---
title: Molina Healthcare of Nebraska ABA coverage (Heritage Health MCO).
url: "https://carelu.com/payers/molina-healthcare-nebraska"
markdown_url: "https://carelu.com/payers/molina-healthcare-nebraska.md"
state: NE (Nebraska)
payer: Molina Healthcare of Nebraska
kind: Medicaid managed care plan (MCO)
parent_program: Nebraska Medicaid (Heritage Health)
description: "How Molina Healthcare of Nebraska administers Nebraska Medicaid ABA — the 2024 Heritage Health entrant, Availity Essentials submission, quarterly PA code-list changes, and what remains unpublished about its ABA-specific rules."
last_reviewed: September 2026
vob_data_updated: 2026-07-23
---

# Molina Healthcare of Nebraska ABA coverage (Heritage Health MCO).

_Payer Guide · Molina Healthcare (NE) · Last updated September 2026 · 7 primary sources_

> Newest MCO (2024); state-baseline rules, Availity intake, quarterly PA-list churn.

Molina Healthcare of Nebraska is the newest Heritage Health MCO — it entered January 1, 2024, replacing Healthy Blue — and has the least Nebraska-specific published ABA infrastructure of the three plans. No Nebraska-specific ABA clinical policy has been published: Molina applies the state Medicaid Service Definitions plus its corporate behavioral-health criteria, so treat it as state-baseline clinically and expect the differentiation to be operational — Availity intake, corporate forms, and quarterly PA code-list churn.

This plan administers the **Nebraska Medicaid (Heritage Health)** ABA benefit: the state rules are the floor, and this page covers what the plan layers on top. Read it together with the [Nebraska Medicaid (Heritage Health) guide](https://carelu.com/payers/nebraska-medicaid).

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment:** Not published / unverified. Verify via: Molina Nebraska’s current-quarter prior-authorization code-change PDF and the PA look-up tool on Availity Essentials — the code-level PA answer is published there, not in any ABA policy. Molina’s PA code lists change quarterly, so re-check per cohort rather than per year.
- **Prior auth for treatment**: Required — ABA treatment runs on prior authorization under the state MSD (ABA assessment + treatment plan filed with the initial request); Molina publishes no ABA-specific form, so submit via Availity Essentials (fax (833) 832-1015, phone (844) 782-2678) and re-check the current-quarter PA code list [3][1]
- **Autism diagnosis required?**: State MSD rules govern — ASD or a developmental or intellectual disability qualifies, with an IDI within the previous 12 months establishing the need; Molina publishes no Nebraska-specific diagnosis criteria [3][5]

## At a glance

- **Plan type:** Heritage Health MCO — entered 1/1/2024, replacing Healthy Blue
- **Clinical rules:** State MSDs + Molina corporate BH criteria (no published NE ABA policy)
- **Submission:** Availity Essentials (preferred), fax (833) 832-1015, phone (844) 782-2678
- **PA code lists:** Change quarterly — re-verify ABA codes each quarter
- **ABA UM:** In-house — Molina hires NE-based LBA care review clinicians
- **Rates:** Tracks the state fee schedule per DHHS direction (HPA 25-08)

## What's published — and what isn't

Molina's Nebraska Medicaid PA page establishes the machinery: requests submit through Availity Essentials (preferred), by fax to (833) 832-1015, or by phone at (844) 782-2678, with a Behavioral Health Certification of Need for Services form published for BH services and quarterly PA code-change PDFs posted for the current year. What it does not establish is an ABA-specific rulebook: we found no published Nebraska statement on whether the ABA assessment codes need PA, and third-party descriptions of Molina's ABA treatment-PA specifics could not be verified against a Molina document. Practically: assume the state MSD rules govern clinically, confirm ABA code-level PA requirements through Availity or the plan's PA look-up tool before every new intake cohort, and re-check quarterly — the PA lists genuinely change. [1]

## Working with the newest plan

Molina took over from Healthy Blue on January 1, 2024 under a five-year contract (with a two-year option), alongside Nebraska Total Care and UnitedHealthcare. Its ABA utilization management is done in-house — the plan hires Nebraska-based "Care Review Clinician, ABA" roles requiring an LBA license — so expect clinical conversations with licensed analysts rather than a delegated vendor. Rates follow the state schedule per DHHS's Health Plan Advisory 25-08, the same as the other two MCOs. Given the thin published ABA surface, the operating posture at this plan is verify-first: every code, every quarter, in the portal. [2][7]

## Intake gates

The questions that decide whether a family can start with Molina Healthcare of Nebraska, and what they have to bring.

- **Age limit**: Follows the Nebraska Medicaid rule: admission is "Age: 0-20" under both ABA service definitions, with DD-waiver recipients able to receive the ABA assessment codes (97151/97152) regardless of age. Molina publishes no Nebraska-specific ABA clinical policy — its Nebraska Medicaid prior-authorization page sets only the machinery (Availity Essentials, fax (833) 832-1015, phone (844) 782-2678, a Behavioral Health Certification of Need form, and quarterly PA code-change PDFs), with no ABA criteria, caps or code rules on it. [3][5][1]
- **Diagnosis recency**: Follows the Nebraska Medicaid rule: an Initial Diagnostic Interview completed within the previous 12 months of admission must establish the need for the ABA assessment, with an IDI addendum where the clinical presentation has changed significantly inside that window. Molina publishes no Nebraska-specific ABA clinical policy — its Nebraska Medicaid prior-authorization page sets only the machinery (Availity Essentials, fax (833) 832-1015, phone (844) 782-2678, a Behavioral Health Certification of Need form, and quarterly PA code-change PDFs), with no ABA criteria, caps or code rules on it. [3][5][1]
- **Who may diagnose**: Follows the Nebraska Medicaid rule: the IDI is performed by "A licensed practitioner who is able to diagnose and treat major mental illness within his/her scope of practice" — Physician, Physician Assistant, APRN/NP, Psychologist or LIMHP — and the qualifying diagnosis is ASD or a developmental or intellectual disability. Molina publishes no Nebraska-specific ABA clinical policy — its Nebraska Medicaid prior-authorization page sets only the machinery (Availity Essentials, fax (833) 832-1015, phone (844) 782-2678, a Behavioral Health Certification of Need form, and quarterly PA code-change PDFs), with no ABA criteria, caps or code rules on it. [4][3][1]
- **Diagnostic tools required**: Follows the Nebraska Medicaid rule: no ASD diagnostic instrument is required; the ABA assessment must include skills-based and standardized/norm-referenced or criterion-referenced assessments, and the treatment plan must carry baseline and ongoing measurement "using norm-referenced / standardized assessment tools, for example Vineland, VB-MAPP, ABLLS." Molina publishes no Nebraska-specific ABA clinical policy — its Nebraska Medicaid prior-authorization page sets only the machinery (Availity Essentials, fax (833) 832-1015, phone (844) 782-2678, a Behavioral Health Certification of Need form, and quarterly PA code-change PDFs), with no ABA criteria, caps or code rules on it. [5][3][1]
- **Referral required?**: Follows the Nebraska Medicaid rule: no referral or physician order is a condition of the benefit — the gate is the IDI establishing need plus the ABA assessment, filed with the treatment plan on the initial PA request. Molina publishes no Nebraska-specific ABA clinical policy — its Nebraska Medicaid prior-authorization page sets only the machinery (Availity Essentials, fax (833) 832-1015, phone (844) 782-2678, a Behavioral Health Certification of Need form, and quarterly PA code-change PDFs), with no ABA criteria, caps or code rules on it. [3][5][1]
- **Telehealth**: Follows the Nebraska Medicaid rule: audiovisual telehealth is available for 97155 (only while 97153 runs concurrently), 97156 and the 97151 assessment under the conditions the service definitions spell out, while 97152, 97153, 97154 and 97158 cannot be delivered remotely. Molina publishes no Nebraska-specific ABA clinical policy — its Nebraska Medicaid prior-authorization page sets only the machinery (Availity Essentials, fax (833) 832-1015, phone (844) 782-2678, a Behavioral Health Certification of Need form, and quarterly PA code-change PDFs), with no ABA criteria, caps or code rules on it. [3][5][1]
  - Ask the plan: Molina Nebraska via Availity Essentials or the PA look-up tool, and the current-quarter PA code-change PDF — Molina's PA code lists change quarterly, so re-check per cohort rather than per year.
- **Prior-auth decision time**: Molina's 2026 Nebraska manual is out of date against federal law. Its table still reads "Prior Authorization Standard: 14 Calendar days" and "Prior Authorization Urgent: 72 hours." Heritage Health rating periods run by calendar year, so from January 1, 2026 the federal floor caps standard decisions at "7 calendar days after receiving the request for service." Expedited decisions stay at 72 hours, and either clock can be extended up to 14 calendar days. Hold Molina to seven days. Urgent requests must include "Supporting documentation … to justify the expedited request." After a denial, a peer-to-peer can be requested "within five (5) business days of the denial notification." Molina publishes no ABA reauthorization lead time. [8][9][10]
  - Ask the plan: Molina Nebraska Provider Services (844) 782-2678: confirm the standard turnaround it now applies and any ABA reauthorization lead time. Its manual still prints 14 days.
- **Other insurance (who pays first)**: "Medicaid is always the payer of last resort," except for Indian Health Service, Ryan White and similar federal programs. "If third-party liability can be established, Providers must first bill the primary payer and submit a primary explanation of benefits (EOB) to Molina for secondary Claim processing," and "Primary carrier payment information is required with the Claim submission." Timely filing restarts: "the Provider must submit Claims to Molina within 180 calendar days after final determination by the primary payer." Molina "will not deny Provider Claims on the basis of untimely filing for Claims that involve coordination of services or subrogation." Molina pays the secondary amount "based on the state regulatory COB methodology." The manual does not say whether Molina's ABA prior auth is required when another plan is primary. [8]
  - Ask the plan: Molina Nebraska PA look-up tool on Availity Essentials or (844) 782-2678: ask whether ABA prior authorization is still required when a commercial plan is primary.

## Delivery and billing rules

Coverage decides whether Molina Healthcare of Nebraska 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**: Follows the Nebraska Medicaid rule: direct supervision by observation of the technician at no less than 10% of weekly direct service hours (97153/97154/97155), documented in progress notes with a corrective action plan when missed; at least one hour a month of in-person observation of each technician or LaBA; at least one hour a month of in-person direct service by the treating LBA or psychologist; and no more than 24 technicians per LBA. Molina runs ABA utilization management in-house with Nebraska-licensed LBA care review clinicians, but publishes no supervision standard of its own. [3][1]
- **Daily limits / MUEs**: Follows the Nebraska Medicaid rule: direct ABA "may not exceed 6 hours in a single day or a total of 20 hours per week," with additional hours available on prior authorization and clinical justification; group work runs one technician to 2-5 children on 97154 and one licensed clinician to 2-5 on 97158. No per-code MUE table is published by the state, and Molina publishes none either — what Molina does publish is quarterly PA code-change PDFs, so unit handling is a quarterly re-check rather than a fixed table. [3][1]
  - Ask the plan: Molina Nebraska via Availity Essentials or the PA look-up tool, and the current-quarter PA code-change PDF — Molina's PA code lists change quarterly, so re-check per cohort rather than per year.
- **Session-note signature**: Nebraska says what a progress note must contain, sets the deadline by reference, and never names a session-note signer. Progress notes "must be completed within the time frame specified in the program's policies and procedures" and must substantiate each service through narrative description, "Include an accurate start and end time for the service," tie the service to plan goals and priorities, document participation and revision of goals, and record the individual's response "in the individual's own words if possible, if age and developmentally appropriate." Signatures attach to the other documents: the treatment plan must "Be approved and signed by the licensed clinician or supervisor if provisionally licensed" and carry the individual's or guardian's signature (a parent or guardian where the individual is under 19); the ABA assessment report "must be signed by the licensed clinicians who participated in the development of the report, including the supervising practitioner, when applicable"; and the discharge summary must "contain the signature of the supervising clinician and date of signature." Supervision itself must be documented in progress notes. Molina publishes no ABA-specific documentation policy for Nebraska. [6][5][3]
- **Place of service**: Community, home, office or clinic — and school is not yours to bill. The treatment MSD lists the allowable settings as "Community, Home, Office or Clinic," then carves the school out entirely: "ABA services are covered as part of the Medicaid school-based services program, and are the responsibility of the school as outlined in Nebraska Administrative Code Title 471, Chapter 25 and the Medicaid State Plan. Independent providers may not bill Medicaid directly for services provided at a school." The assessment MSD keeps School on its settings list under the same carve-out. Where ABA does run in an educational setting, "A school plan is required for all educational settings, to include both public and private schools" (not daycare or after-school), it must be included in the student's IEP, it must focus on reducing behaviors that impede academic engagement rather than on general skill acquisition, and it must be time-limited with a transition plan shifting instructional control to school staff. Excluded outright: "Services delivered in the school setting as a shadow, or an aide, or to provide general support to the child or youth," and training for school personnel. Group homes are not addressed. Molina publishes no deviation from this. [3][5][1]
- **Concurrent billing (97153 + 97155)** _(ask the plan)_: Not stated in billing terms, though the definitions read as if it happens. The telehealth rule allows 97155 by audiovisual telehealth only where "The individual is receiving 97153 services concurrently," and the supervision percentage is measured against "direct service hours (97153/97154/97155)" as a single weekly pool — both of which presume the analyst and the technician on the clock at the same time. But neither MSD says in terms that both codes may be billed for the same clock time. What Nebraska does prohibit by name is a different concurrency: "Services delivered concurrently (at the same time) as another treatment modality (i.e. ST, OT, PT)," and "Services delivered by 2 LBAs unless non-duplicative and clinically appropriate." Molina publishes nothing ABA-specific for Nebraska, so the state position is the only one on the record. [3]
  - Ask the plan: Molina Nebraska via Availity Essentials or the PA look-up tool, and the current-quarter PA code-change PDF — Molina's PA code lists change quarterly, so re-check per cohort rather than per year.
- **Bill as provider** _(ask the plan)_: Nebraska controls this through code-level provider eligibility rather than a modifier set. Licensed clinicians who may bill 97151 — and who render 97155, 97156 and 97158 — are a psychiatrist, physician, psychologist or provisionally licensed psychologist, each with training in ABA, or a Licensed Behavior Analyst. Technicians who may bill 97152, 97153 and 97154 under a licensed clinician's supervision are a Licensed assistant Behavior Analyst or a Registered Behavior Technician. Since January 1, 2025 every BCBA must be licensed as an LBA and every BCaBA as a LaBA, so the state license rather than the BACB certificate is what makes the claim payable, and RBT is enrolled as its own Medicaid provider type (85) on the fee schedule. Which NPI carries the claim line is not stated. Molina publishes no Nebraska ABA billing policy. [3][5][1]
  - Ask the plan: Molina Nebraska via Availity Essentials or the PA look-up tool, and the current-quarter PA code-change PDF — Molina's PA code lists change quarterly, so re-check per cohort rather than per year.

## What intake should collect for Molina Healthcare of Nebraska

- **Availity access confirmed:** Availity Essentials is the preferred PA channel — make sure registration covers Molina NE before the first request.
- **Current-quarter PA code list:** ABA code PA status can change quarterly — pull the latest PA code-change PDF or use the look-up tool.
- **Qualifying diagnosis + IDI:** State MSD rules govern: ASD or developmental/intellectual disability, with an IDI in the previous 12 months.
- **Certification of Need form:** Molina publishes a BH Certification of Need for Services form — have it in the submission packet.

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

## Verification of benefits (VOB) data

How Molina Healthcare of Nebraska ABA benefits route and read on an eligibility check. Data last updated 2026-07-23.

### EDI routing

- **Payer ID (pVerify):** 06080
- **Supports 270/271 eligibility:** Yes
- **Behavioral health administrator:** none — Inferred from absence — Molina's NE Medicaid PA page names no BH carve-out vendor and publishes no Nebraska-specific ABA clinical policy at all. Confirm via Molina NE provider services.
- **ABA rides on:** medical benefit
- **Two-hop verification required:** No

### Code-level coverage

| Code | Covered | Prior auth | Unit cap | Place of service | Telehealth | Modifiers |
| --- | --- | --- | --- | --- | --- | --- |
| 97151 | Yes | — | No per-code daily/weekly unit cap published. Staffing ratio: 1 licensed clinician : 1 child. | home, community, office or clinic, telehealth — POS 02 (patient not at home) or POS 10 (patient at home) | Yes, conditional — audiovisual only (modifier 95). Allowed if caregivers are on-site using live synchronous methods, the environment is assessed safe (or modified to be), caregivers have a secure internet connection, the individual does not need more than 1:1 support, and use is documented as clinically necessary (not for provider/caregiver convenience). | 95 (telehealth, audiovisual — informational modifier, placed after any payment modifier), with POS 02 or 10, No CPT modifier for licensure tier — billed by enrolled Provider Type 1 (MD), 2 (DO), 57 (Provisionally Licensed PhD), 67 (Licensed Psychologist), or 83 (BCBA/LBA); Provider Types 84 (BCaBA/LaBA) and 85 (RBT) are not reimbursed for this code ($0 in the fee schedule) |
| 97152 | Yes | — | No per-code daily/weekly unit cap published. Staffing ratio: 1 technician : 1 child. | home, community, office or clinic | No — the ABA Behavior Identification Assessment MSD states verbatim this code "cannot be completed via telehealth." | No telehealth modifier applicable (telehealth not allowed for this code), Billed by Provider Type 57 (Provisionally Licensed PhD), 67 (Licensed Psychologist), 84 (BCaBA/LaBA), or 85 (RBT); Provider Types 1 (MD), 2 (DO), and 83 (BCBA/LBA) are not reimbursed for this code ($0 in the fee schedule) |
| 97153 | Yes | Presumed required (state MSD default), but Molina publishes no Nebraska-specific ABA PA policy — submission channels are Availity Essentials (preferred), fax (833) 832-1015, or phone (844) 782-2678, with a BH Certification of Need for Services form for BH services generally. PA code lists change quarterly; re-verify every quarter. | Grouped with 97154/97155 under the MSD's "direct ABA service hours" definition (the same codes subject to the 10%-of-hours direct-supervision rule): may not exceed 24 units/day (6 hrs) per the treatment MSD's literal text, with a weekly cap the state's own documents state two different ways — 80 units/week (20 hrs) per the treatment MSD's literal text; 120 units/week (30 hrs) per Provider Bulletin 25-02 and the DHHS ABA Facts page. Both figures given deliberately, not resolved by fiat — request against the 20-hr/week reading as the conservative floor and cite the 30-hr materials when clinical need justifies more; either way, hours above 6/day require PA'd clinical justification. per day (verified: 24 units / 6 hrs) and week (conflicting: 80 vs 120 units / 20 vs 30 hrs — see unitCap) | home, community, office or clinic | No — the treatment MSD states verbatim: "Other ABA treatment services (CPT 97153, 97154, 97158) cannot be provided via telehealth." | No telehealth modifier applicable (telehealth not allowed for this code), Billed by Provider Type 57, 67, 83 (BCBA/LBA), 84 (BCaBA/LaBA), or 85 (RBT); Provider Types 1 (MD)/2 (DO) not reimbursed ($0 in the fee schedule) |
| 97154 | Yes | Presumed required (state MSD default), but Molina publishes no Nebraska-specific ABA PA policy — submission channels are Availity Essentials (preferred), fax (833) 832-1015, or phone (844) 782-2678, with a BH Certification of Need for Services form for BH services generally. PA code lists change quarterly; re-verify every quarter. | Grouped with 97153/97155 under the MSD's "direct ABA service hours" definition — see the 97153 entry for the same 6-hr/day, 20-vs-30-hr/week conflict. Staffing ratio: 1 technician : 2-5 children (group). per day (verified: 24 units / 6 hrs, combined w/ 97153/97155) and week (conflicting — see 97153) | home, community, office or clinic | No — the treatment MSD states verbatim: "Other ABA treatment services (CPT 97153, 97154, 97158) cannot be provided via telehealth." | No telehealth modifier applicable (telehealth not allowed for this code), Billed by Provider Type 57, 67, 83 (BCBA/LBA), 84 (BCaBA/LaBA), or 85 (RBT); Provider Types 1 (MD)/2 (DO) not reimbursed ($0 in the fee schedule) |
| 97155 | Yes | Presumed required (state MSD default), but Molina publishes no Nebraska-specific ABA PA policy — submission channels are Availity Essentials (preferred), fax (833) 832-1015, or phone (844) 782-2678, with a BH Certification of Need for Services form for BH services generally. PA code lists change quarterly; re-verify every quarter. | Grouped with 97153/97154 under the MSD's "direct ABA service hours" definition — see the 97153 entry for the same 6-hr/day, 20-vs-30-hr/week conflict. Staffing ratio: 1 licensed clinician : 1 child. per day (verified: 24 units / 6 hrs, combined w/ 97153/97154) and week (conflicting — see 97153) | home, community, office or clinic, telehealth — POS 02 (patient not at home) or POS 10 (patient at home) | Yes, conditional — audiovisual only (modifier 95). Allowed only if the individual is receiving 97153 services concurrently, plus environment/safety and documented-necessity conditions from the treatment MSD are met. | 95 (telehealth, audiovisual), with POS 02 or 10 — conditional, see telehealth field, Billed by Provider Type 1 (MD), 2 (DO), 57, 67, or 83 (BCBA/LBA); Provider Types 84 (BCaBA/LaBA)/85 (RBT) not reimbursed ($0 in the fee schedule) |
| 97156 | Yes | Presumed required (state MSD default), but Molina publishes no Nebraska-specific ABA PA policy — submission channels are Availity Essentials (preferred), fax (833) 832-1015, or phone (844) 782-2678, with a BH Certification of Need for Services form for BH services generally. PA code lists change quarterly; re-verify every quarter. | Not grouped into the MSD's "direct ABA service hours" definition (that phrase is specifically 97153/97154/97155) — no separate per-code daily/weekly unit cap was found for 97156 itself. A distinct, non-unit-cap mechanism applies instead: caregiver participation minimums of 1 hr/month (services <=10 hrs/month) or 2-4 hrs/month (services >10 hrs/month), tracked for continued-stay review rather than billed as a cap. | home, community, office or clinic, telehealth — POS 02 (patient not at home) or POS 10 (patient at home) | Yes, conditional — audiovisual only (modifier 95), per the treatment MSD's documented-necessity and environment/safety conditions for family training. | 95 (telehealth, audiovisual), with POS 02 or 10 — conditional, see telehealth field, Billed by Provider Type 1 (MD), 2 (DO), 57, 67, or 83 (BCBA/LBA); Provider Types 84 (BCaBA/LaBA)/85 (RBT) not reimbursed ($0 in the fee schedule) |
| 97157 | No | N/A — not a billable Nebraska Medicaid ABA code | N/A per N/A | — | N/A | — |
| 97158 | Yes | Presumed required (state MSD default), but Molina publishes no Nebraska-specific ABA PA policy — submission channels are Availity Essentials (preferred), fax (833) 832-1015, or phone (844) 782-2678, with a BH Certification of Need for Services form for BH services generally. PA code lists change quarterly; re-verify every quarter. | No per-code daily/weekly unit cap found (not part of the "direct ABA service hours" 97153/97154/97155 grouping). Staffing ratio: 1 licensed clinician : 2-5 children (group). | home, community, office or clinic | No — the treatment MSD states verbatim: "Other ABA treatment services (CPT 97153, 97154, 97158) cannot be provided via telehealth." | No telehealth modifier applicable (telehealth not allowed for this code), Billed by Provider Type 1 (MD), 2 (DO), 57, 67, or 83 (BCBA/LBA); Provider Types 84 (BCaBA/LaBA)/85 (RBT) not reimbursed ($0 in the fee schedule) |
| 0362T | No | N/A — not a billable Nebraska Medicaid ABA code | N/A per N/A | — | N/A | — |
| 0373T | No | N/A — not a billable Nebraska Medicaid ABA code | N/A per N/A | — | N/A | — |

Code notes:

- **97151:** Rate $38.16/15min is flat across every eligible provider type — no BCBA-vs-physician differential where both are eligible to bill (see rates.byCode).
- **97153:** Direct supervision by observation required for no less than 10% of weekly direct-service hours (97153/97154/97155 combined), documented in progress notes; failure must be documented with a corrective-action plan. An LBA may supervise at most 24 technicians.
- **97156:** Staffing ratio: 1 licensed clinician : 1 family. Teachers count for at most 25% of required caregiver-training hours; IEP meetings are not billable.
- **97157, 0362T, 0373T:** Not part of Nebraska Medicaid's billable ABA code set — confirmed absent from Provider Bulletin 25-14, the DHHS "Applied Behavior Analysis Facts" page, the MHSUD fee schedule's "ABA" tab, and both ABA Medicaid Service Definitions' own "Fee schedule codes for this service are" lists (checked directly, all four, this pass). If a family's MCO nonetheless authorizes this code, verify the rate directly with DHHS Rate & Reimbursement (DHHS.ratesreimbursement@nebraska.gov) — do not assume a rate from the pattern of the other 7 codes.

### Medicaid rates

Source: Nebraska DHHS Provider Bulletin 25-14 sets the statewide fee-for-service rate; Health Plan Advisory 25-08 directs all 3 Heritage Health MCOs to track it identically — no independent MCO-negotiated ABA rate found. Effective 2025-08-01.

| Code | Rate | Unit | Modifier tiers |
| --- | --- | --- | --- |
| 97151 | 38.16 | 15min | 1 (MD): 38.16; 2 (DO): 38.16; 57 (Provisionally Licensed PhD): 38.16; 67 (Licensed Psychologist): 38.16; 83 (BCBA/LBA): 38.16; 84 (BCaBA/LaBA): not billable — $0 in the fee schedule; 85 (RBT): not billable — $0 in the fee schedule |
| 97152 | 25.88 | 15min | 57 (Provisionally Licensed PhD): 25.88; 67 (Licensed Psychologist): 25.88; 84 (BCaBA/LaBA): 25.88; 85 (RBT): 25.88; 1 (MD): not billable — $0 in the fee schedule; 2 (DO): not billable — $0 in the fee schedule; 83 (BCBA/LBA): not billable — $0 in the fee schedule |
| 97153 | 18.70 | 15min | 57 (Provisionally Licensed PhD): 18.70; 67 (Licensed Psychologist): 18.70; 83 (BCBA/LBA): 18.70; 84 (BCaBA/LaBA): 18.70; 85 (RBT): 18.70; 1 (MD): not billable — $0 in the fee schedule; 2 (DO): not billable — $0 in the fee schedule |
| 97154 | 7.49 | 15min | 57 (Provisionally Licensed PhD): 7.49; 67 (Licensed Psychologist): 7.49; 83 (BCBA/LBA): 7.49; 84 (BCaBA/LaBA): 7.49; 85 (RBT): 7.49; 1 (MD): not billable — $0 in the fee schedule; 2 (DO): not billable — $0 in the fee schedule |
| 97155 | 22.72 | 15min | 1 (MD): 22.72; 2 (DO): 22.72; 57 (Provisionally Licensed PhD): 22.72; 67 (Licensed Psychologist): 22.72; 83 (BCBA/LBA): 22.72; 84 (BCaBA/LaBA): not billable — $0 in the fee schedule; 85 (RBT): not billable — $0 in the fee schedule |
| 97156 | 26.06 | 15min | 1 (MD): 26.06; 2 (DO): 26.06; 57 (Provisionally Licensed PhD): 26.06; 67 (Licensed Psychologist): 26.06; 83 (BCBA/LBA): 26.06; 84 (BCaBA/LaBA): not billable — $0 in the fee schedule; 85 (RBT): not billable — $0 in the fee schedule |
| 97158 | 12.05 | 15min | 1 (MD): 12.05; 2 (DO): 12.05; 57 (Provisionally Licensed PhD): 12.05; 67 (Licensed Psychologist): 12.05; 83 (BCBA/LBA): 12.05; 84 (BCaBA/LaBA): not billable — $0 in the fee schedule; 85 (RBT): not billable — $0 in the fee schedule |

### Contacts

- **Provider services phone:** (844) 782-2678
- **Portal:** [Availity Essentials (Molina Healthcare of Nebraska)](https://www.availity.com/molinahealthcare)
- **Fax:** (833) 832-1015

Questions to ask on a verification call:

- Do the ABA assessment codes (97151/97152) require prior authorization for this member, and if so, through which channel?
- Is prior authorization required for the ongoing ABA treatment codes (97153-97158), and what is the current quarterly PA code list?
- For this member, is the weekly direct-service-hour cap 20 hours or 30 hours per week?
- Can you confirm whether ABA benefits are managed directly by Molina or through a separate behavioral health vendor?

### VOB data sources

- https://pverify.com/wp-content/uploads/2026/03/pVerifyPayers_All-Payers-List-3-2026.pdf (accessed 2026-07-23)
- https://www.molinahealthcare.com/providers/ne/medicaid/Claims/priorauth.aspx (accessed 2026-07-23)
- https://dhhs.ne.gov/Documents/270-271%20Companion%20guide.pdf (accessed 2026-07-23; source document older than 18 months)
- https://dhhs.ne.gov/Behavioral%20Health%20Service%20Definitions/Applied%20Behavior%20Analysis%20Behavior%20Identification%20Assessment.pdf (accessed 2026-07-23)
- https://dhhs.ne.gov/Behavioral%20Health%20Service%20Definitions/Applied%20Behavior%20Analysis.pdf (accessed 2026-07-23)
- https://dhhs.ne.gov/Medicaid%20Provider%20Bulletins/Provider%20Bulletin%2025-14.pdf (accessed 2026-07-23)
- https://dhhs.ne.gov/Medicaid%20Practitioner%20Fee%20Schedules/REVISED%20MHSUD%20SFY27%20Fee%20Schedule.xlsx (accessed 2026-07-23)
- https://dhhs.ne.gov/Medicaid%20Provider%20Bulletins/Provider%20Bulletin%2025-02.pdf (accessed 2026-07-23)
- https://dhhs.ne.gov/Pages/Applied-Behavior-Analysis.aspx (accessed 2026-07-23)
- https://dhhs.ne.gov/Guidance%20Docs/Health%20Plan%20Advisory%2025-08%20-%20Applied%20Behavior%20Analysis%20Rates.pdf (accessed 2026-07-23)
- https://dhhs.ne.gov/Medicaid%20Practitioner%20Fee%20Schedules/Mental%20Health%20and%20Substance%20July%201%202025%20Updated%207.31.25.xlsx (accessed 2026-07-23)

## Common questions

### Does Molina Healthcare of Nebraska cover ABA therapy?

Yes — as a Heritage Health MCO it administers the Nebraska Medicaid ABA benefit under the state Medicaid Service Definitions. Molina publishes no Nebraska-specific ABA clinical policy, so the state rules plus corporate BH criteria govern.

### Does Molina Nebraska require PA on ABA assessments?

No published Nebraska-specific answer exists — Molina's PA requirements live in quarterly code lists and its PA look-up tool. Verify the ABA codes in Availity or with the plan directly, and re-check each quarter.

### How do I submit an ABA prior authorization to Molina Nebraska?

Availity Essentials is the preferred channel; fax (833) 832-1015 and phone (844) 782-2678 are the fallbacks. Include the state-required package — treatment plan, ABA assessment, and IDI.

## Primary sources

1. [Molina NE Medicaid — prior authorization page](https://www.molinahealthcare.com/providers/ne/medicaid/Claims/priorauth.aspx)
2. [Healthcare Dive — Nebraska Medicaid managed care awards (1/1/2024)](https://www.healthcaredive.com/news/Nebraska-Medicaid-managed-care/632712/)
3. [ABA Medicaid Service Definition (treatment MSD)](https://dhhs.ne.gov/Behavioral%20Health%20Service%20Definitions/Applied%20Behavior%20Analysis.pdf)
4. [Initial Diagnostic Interview Medicaid Service Definition](https://dhhs.ne.gov/Behavioral%20Health%20Service%20Definitions/Initial%20Diagnostic%20Interview.pdf)
5. [ABA Behavior Identification Assessment MSD](https://dhhs.ne.gov/Behavioral%20Health%20Service%20Definitions/Applied%20Behavior%20Analysis%20Behavior%20Identification%20Assessment.pdf)
6. [Medicaid Requirements for Substance Use Disorder and Applied Behavior Analysis Services (umbrella staffing document)](https://dhhs.ne.gov/Behavioral%20Health%20Service%20Definitions/Medicaid%20Requirements%20for%20Substance%20Use%20Disorder%20and%20Applied%20Behavior%20Analysis%20Services.pdf)
7. [Health Plan Advisory 25-08 — ABA Rates (to Heritage Health MCOs)](https://dhhs.ne.gov/Guidance%20Docs/Health%20Plan%20Advisory%2025-08%20-%20Applied%20Behavior%20Analysis%20Rates.pdf)
8. [Molina Healthcare of Nebraska — Medicaid Provider Manual 2026](https://www.molinahealthcare.com/-/media/Molina/PublicWebsite/PDF/Providers/ne/EN/Provider-Manual-2026.ashx)
9. [42 CFR 438.210(d) — Timeframe for decisions (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-438/subpart-D/section-438.210)
10. [Contract Year 2025–2026 External Quality Review Technical Report for Heritage Health (HSAG)](https://dhhs.ne.gov/Documents/Heritage%20Health%20Aggregate%20Report%20-%20Measurement%20Year%202025.pdf)

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.