---
title: Nebraska Total Care ABA coverage (Heritage Health MCO).
url: "https://carelu.com/payers/nebraska-total-care"
markdown_url: "https://carelu.com/payers/nebraska-total-care.md"
state: NE (Nebraska)
payer: Nebraska Total Care (Centene)
kind: Medicaid managed care plan (MCO)
parent_program: Nebraska Medicaid (Heritage Health)
description: "How Nebraska Total Care (Centene) administers Nebraska Medicaid ABA — the NE.CP.BH.105 documentation policy, OTR-based prior authorization, IDI and FBA requirements in the assessment package, and why denial risk here is documentation-driven."
last_reviewed: September 2026
vob_data_updated: 2026-07-23
---

# Nebraska Total Care ABA coverage (Heritage Health MCO).

_Payer Guide · Nebraska Total Care · Last updated September 2026 · 6 primary sources_

> Closest to the state baseline; OTR-based PA, documentation-heavy NE.CP.BH.105 policy.

Nebraska Total Care, Centene's Heritage Health plan, is the closest of the three MCOs to the state baseline: its Nebraska-specific policy NE.CP.BH.105 ("Applied Behavioral Analysis Documentation Requirements," rev. 06/2024) operationalizes the DHHS Medicaid Service Definitions rather than imposing distinct medical-necessity criteria — and its own footer says state Medicaid provisions take precedence in any conflict. What the plan adds is paperwork rigor: an OTR-based authorization workflow and a documentation checklist detailed enough that denial risk here is documentation-driven more than criteria-driven.

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: Nebraska Total Care’s prior-authorization code list / Pre-Auth Check tool on provider.nebraskatotalcare.com — NE.CP.BH.105 sets the assessment package contents but not the code-level PA requirement.
- **Prior auth for treatment**: Required — Outpatient Treatment Request (OTR) via the provider portal or fax 866-593-1955, with hours per code, titration/discharge plan, crisis plan, and coordination-of-care attempts [1][2]
- **Autism diagnosis required?**: ASD per DSM-5-TR "or an appropriate diagnosis as otherwise specified according to state-defined ABA criteria" — mirrors the state's non-ASD pathway [1]

## At a glance

- **Plan type:** Heritage Health MCO (Centene)
- **Clinical rules:** State MSDs, operationalized by NE.CP.BH.105 (documentation policy)
- **Prior auth:** OTR process — ABA Form via portal or fax 866-593-1955
- **Assessment package:** Must include the IDI and an FBA with direct assessment + data analysis
- **Group sessions:** Group adaptive treatment: minimum 2, maximum 8 participants
- **Rates:** Tracks the state fee schedule per DHHS direction (HPA 25-08)

## How Nebraska Total Care runs ABA authorization

ABA requests go through the Outpatient Treatment Request (OTR) process — the plan publishes an ABA Form and an ABA OTR Tip Sheet — submitted through the secure provider portal (provider.nebraskatotalcare.com) or by fax to 866-593-1955. The treatment plan must include hours requested per service with clinical justification, billing codes, a titration/discharge plan, a crisis plan, and documented coordination-of-care attempts down to dates, success, and contact names. On the front end, NE.CP.BH.105 requires the behavior identification assessment package to include the IDI and a functional behavior assessment with direct assessment and data analysis. One honest gap: we did not locate a published NTC statement that the assessment CPT codes themselves require PA — verify the assessment-PA question in the portal or with the plan before booking, rather than assuming either way. [1][2]

## Documentation is the denial risk

The policy's documentation checklist is unusually granular: time in/out, pauses in service with resume times, even preferred-versus-legal name conventions. Paired with the plan's published tip-sheet suite (assessment/plans, caregiver training, coordination of care, transition planning), the signal is active chart auditing — build session-note templates to the checklist rather than remediating at audit. Clinically, the policy mirrors the state: it accepts a confirmed DSM-5-TR ASD diagnosis "or an appropriate diagnosis as otherwise specified according to state-defined ABA criteria," which preserves Nebraska's developmental/intellectual-disability pathway, and group adaptive treatment sessions must run with 2–8 participants. Rates track the state fee schedule per DHHS direction. [1][6]

## Intake gates

The questions that decide whether a family can start with Nebraska Total Care (Centene), 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. NE.CP.BH.105 is a documentation policy and states no age criterion of its own, and its footer is explicit that for Medicaid members "when state Medicaid coverage provisions conflict with the coverage provisions in this clinical policy, state Medicaid coverage provisions take precedence." [3][1]
- **Diagnosis recency**: Follows the Nebraska Medicaid rule: an Initial Diagnostic Interview completed within the previous 12 months, with an IDI addendum where the clinical presentation has changed. Nebraska Total Care operationalizes rather than relaxes it — NE.CP.BH.105 requires the behavior identification assessment package to contain both the "Initial Diagnostic Interview (IDI)" and a "Functional Behavioral Assessment (FBA), including both of the following assessment techniques: Direct assessment; Data analysis." [1][3]
- **Who may diagnose**: Two layers, and the plan's is the stricter one. The state routes the diagnosis through the IDI, 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. NE.CP.BH.105 then requires "Confirmed autism spectrum disorder (ASD) diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5 TR) criteria or an appropriate diagnosis as otherwise specified according to state-defined ABA criteria" — wording that deliberately preserves Nebraska's non-ASD pathway — plus a recommendation from a practitioner "qualified to diagnose ASD and recommend ABA." [4][1]
- **Diagnostic tools required**: No ASD diagnostic instrument is required. What NE.CP.BH.105 requires instead is a battery inside the assessment: the IDI and an FBA with direct assessment and data analysis, plus "Administration of assessments, including but not limited to the following: Preference assessments; Standardized testing; Criterion-referenced testing; Functional Analysis." Behind it the state definitions ask for skills-based and standardized/norm-referenced or criterion-referenced assessments, with Vineland, VB-MAPP and ABLLS named for baseline and progress measurement. [1][3]
- **Referral required?**: This is where Nebraska Total Care adds a gate the state does not have. NE.CP.BH.105 requires every ABA request to contain a "Recommendation for treatment with ABA by a physician, psychologist, social worker, or another appropriately licensed health care practitioner working within their scope of practice and who is qualified to diagnose ASD and recommend ABA." The state MSDs require no referral or order at all — their gate is the IDI plus the ABA assessment — so collect the recommendation for this plan specifically, not as a statewide habit. [1][3]
- **Telehealth**: Follows the Nebraska Medicaid rule: audiovisual telehealth for 97155 (only while the individual is receiving 97153 concurrently), 97156, and the 97151 assessment, each under the conditions the service definitions spell out; 97152, 97153, 97154 and 97158 cannot be delivered by telehealth. NE.CP.BH.105 states no telehealth position of its own. [3][5]
  - Ask the plan: Nebraska Total Care provider services / the secure provider portal at provider.nebraskatotalcare.com.
- **Prior-auth decision time**: Nebraska Total Care publishes its own clock, and it matches the 2026 federal floor. "Preservice/non-urgent: Seven (7) calendar days"; "Preservice/Urgent: 72 hours"; "Concurrent review: 72 hours," with decisions made "as expeditiously as the member's health condition requires." The behavioral-health section says the same for the ABA request form (the OTR): "allow up to seven (7) calendar days to process non-urgent requests." Requests faxed or sent through the portal after 8 a.m.–5 p.m. CST, Monday to Friday, are "processed the next business day." Plan ahead, because nothing is backdated: "We will not retroactively certify routine services. The dates of the authorization request must correspond to the dates of expected services." An incomplete OTR "can result in authorization delays and/or denials." The plan publishes no ABA reauthorization lead time; its medical-side table asks five business days before elective outpatient services. [7]
- **Other insurance (who pays first)**: "Nebraska Total Care is always the payer of last resort," and "Any other insurance, including Medicare, is always primary to Medicaid coverage." Bill the primary plan first. Then "submit a copy of the Explanation of Benefits (EOB) or Explanation of Payment (EOP), or rejection letter from the other insurance when the claim is filed." Without it the claim "will deny until this information is received." When a child has two primary plans ("Medicaid would be the third payer"), the claim "must be submitted on a paper claim," not by EDI or the portal. As secondary payer, claims are due "within 365 calendar days of the date of service" instead of 180. A third-party payment received after Nebraska Total Care has paid must be refunded within 30 calendar days, with the EOB. The manual does not say whether its own ABA prior auth is required when another plan is primary. [8][7]
  - Ask the plan: Nebraska Total Care Pre-Auth check tool or 1-844-385-2192: ask whether an OTR is still required for ABA when a commercial plan is primary.

## Delivery and billing rules

Coverage decides whether Nebraska Total Care (Centene) 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. NE.CP.BH.105 adds an expectation rather than a number — "A comprehensive infrastructure for case supervision by a behavior analyst of all assessments and treatment" — and publishes no ratio of its own. [3][1]
- **Daily limits / MUEs**: Two answers stacked. The state sets the clinical ceiling: direct ABA "may not exceed 6 hours in a single day or a total of 20 hours per week," with more available on prior authorization and clinical justification. Nebraska Total Care answers the per-code question by pointing outward rather than publishing a table: "Providers should reference the most recent version of ABA Coding Coalition for information on Medically Unlikely Edits (MUEs), and related processes for code usage and descriptors. The Centers for Medicare & Medicaid Services guidelines should be used to determine the maximum units of service a provider can report under most circumstances during a single date of service." One hard plan number does exist, for group work: "The minimum number of participants in group adaptive treatment is two and the maximum amount is eight." [1][3]
- **Session-note signature**: Nebraska Total Care is the one Heritage Health plan that names a session-note signer, and it is the person who delivered the service: every note must carry the "Rendering clinician/technician's name, credentials, and dated signature." The surrounding checklist is unusually granular — provider organization name at the top of each page, member name on every page, DOB or unique identifier, date of rendered service, date of note creation if different, "Time service was initiated (time in) and the time the service ended (time out)," "Pauses in services indicating the time the service was paused and the time it resumed," location of services, type/code of service, who else was present and their relationship, and a session summary. An addendum needs a clear reference to the note it supplements, the date completed, and a "Signature with credentials." One deadline is stated outright: "Completion of the treatment record prior to submission of a claim." [1]
- **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. Nebraska Total Care publishes no Nebraska-specific ABA policy that deviates from this, and its own material was checked for one. Its own note checklist requires the "Location of services" on every session note, so the setting is an audited field here rather than a background fact. [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." Nebraska Total Care republishes no concurrency edit; NE.CP.BH.105 points providers to the ABA Coding Coalition and CMS for unit questions instead. [3][1]
  - Ask the plan: Nebraska Total Care provider services / the secure provider portal at provider.nebraskatotalcare.com.
- **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. NE.CP.BH.105 requires the rendering clinician or technician to be named with credentials on every note, but says nothing about which NPI carries the claim. [3][1]
  - Ask the plan: Nebraska Total Care provider services / the secure provider portal at provider.nebraskatotalcare.com.

## What intake should collect for Nebraska Total Care (Centene)

- **IDI + FBA for the assessment package:** NE.CP.BH.105 requires both in the behavior identification assessment — line them up before submission.
- **Qualifying diagnosis:** ASD or the state's non-ASD pathway (developmental/intellectual disability) — the policy honors both.
- **Coordination-of-care log:** The OTR wants attempts with dates, outcome, and contact names — start the log at intake.
- **Crisis + titration/discharge plans:** Both are required treatment-plan elements — missing sections bounce requests.

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

## Verification of benefits (VOB) data

How Nebraska Total Care (Centene) ABA benefits route and read on an eligibility check. Data last updated 2026-07-23.

### EDI routing

- **Payer ID (pVerify):** 01205
- **Supports 270/271 eligibility:** Yes
- **Behavioral health administrator:** none — Inferred from absence — NE.CP.BH.105 names no BH carve-out vendor anywhere in the document; not an explicit "no carve-out" statement. Confirm via Nebraska Total Care 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 | Required — Outpatient Treatment Request (OTR): the ABA Form via the secure provider portal (provider.nebraskatotalcare.com) or fax 866-593-1955. Must include hours requested per code with clinical justification, billing codes, a titration/discharge plan, a crisis plan, and coordination-of-care attempts logged by date/outcome/contact name. | 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 | Required — Outpatient Treatment Request (OTR): the ABA Form via the secure provider portal (provider.nebraskatotalcare.com) or fax 866-593-1955. Must include hours requested per code with clinical justification, billing codes, a titration/discharge plan, a crisis plan, and coordination-of-care attempts logged by date/outcome/contact name. | 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 | Required — Outpatient Treatment Request (OTR): the ABA Form via the secure provider portal (provider.nebraskatotalcare.com) or fax 866-593-1955. Must include hours requested per code with clinical justification, billing codes, a titration/discharge plan, a crisis plan, and coordination-of-care attempts logged by date/outcome/contact name. | 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 | Required — Outpatient Treatment Request (OTR): the ABA Form via the secure provider portal (provider.nebraskatotalcare.com) or fax 866-593-1955. Must include hours requested per code with clinical justification, billing codes, a titration/discharge plan, a crisis plan, and coordination-of-care attempts logged by date/outcome/contact name. | 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 | Required — Outpatient Treatment Request (OTR): the ABA Form via the secure provider portal (provider.nebraskatotalcare.com) or fax 866-593-1955. Must include hours requested per code with clinical justification, billing codes, a titration/discharge plan, a crisis plan, and coordination-of-care attempts logged by date/outcome/contact name. | 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.
- **97154, 97158:** NE.CP.BH.105 sets group adaptive treatment at 2-8 participants — wider than the state MSD's own staffing-ratio table (2-5 children). Documented plan-specific variation, not reconciled here.
- **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:** 1-844-385-2192 (TTY: 711)
- **Hours:** Monday to Friday, 7 a.m. to 6 p.m. Central (provider services).
- **Portal:** [Nebraska Total Care Secure Provider Portal](https://provider.nebraskatotalcare.com)
- **Fax:** 866-593-1955 (ABA Form / Outpatient Treatment Request submission)

Questions to ask on a verification call:

- Do the assessment codes 97151/97152 require a standalone prior authorization, or are they always bundled into the Outpatient Treatment Request package?
- For this member, is the weekly cap on direct ABA service hours (97153/97154/97155) 20 hours or 30 hours per week?
- For group adaptive treatment (97154/97158), does Nebraska Total Care apply its own 2-8 participant group size or the state MSD's 2-5 ratio for this member's authorization?
- Is there a specific unit or monthly cap on 97156 (family training) for this member?

### VOB data sources

- https://pverify.com/wp-content/uploads/2026/03/pVerifyPayers_All-Payers-List-3-2026.pdf (accessed 2026-07-23)
- https://www.nebraskatotalcare.com/content/dam/centene/Nebraska/policies/clinical-policies/NE.CP.BH.105_Applied_Behavioral_Analysis_Documentation_Requirements_07022024_508.pdf (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://www.nebraskatotalcare.com/providers/resources/behavioral-health-forms.html (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)
- https://www.nebraskatotalcare.com/contact-us.html (accessed 2026-07-23)

## Common questions

### Does Nebraska Total Care cover ABA therapy?

Yes — it administers the Nebraska Medicaid ABA benefit under the state Medicaid Service Definitions, with its NE.CP.BH.105 documentation policy layered on top. Its own policy says state provisions take precedence in any conflict.

### How do I submit an ABA authorization to Nebraska Total Care?

Through the Outpatient Treatment Request (OTR) process — the ABA Form via the secure provider portal (provider.nebraskatotalcare.com) or fax 866-593-1955, with hours per code, clinical justification, titration/discharge and crisis plans, and coordination-of-care documentation.

### Does the ABA assessment itself need PA at Nebraska Total Care?

The plan publishes no clear statewide statement that the assessment CPT codes require PA — the published policy focuses on what the assessment package must contain (IDI + FBA). Verify assessment-PA handling in the portal or with the plan before booking.

## Primary sources

1. [NE.CP.BH.105 — Applied Behavioral Analysis Documentation Requirements](https://www.nebraskatotalcare.com/content/dam/centene/Nebraska/policies/clinical-policies/NE.CP.BH.105_Applied_Behavioral_Analysis_Documentation_Requirements_07022024_508.pdf)
2. [Nebraska Total Care — behavioral health forms](https://www.nebraskatotalcare.com/providers/resources/behavioral-health-forms.html)
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. [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)
7. [Nebraska Total Care 2026 Provider Manual (PROV16-NE-00025 rev 01/2026)](https://www.nebraskatotalcare.com/content/dam/centene/Nebraska/PDFs/ProviderRelations/NTC_10_Provider_Manual_03032025_01122026_Final_508.pdf)
8. [Nebraska Total Care 2026 Provider Billing Guide — Third Party Liability / Coordination of Benefits](https://www.nebraskatotalcare.com/content/dam/centene/Nebraska/PDFs/ProviderRelations/NTC_Provider_Billing_Guide_12152025_01132026_508.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.