert on the fee schedule. | 16 units/day per day | 11 = office, 12 = home (U8 modifier required), 03 = school, 99 = other (U8 modifier required), telehealth (TM modifier) | Yes — TM modifier. The ABA fee schedule marks every TM (telemedicine) row as NOT requiring precertification, unlike in-person rows. Delivered only by the tiers each code allows (LaBAs and technicians are limited per the manual). | HO, U8 (in-home, higher rate), TM |
| 0373T | Yes | Required — precertification via the faxed ABA precertification request form (form 2575-045 per missouri.ts prose) to the MHD Behavioral Health Services help desk, (573) 635-6516; the sole exception is school-based ABA delivered under an IEP. Precertified for up to 6 months. Telehealth (TM) rows are marked no-precert on the fee schedule. | 32 units/day per day | 11 = office, 12 = home (U8 modifier required), 03 = school, 99 = other (U8 modifier required), telehealth (TM modifier) | Yes — TM modifier. The ABA fee schedule marks every TM (telemedicine) row as NOT requiring precertification, unlike in-person rows. Delivered only by the tiers each code allows (LaBAs and technicians are limited per the manual). | HO, U8 (in-home, higher rate), TM |

Code notes:

- **97151:** Behavior-identification assessment — behavior analyst / psychologist tier only (HO); no HN or HM tier. In-home via U8; telehealth via TM.
- **97152:** Supporting assessment (one technician) — HO, HN, or HM (RBT billed by the supervisor, HO+HM or HN+HM). In-home HO/HN via U8; technician rows never carry U8.
- **97153:** Direct treatment by protocol — HO $20.13 / HN $20.13 / HM $16.37 (RBT billed by supervisor). 32 units = 8 hrs/day. In-home HO/HN via U8; technician rows never carry U8.
- **97154:** Group treatment by protocol — billable ONLY as a technician service, HM combined with the supervisor tier (HO+HM or HN+HM); no standalone HO/HN, U8, or RHC pricing. Rate $2.05, effective 5/1/2025.
- **97155:** Treatment with protocol modification — HO $25.26 (in-home $27.46 with U8) / HN $17.73 (no in-home bump). Behavior analyst / assistant tiers only; no technician tier.
- **97156:** Family treatment guidance — HO $25.26 / HN $20.13 (HN raised eff 7/1/2024). Behavior analyst / assistant tiers; no technician tier.
- **97157:** Multiple-family group treatment guidance — HO $3.16 / HN $2.52 (effective 12/18/2025). Behavior analyst / assistant tiers; no technician tier.
- **97158:** Group treatment with protocol modification — HO $3.16 / HN $2.14. Behavior analyst / assistant tiers; no technician tier and (per the fee file) no U8 in-home row.
- **0362T:** Supporting assessment, two or more technicians — behavior analyst / psychologist tier only (HO); in-home $27.46 with U8.
- **0373T:** Treatment with protocol modification, two or more technicians — behavior analyst / psychologist tier only (HO); in-home $27.46 with U8.

### Medicaid rates

Source: MHD Applied Behavioral Analysis fee schedule (.xlsx, apps.dss.mo.gov static portal), file-stamped 2026-07-07; cross-confirmed against the Behavioral Health Services Manual §1.16. Per 15-min unit; TM (telemedicine) rows precert-not-required. Effective 2026-07-07 (file stamp; per-code rate-effective dates vary — noted per code).

| Code | Rate | Unit | Modifier tiers |
| --- | --- | --- | --- |
| 97151 | Modifier-tiered — see modifierTiers (max 32 units/day; eff 7/1/2022) | 15min | HO: $25.26 (behavior analyst/psychologist); U8+HO: $25.26 (in-home); TM+HO: $25.26 (telehealth, no precert) |
| 97152 | Modifier-tiered — see modifierTiers (max 16 units/day; eff 7/1/2022) | 15min | HO: $25.26 (behavior analyst/psychologist); HN: $17.12 (assistant BA); HM: $15.00 (RBT, billed by supervisor) |
| 97153 | Modifier-tiered — see modifierTiers (max 32 units/day = 8 hrs; HO/HN/HM rates eff 7/1/2024) | 15min | HO: $20.13 (behavior analyst/psychologist); HN: $20.13 (assistant BA); HM: $16.37 (RBT, billed by supervisor; raised from $17.73 base eff 7/1/2024) |
| 97154 | $2.05 per 15-min unit — technician service only, HM + supervisor tier (HO+HM or HN+HM); no standalone HO/HN pricing (max 8 units/day; eff 5/1/2025) | 15min | HM (billed by HO or HN): $2.05 |
| 97155 | Modifier-tiered — see modifierTiers (max 24 units/day; eff 7/1/2022) | 15min | HO: $25.26 (behavior analyst/psychologist); U8+HO: $27.46 (in-home, HO only); HN: $17.73 (assistant BA; no in-home bump) |
| 97156 | Modifier-tiered — see modifierTiers (max 16 units/day; HN eff 7/1/2024) | 15min | HO: $25.26 (behavior analyst/psychologist); HN: $20.13 (assistant BA) |
| 97157 | Modifier-tiered — see modifierTiers (max 8 units/day; eff 12/18/2025) | 15min | HO: $3.16 (behavior analyst/psychologist); HN: $2.52 (assistant BA) |
| 97158 | Modifier-tiered — see modifierTiers (max 6 units/day; eff 7/1/2022) | 15min | HO: $3.16 (behavior analyst/psychologist); HN: $2.14 (assistant BA) |
| 0362T | Modifier-tiered — see modifierTiers (max 16 units/day; eff 7/1/2022) | 15min | HO: $25.26 (behavior analyst/psychologist); U8+HO: $27.46 (in-home) |
| 0373T | Modifier-tiered — see modifierTiers (max 32 units/day; eff 7/1/2022) | 15min | HO: $25.26 (behavior analyst/psychologist); U8+HO: $27.46 (in-home) |

### Contacts

- **Portal:** [eMOMED (MO HealthNet Provider Portal)](https://www.emomed.com)
- **Fax:** (573) 635-6516 — MHD Behavioral Health Services Help Desk; fax (or e-signed fax) the Applied Behavior Analysis Request for Precertification form (2575-045) here.

Questions to ask on a verification call:

- Can you confirm this member's current MO HealthNet eligibility span and that ABA benefits bill fee-for-service regardless of any managed-care plan (Healthy Blue, Home State Health, UnitedHealthcare Community Plan, Show Me Healthy Kids) shown on the 271?
- Is there an active ABA precertification on file for this member, and if so, what is the expiration date (precerts run up to 6 months)?

### VOB data sources

- https://www.emomed.com/public/publicdocs/5010%20Companion%20Guide.pdf (accessed 2026-07-23)
- https://pverify.com/wp-content/uploads/2026/03/pVerifyPayers_All-Payers-List-3-2026.pdf (accessed 2026-07-23)
- https://essentials.availity.com/availity/documents/payer_list_wShortNames.pdf (accessed 2026-07-23; source document older than 18 months)
- https://mydss.mo.gov/sites/mydss/files/media/pdf/2024/10/mo-healthnet-managed-care-policy-statements_SFY25-10-2024.pdf (accessed 2026-07-23)
- https://provider.healthybluemo.com/docs/gpp/MO_CAID_HealthNetManagedCareProviderManual.pdf (accessed 2026-07-23)
- https://apps.dss.mo.gov/fmsfeeschedules/dlfiles/Applied%20Behavioral%20Analysis.xlsx (accessed 2026-07-23)
- https://mydss.mo.gov/sites/mydss/files/media/file/2026/05/Behavioral%20Health%20Services%20Manual.docx (accessed 2026-07-23)
- https://www.law.cornell.edu/regulations/missouri/13-CSR-70-98-030 (accessed 2026-07-23)
- https://mydss.mo.gov/mhd/hot-tips/updated-precertification-forms-bh-services-and-aba (accessed 2026-07-23)
- https://mydss.mo.gov/mhd/behavioral-health-services (accessed 2026-07-23)

## Common questions

### Does MO HealthNet cover ABA therapy?

Yes — for participants under 21, with precertification. The standard benefit requires an ASD diagnosis from a licensed physician or psychologist; under EPSDT/HCY, ABA is also covered for other diagnoses when medically necessary.

### Do I need to contract with Missouri's Medicaid MCOs to provide ABA?

No. ABA is fully carved out of managed care — every member, including MCO and Show Me Healthy Kids enrollees, gets ABA through state fee-for-service. One payer, one precert form, no MCO credentialing for ABA.

### How do I get an ABA authorization from MO HealthNet?

Fax form 2575-045 (the ABA Request for Precertification) with the required clinicals to the Behavioral Health Services help desk at (573) 635-6516. There's no portal or UM vendor — approval comes back by fax with hours and dates, for periods up to 6 months.

### What does MO HealthNet pay for ABA?

Per 15-minute unit: 97151 at $25.26; 97153 at $20.13 (analyst/assistant tiers) or $16.37 with the HM technician modifier; 97155 at $25.26 ($27.46 in-home with U8); 97156 at $25.26. The HM-vs-HO split makes staffing mix the key revenue lever.

### Can RBTs provide ABA under MO HealthNet?

Yes, billed by the licensed supervisor with the HM modifier — but the national RBT credential is mandatory: technicians have 90 calendar days from passing the initial competency assessment to pass the RBT exam and be BACB-credentialed.

## Primary sources

1. [MO HealthNet Behavioral Health Services Manual, §1.16 ABA Services (May 2026)](https://mydss.mo.gov/sites/mydss/files/media/file/2026/05/Behavioral%20Health%20Services%20Manual.docx)
2. [MHD Applied Behavioral Analysis fee schedule (official download portal)](https://apps.dss.mo.gov/fmsfeeschedules/DLFiles.aspx)
3. [MO HealthNet Behavioral Health Services page (precert form 2575-045, bulletins)](https://mydss.mo.gov/mhd/behavioral-health-services)
4. [MHD ABA provider training — Applied Behavior Analysis Services (April 2022)](https://dss.mo.gov/mhd/providers/education/files/rodgers-applied-behavior-analysis.pdf)
5. [Healthy Blue MO HealthNet Managed Care Provider Manual](https://provider.healthybluemo.com/docs/gpp/MO_CAID_HealthNetManagedCareProviderManual.pdf)
6. [Show Me Healthy Kids Provider Reference Manual](https://www.homestatehealth.com/content/dam/centene/home-state-health/pdfs/HSH-SMHK-Provider-Manual_508%20Compliant%20063022.pdf)
7. [13 CSR 70-98.030 — Applied Behavior Analysis Services](https://www.law.cornell.edu/regulations/missouri/13-CSR-70-98-030)
8. [MO HealthNet Provider Bulletin Vol. 47 No. 19 — Grace Period for RBT Credential](https://mydss.mo.gov/sites/mydss/files/media/pdf/2024/09/ABA-Grace-Period-RBT-Bulletin.pdf)
9. [BACB RBT Handbook](https://assets.bacb.com/wp-content/uploads/2022/01/RBTHandbook_230407-a.pdf)
10. [BACB — Meeting RBT Requirements During the 2026 Transition](https://www.bacb.com/wp-content/uploads/2025/07/RBT-2026-Requirements_250723-a.pdf)
11. [RSMo § 337.315 — behavior analyst licensure (Missouri Revisor of Statutes)](https://revisor.mo.gov/main/OneSection.aspx?section=337.315)
12. [Missouri Behavior Analyst Advisory Board (Division of Professional Registration)](https://pr.mo.gov/ba.asp)
13. [MMAC — Provider Assigned Risk Categories](https://mmac.mo.gov/providers/provider-enrollment/new-providers/provider-assigned-risk-categories/)
14. [MMAC — Fingerprint Based Criminal History Checks](https://mmac.mo.gov/providers/provider-enrollment/new-providers/fingerprint-based-criminal-history-checks/)
15. [RSMo § 210.900 — Family Care Safety Registry definitions](https://revisor.mo.gov/main/OneSection.aspx?section=210.900)
16. [MO DHSS FAQ — Family Care Safety Registry registration requirements](https://mohealth.uservoice.com/knowledgebase/articles/1166425-who-is-required-to-register-with-the-family-care-s)
17. [MO HealthNet Managed Care Policy Statements (rev. 7/2023)](https://dss.mo.gov/business-processes/managed-care/vendor-docs-2022/mo-healthnet-managed-care-policy-statements-09-23.pdf)
18. [42 CFR 440.230(e) — State Medicaid agency prior-authorization timeframes (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-440/subpart-B/section-440.230)
19. [MO HealthNet General Sections Provider Manual, §8.2 Prior Authorization Guidelines (March 2026)](https://dss.mo.gov/sites/mydss/files/media/file/2026/03/General-Sections-Provider-Manual.docx)
20. [42 CFR 433.139 — Medicaid third-party liability (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-433/subpart-D/section-433.139)

Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed September 2026; it is general information, not billing, legal, or clinical advice. Always verify current requirements against the payer's live policy and a benefits check for the specific member.

Source: Carelu ABA Payer Directory — https://carelu.com/payers. Free to cite with attribution.