Change log
Every dated ABA Medicaid change we've verified for 2025-26, newest first. Download as CSV or JSON.
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Scheduled: additional 4% cut to all ABA codes
Further 4% max-fee cut including group codes (97153 -> $15.39; 97155 U3 -> $24.93).
Source: IHCP Bulletin BT202627 (Feb 26, 2026) · Verified: official source · checked Oct 20, 2026 -
97153 cut 33% to $9.63/unit
Third cut in a year: technician direct therapy (97153) drops from $14.45 to $9.63 per 15 min ($38.52/hr) for Medicaid fee-for-service, a cumulative ~50% cut from $19.26. Authorized by the FY2026-27 enacted budget. Other ABA codes stay at $19.26.
Source: NYS Medicaid Update, Aug 2026 (Vol. 42 No. 9) · Verified: official source · checked Oct 20, 2026 -
ABA ends for Medicaid members 21+
IHCP no longer authorizes or reimburses ABA for members 21 and older for dates of service on/after Oct 1, 2026, after a 6-month transition window (Apr 1 - Sep 30, 2026). ABA is now covered only through EPSDT.
Source: IHCP Bulletin BT202627 (Feb 26, 2026) · Verified: official source · checked Oct 20, 2026 -
ABA moves from tiered case rate to fee-for-service
DVHA stops reimbursing the tiered monthly case rate; all ABA billed fee-for-service. Expected to be budget neutral. The state said it will not reverse the concurrent-billing ban.
Source: Vermont GCR 26-058 (final) · Verified: official source · checked Oct 20, 2026 -
Extrapolated overpayment audits authorized (HB26-1412)
For audits started after July 1, 2026, HCPF may recover pediatric behavioral therapy overpayments (2022-23 services; 2024-25 if a pattern is found) using statistical sampling and extrapolation.
Source: Colorado General Assembly: HB26-1412 · Verified: official source · checked Oct 20, 2026 -
CareSource: ABA paid at 80% of fee schedule (partly rescinded July)
Managed care plan CareSource notified ABA providers (Mar 27) of a 20% cut effective May 11, 2026. In July it rescinded the cut for some providers in shortage areas only; others who refused were dropped from network.
Source: WRDW News 12, Jul 22, 2026 · Reported: news source · checked Oct 20, 2026 -
HB 696 signed (Session Law 2026-1)
Medicaid oversight law signed by the Governor Apr 30, 2026. Trade press reports it includes ABA rules such as in-person assessment requirements, a 50% telehealth supervision cap and a minimum supervision floor; read the ratified text for exact provisions.
Source: NC General Assembly: H696 / SL 2026-1 · Verified: official source · checked Oct 20, 2026 -
97153 second 12.5% cut to $14.45/unit
Second of two 12.5% reductions to 97153.
Source: Behavioral Health Business, Sep 23, 2026 · Reported: news source · checked Oct 20, 2026 -
6% cut to individual ABA codes
6% max-fee reduction to all non-group ABA codes (97153 $17.06 -> $16.04; 97155 U3 $27.63 -> $25.97).
Source: IHCP Bulletin BT202627 (Feb 26, 2026) · Verified: official source · checked Oct 20, 2026 -
4,000-hour lifetime cap on comprehensive ABA
Up to 4,000 hours (16,000 units) of comprehensive ABA per lifetime; after that, only targeted ABA. IHCP Portal adds visibility into hours used.
Source: IHCP Bulletin BT202627 (Feb 26, 2026) · Verified: official source · checked Oct 20, 2026 -
Telehealth (modifier 95) barred for 97151/97152/97153/97154/0373T
These codes can no longer be billed with modifier 95. Prior-authorization requests must include caregiver coaching. 97153 may now also be rendered by BCaBA/BCBA/BCBA-D/HSPP (modifiers U2/U3).
Source: IHCP Bulletin BT202627 (Feb 26, 2026) · Verified: official source · checked Oct 20, 2026 -
Proposed: cut ABA rate benchmark from 100% to 95% of comparable states
Legislative staff estimated ~$2.7M general-fund savings by paying 95% of the comparable-state average. Status not yet confirmed.
Source: Colorado Association of Health Plans (news repost) · Reported: news source · checked Oct 20, 2026 -
Federal OIG: $77.8M improper ABA payments
HHS OIG estimated Colorado paid at least $77.8M in improper FFS ABA payments for children (plus $207.4M potentially improper), citing documentation, credentialing and referral gaps.
Source: HHS OIG report A-09-24-02004 (Feb 2026) · Verified: official source · checked Oct 20, 2026 -
A03896: 680-hour annual cap on ABA insurance coverage
Would cap insurance coverage for ABA (and DIR/Floortime) at 680 hours per person per year (~13 hrs/week). Bill trackers show it referred to the Assembly Insurance Committee on Jan 7, 2026 with no later action; the official page timed out on our check date, so status is not yet re-confirmed.
Source: NY Senate: Assembly Bill A3896 (2025-26) · Reported: news source · checked Oct 20, 2026 -
Concurrent billing of 97153 + 97155 banned
97153 and 97155 can no longer be billed for the same member at the same time (same day at different times is allowed). Telehealth limited to 97155/97156/97157. Estimated savings $1,433,813/yr.
Source: Vermont GCR 25-042 (final) · Verified: official source · checked Oct 20, 2026 -
2% cut to ABA fee schedule
HCA cut FFS rates 2% for 97151, 97153-97157, 0362T, 0373T and H2020, rolling back part of the 2024 increase. Ongoing unless the legislature acts.
Source: WA HCA: Managed care rate reductions guidance & FAQ · Verified: official source · checked Oct 20, 2026 -
10% ABA cut reversed
After court rulings, NCDHHS reversed the Oct 1, 2025 rate reductions and restored Sept 30, 2025 rates; updated fee schedules targeted for Jan 5, 2026, with claims reprocessed.
Source: NC Medicaid: Rate Reduction Reversal Update (Dec 19, 2025) · Verified: official source · checked Oct 20, 2026 -
ABA codes replaced by Behavioral Intervention H-codes
Behavioral Modification & Consultation (97xxx codes, Magellan) moved to Behavioral Intervention billed to Idaho Medicaid FFS (Gainwell) with Telligen authorizations: e.g. 97153 -> H0004 TG/TF, 97154 -> H0005, 97151 -> H0032.
Source: Idaho DHW: Children's DDA providers page · Verified: official source · checked Oct 20, 2026 -
97153 first 12.5% cut
First of two 12.5% reductions to 97153 (from $19.26).
Source: Behavioral Health Business, Sep 23, 2026 · Reported: news source · checked Oct 20, 2026 -
10% cut to RB-BHT/ABA codes (later reversed)
State budget rate reductions cut RB-BHT codes 97151-97157 by 10%.
Source: NC Medicaid SPA #25-0026 public notice · Verified: official source · checked Oct 20, 2026 -
ABA rates cut after 'market study'
Nebraska reset ABA rates (97153 to $18.70, 97155 to $22.72, 97154 to $7.49, 97158 to $12.05). Managed care rates adjusted to match. DHHS cites ABA spending rising from $4.6M (2020) to over $85M (2024).
Source: Nebraska Medicaid Provider Bulletin 25-14 · Verified: official source · checked Oct 20, 2026 -
Service definitions: up to 30 hrs/week, 6 hrs/day
Final ABA service definitions allow up to 30 hours/week and 6 direct hours/day unless more is shown medically necessary; RBT supervision raised to 10-20%; 2-4 hrs/month caregiver involvement; treatment plan review every 90 days.
Source: Nebraska Medicaid Provider Bulletin 25-02 · Verified: official source · checked Oct 20, 2026
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