Updated
ABA is billed with ten codes in 15-minute units: 97151 (BCBA assessment), 97152 and 0362T (supporting assessment), 97153 (technician 1:1 therapy, most billed hours), 97154/97158 (group), 97155 (BCBA protocol modification), 97156/97157 (parent training) and 0373T (severe behavior). Medicaid pays 97153 from about $12 to $24 per unit depending on the state.
ABA is billed with ten codes: eight Category I CPT codes (97151–97158) and two Category III codes (0362T and 0373T) for severe destructive behavior. They took effect January 1, 2019, and replaced the old temporary set. Every code is billed in 15-minute units.
The codes split along two lines, and once you see them the whole set makes sense. The first is assessment versus treatment. The second is who is in the room: a technician working from a protocol, or a qualified healthcare professional (usually a BCBA) who can change the protocol. After that, the only other questions are one patient or a group, and whether the caregiver is the person being taught.
This page walks through each code, then covers the rules that decide whether a claim actually pays: units, daily limits, concurrent billing, credential modifiers and prior authorization. It ends with current Medicaid rates by state, taken from our payer directory.
"QHP" is the qualified healthcare professional: a BCBA, a licensed behavior analyst, or another licensed professional allowed by the payer and state. "Technician" is usually an RBT, though some states and payers accept other credentials.
97151 covers the BCBA’s assessment work: observing the child, interviewing caregivers, running standardized tools, scoring and interpretation, and writing the report and treatment plan. It is the one ABA code that includes time without the child present, since writing the plan counts. Most payers require a prior authorization for it, cap the units per assessment, and allow a re-assessment roughly every six months to renew treatment. Some states pay it differently: Colorado Medicaid pays 97151 as one flat amount per assessment, billable once every 365 days, instead of per unit.
97152 is the technician’s part of an assessment, for example running a preference assessment or collecting baseline data while the BCBA directs. 0362T is the version for severe destructive behavior. It needs the QHP on site, two or more technicians, and an environment set up for the child’s behavior. It is billed per 15 minutes of technician time, and not every state covers it.
Whether assessment codes need a prior auth varies a lot. Virginia Medicaid, for example, needs no authorization for 97151, 97152 or 0362T, while most commercial plans want one before the first unit. Check the specific plan before scheduling, not after.
97153 is the bulk of every ABA practice’s revenue: the technician delivering direct 1:1 therapy from the BCBA’s protocol. The hours a family is authorized for are almost always 97153 hours, and the gap between authorized and delivered 97153 units is where most practices leak money.
97155 is the BCBA working face to face with the child and adjusting the protocol, often while directing the technician in the same session. It is also the code for most direct supervision. 97156 is parent training, with or without the child present. Payers increasingly treat it as a required part of the plan, not an optional one.
The group codes, 97154, 97157 and 97158, cover social-skills groups, multi-family parent groups and group sessions with a BCBA modifying the protocol. Most payers cap groups at eight. 0373T is the severe-behavior treatment code, with the same on-site-QHP, two-technician structure as 0362T.
Every ABA code is a 15-minute unit. Under the CPT time convention, you can bill a unit once you pass the midpoint, meaning 8 minutes of a 15-minute unit. Some payers follow the CMS rule of adding up all timed minutes in a day and dividing instead. Either way, bill the minutes you documented, not the minutes you scheduled. Session notes need start and stop times that support the units on the claim.
There is also a daily ceiling. Many plans apply the CMS medically unlikely edits (MUEs) for ABA: 97151 and 97153 at 32 units a day (8 hours), 0373T at 32, 97155 at 24, 97154 at 18, and 97152, 97156, 97157, 97158 and 0362T at 16. A claim over the ceiling usually denies outright, even when the hours were authorized. Some plans set tighter per-day limits of their own, and those win.
The most common billing question in ABA is whether the technician’s 97153 and the BCBA’s 97155 can both be billed for the same minutes, when the BCBA is in the session directing the technician.
The CPT descriptors allow it: 97155 explicitly "may include simultaneous direction of a technician," and each person bills their own code. What the payer allows is a separate question, and the answers differ. Some plans pay both lines when both people are face to face with the child and the BCBA is directing. Some pay only the BCBA line. Some say nothing, which is not the same as permission. One person can never bill 97153 and 97155 for the same minutes.
Our payer guides record a concurrent-billing answer for each plan where the plan publishes one, and mark it "not published" where it doesn’t. When it’s unpublished, ask the plan in writing before you build a supervision model around it.
Many Medicaid programs, and some commercial plans, pay the same code at different rates depending on who delivered it. The level is reported with a modifier. The common set is HM (less than a bachelor’s, typically an RBT), HN (bachelor’s level, typically a BCaBA), HO (master’s level, typically a BCBA) and HP (doctoral level). Some states use their own U-modifiers instead. Indiana uses U1–U3, and New Mexico uses U1 through U9 across its practitioner levels.
The spread is large. In Virginia Medicaid, 97155 pays $23.48 per unit from a licensed assistant behavior analyst and $46.63 from a licensed behavior analyst. A missing or wrong modifier either denies the claim or quietly pays it at the lowest level, so modifier logic belongs in your billing setup, not in someone’s memory. Telehealth adds its own modifier (95 or GT), and a few plans don’t pay certain codes by telehealth at all.
Almost every payer authorizes ABA in two steps. First the assessment (97151, sometimes with 97152), then a treatment authorization built from the assessment’s plan: a number of 97153 hours per week, plus 97155 and 97156 units, usually for six months. Renewal needs a re-assessment and progress data.
The front end of this is intake, and it is where most delays start. The assessment auth usually needs the diagnosis report, sometimes a physician referral or order, and in some states a diagnosis from a specific kind of clinician or one issued within a set time frame. A missing diagnostic report can hold up the first unit by weeks. Our records-request guide, linked below, covers how to shorten that.
Medicaid is the one payer type that publishes its ABA rates. Commercial rates are contract-specific and never public. The table shows the published fee-for-service or state benchmark rate per 15-minute unit. Where a state pays by credential, both ends of the range are shown. Managed care plans in most states pay at or above the state schedule by contract, but confirm with each plan. Each row links to that state’s full payer guide and sources.
Per 15-minute unit, from each state’s published Medicaid fee schedule as recorded in the Carelu payer directory. Rates change; the linked guide carries the source document and the date we last checked it. Tennessee and Georgia do not publish a public ABA schedule, so they are not listed.
Units billed outside the authorized dates, above the authorized count, or under a code the authorization did not include. Track authorized against used units per code, every week.
The family’s coverage lapsed, changed plans or moved to a Medicaid managed care plan mid-authorization. Re-verify eligibility monthly, not only at intake.
A technician not yet certified or enrolled, a missing HM/HN/HO/HP modifier, or a rendering provider not credentialed with that plan.
A long day that exceeds the plan’s per-day limit for the code, even though the weekly hours were authorized.
Session notes without start and stop times, without the targets worked on, or signed late. These denials come back on audit, sometimes months later.
97153 is adaptive behavior treatment by protocol: direct 1:1 ABA therapy delivered by a technician (usually an RBT) under the direction of a BCBA or other qualified professional, billed in 15-minute units. It accounts for most of an ABA practice’s billed hours.
97153 is the technician delivering therapy from an existing protocol. 97155 is the BCBA or other qualified professional working face to face with the child and modifying the protocol, which can include directing the technician in the same session. 97155 pays more and is often the code for direct supervision.
The CPT descriptors allow it when the technician and the BCBA are both face to face with the child and the BCBA is directing the technician, with each person billing their own code. Whether the payer pays both lines varies by plan. Some do, some pay only one line, and many don’t publish a rule. One person can never bill both codes for the same minutes.
Many plans apply the CMS medically unlikely edit of 32 units (8 hours) per day for 97153. The authorization sets the weekly total, and some plans set a lower per-day limit of their own.
Per 15-minute unit in most states and plans, with an authorized number of units per assessment. A few Medicaid programs pay it differently. Colorado, for example, pays a flat amount per assessment, once every 365 days.
They are Category III codes for children with severe destructive behavior: 0362T for the supporting assessment and 0373T for treatment with protocol modification. Both need the qualified professional on site, two or more technicians, and a setting customized to the child’s behavior. Coverage varies by state.
Nothing on this page bills until a family is enrolled, verified and authorized. Carelu handles everything before the first unit: it answers the family, checks the payer’s rules for that state, verifies benefits and collects the documents the assessment authorization needs. Your team starts with an authorizable case instead of a phone number.
Claims, coding and the authorization itself stay with your billing team and your practice management system. Carelu’s job is to make sure what reaches them is complete.
Eligibility, ABA coverage, in-network status and referral requirements are verified automatically while the family is still in the conversation, before any staff time is spent.
Diagnosis requirements, referral and order rules and assessment prior-auth rules from our payer directory are built into intake, so each family is asked for exactly what their plan and state require.
Diagnosis report, insurance card front and back, signed consents and releases, gathered by text or on a phone-friendly intake form, with each signed document saved as a PDF in the family’s packet.
The verified, documented case goes to your coordinator’s queue and into CentralReach, Rethink, Aloha or your CRM, ready for the assessment auth.
Every billable unit starts with a family who finished intake.
Carelu answers every family, applies the payer’s rules, verifies benefits and collects the authorization packet, so your billing team starts with complete cases.
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