ABA therapy billing
Authorizations, units and credentials matched before every ABA claim goes out.
We bill applied behavior analysis the way payers check it: each code matched to the credential of the person who delivered it, units kept inside the authorization, modifiers set to each plan’s rules, and reauthorizations started before they lapse.
- Full-service rate
- 3% to 6% of collections
- ABA codes
- 97151 to 97158, 0362T, 0373T
- Units
- 15 minutes, inside the auth
- New & smaller practices
- Flexible monthly minimum
What makes ABA billing different
An ABA claim is a record of who did what, for how long, under which authorization. Each code says whether a behavior analyst or a technician delivered it, each is billed in 15-minute units, and most treatment is approved in advance.
So a claim can be coded right and still fail: the RBT was not on the plan’s roster, the units ran past the authorization, or the modifier did not match the credential. We check those before each claim goes out, as part of our full revenue cycle service at 3% to 6% of collections.
ABA codes and who delivers each
The 2026 adaptive behavior codes, each billed per 15 minutes. Payers decide whose NPI goes on the claim.
- 97151Assessment by a physician or other qualified health care professional (QHP), usually the BCBA, including scoring and writing the treatment plan.
- 97152, 0362TSupporting assessment by a technician. 0362T is for destructive behavior, with two or more technicians and the QHP on site.
- 97153Treatment by protocol, one patient, delivered by a technician (usually the RBT). Most direct therapy hours.
- 97154Group treatment by protocol, delivered by a technician to two or more patients.
- 97155Protocol modification by the QHP with one patient, which may include directing the technician at the same time.
- 0373TProtocol modification for destructive behavior, two or more technicians, QHP on site.
- 97156, 97157Caregiver training by the QHP: 97156 for one family, with or without the patient; 97157 for several families, without patients.
- 97158Group treatment with protocol modification, delivered by the QHP.
15-minute units, and how they are counted
CPT’s general time rule says a unit of time is attained when the midpoint is passed, so 8 minutes can count as one unit of a 15-minute code. Payers can set their own rule: Blue Cross Blue Shield of Michigan tells ABA providers it does not bill ABA with an eight-minute rule and wants notes in 15-minute intervals.
Payers also cap units. Nevada Medicaid’s ABA billing guide limits each patient to 40 hours a week across all ABA codes, and counts 0362T and 0373T by one technician’s time: an hour with three technicians is one hour. We count units from the start and stop times in each note.
The code set changes on January 1, 2027. The ABA Coding Coalition reports that the AMA approved six new codes, revised 97151 to 97158 and their guidelines, and deleted the existing Category III codes. We update fee schedules and authorizations that run into 2027 before the first 2027 claim.
Authorizations, treatment plans and supervision
Most ABA treatment is approved in advance for a set number of units. Nevada Medicaid, for example, requires prior authorization for 97153, 97155, 97156, 97157 and 0373T, but not for the assessment codes 97151, 97152 and 0362T, and allows one assessment every 180 days unless authorized. Louisiana Medicaid’s ABA manual caps each authorization period at 180 days and wants a new assessment at least every six months.
So reauthorization is a cycle: reassessment, progress data on each goal and an updated treatment plan, sent early enough that the next approval starts when the current one ends. We track authorized units, used units and end dates for every patient.
The BACB’s RBT Handbook requires supervision of at least 5% of an RBT’s service hours each calendar month, with at least two real-time contacts, one of them individual, and an observation with a client. Payers add their own: Louisiana approves supervision at two hours for every ten hours of therapy, and Nevada allows up to 20% of treatment hours.
Medicaid, EPSDT and state autism mandates
For children on Medicaid, the coverage rule is EPSDT. CMS’s July 2014 bulletin on autism services says states must cover any Medicaid-coverable service that is medically necessary to correct or ameliorate a condition in a member under 21, and names applied behavior analysis as one treatment. Each state then sets its own provider types, rates and authorization rules.
For commercial plans, state autism insurance laws shape the benefit, and they differ. A review of all 50 states and D.C. found mandates vary greatly, with coverage often ending at an age limit of 18 to 21. Our eligibility and benefits checks confirm each patient’s autism benefit and limits before the assessment.
Why ABA claims deny
The denials ABA providers see most, with the reason code where one usually applies (codes vary by payer):
- No authorization on file for the code or dates billed (CO-197)
- More units than the authorization allows, or past a daily or weekly cap
- Rendering provider not credentialed, or not on the plan’s roster, on the date of service
- An assessment billed more often than the plan allows, such as twice in 180 days
- A provider-level modifier missing or wrong where the payer requires one, such as UD for BCaBA and RBT services in Nevada Medicaid
Our prior authorization team requests each approval and tracks its units. Anything that still denies is corrected or appealed with the note and treatment plan.
How we run ABA billing
Map each payer’s rules
Codes, modifiers, unit caps, roster rules and authorization steps are set up for every payer before the first claim.
Track every authorization
Authorized units, used units and end dates are tracked per patient, with reauthorization flagged weeks ahead.
Check every session
Units, rendering provider, credential and modifier are checked against the session note before the claim goes out.
Work what comes back
Denials and short payments are worked by payer and reason code until paid or closed.
Report monthly
Collections, days in A/R, denials by reason and authorizations close to running out, by payer and by BCBA.
Credentialing for ABA providers
The credentials come from the Behavior Analyst Certification Board: a BCBA is a graduate-level behavior analyst who can practice independently, a BCaBA an undergraduate-level analyst supervised by a BCBA, and an RBT a paraprofessional under close, ongoing supervision. Some states add a license: Louisiana Medicaid requires services by or under a behavior analyst licensed by the state board.
Payers credential differently. Blue Cross Blue Shield of Michigan lets only licensed behavior analysts and BCBAs bill it directly, so a BCaBA’s caregiver training goes through the contracted BCBA. Nevada Medicaid enrolls BCaBAs and RBTs and wants the NPI of whoever delivered the service, not the supervisor’s. We enroll the group and each BCBA with every payer and keep RBT details current where a plan asks. See our behavioral health credentialing page.
For 2026 dates of service, the adaptive behavior codes are 97151 to 97158, plus two Category III codes for destructive behavior, 0362T and 0373T. Each is billed per 15 minutes, and the descriptor says whether a technician or a qualified professional delivers it. The AMA has approved six new codes and revisions for January 1, 2027.
Usually not as an independent provider. Many commercial plans contract only with the BCBA or the group, and the RBT’s sessions go out under that contract. Some Medicaid programs, such as Nevada’s, enroll RBTs and want the RBT’s NPI on the claim. Either way, BACB rules require supervision of at least 5% of the RBT’s service hours each month.
At the end of each authorization period, which the plan sets. Louisiana Medicaid, for example, caps each period at 180 days and wants a new assessment at least every six months. The request needs the reassessment, progress data and an updated treatment plan, so we start it weeks ahead.
For members under 21, yes when it is medically necessary. Under EPSDT, states must cover any Medicaid-coverable service needed to correct or ameliorate a condition, and CMS’s 2014 autism guidance names applied behavior analysis as one treatment. Each state sets its own provider types, rates, modifiers and authorization rules, so we bill to your state’s manual.
They mark the education or credential level of whoever delivered the service, where a payer pays by tier. Blue Cross and Blue Shield of Illinois uses them on 97153: HM below a bachelor’s degree without RBT certification, HN for an RBT, BCaBA or bachelor’s degree, and HO for a BCBA or master’s. A line with none pays at the HM rate. Other payers use other modifiers.
Our full-service rate is 3% to 6% of monthly collections, set by your volume, with no setup or onboarding fees and flexible monthly-minimum plans for new and smaller practices. It covers eligibility checks, prior authorizations, coding, claims, payment posting, denials and A/R follow-up, plus authorization and unit tracking. Your exact rate comes after a free A/R review. Our guide to medical billing costs shows how to compare quotes.
Yes. We don’t list our clients on this site, but ask us and we’ll arrange it: with a current client’s permission, we share their contact details so you can hear how we work from them directly.
From our guides
How much do medical billing services cost?
The four ways billing companies price their work, the fees that sit outside the rate, and in-house arithmetic built from BLS data, so you can compare quotes on your own numbers.
How long does credentialing take?
Credentialing times by payer, the rules that set your effective date, and a 120-day plan that keeps a new provider from seeing patients you cannot bill for.
Send us your last 90 days of ABA claims.
We’ll review them free and show you where units, authorizations or rendering providers are costing you money.