What are the New 2026 Utah Medicaid Reimbursement Rates for Aba Therapy?
The Utah Medicaid ABA therapy rates for 2026 represent the reimbursement amounts set by the state for Applied Behavior Analysis (ABA) services. These updates, overseen by the Utah Division of Services for People with Disabilities (DSPD), have introduced significant coverage expansions to improve access for families across Salt Lake, Utah, Weber, and Davis counties.
While specific dollar amounts are not publicly disclosed in the fee schedule summaries, the 2026 rates are structured around specific billing codes that determine how your child’s treatment is covered. Key updates include:
- Billing Code 97153: This code covers face-to-face, one-on-one therapy between the patient and the therapist.
- Billing Code 97155: This code is utilized for essential clinical supervision by a Board Certified Behavior Analyst (BCBA).
- In-Home Coverage: A major shift in 2026 is the inclusion of In-Home ABA Therapy as a covered service, allowing children to receive evidence-based care in their natural environment rather than only in clinic settings.
- Expanded Parent Training: The updated program introduces greater flexibility for parent training and family collaboration, which is vital for skill generalization.
We encourage you to contact your specific Medicaid plan or reach out to us directly so we can help you verify your benefits and understand how the Utah Medicaid fee schedule 2026 applies to your situation. Our team manages the administrative side, including securing prior authorizations, to help your child begin their journey of Helping Children Reach their True Potential.
Results may vary based on individual circumstances. Insurance coverage and results depend on individual plans and client factors. This information is for educational purposes and is not a substitute for professional medical advice; consult a healthcare or behavioral health professional.
Related FAQs
-
What Autism Benefits are Mandated by Arizona State Law?
Read More »: What Autism Benefits are Mandated by Arizona State Law?Under Arizona state law, specific mandates are in place to ensure that certain health insurance plans provide coverage for the diagnosis and treatment of autism spectrum disorder. Key benefits mandated by Arizona law include: It is important to note that…
-
How do State-regulated Insurance Plans Cover Autism Therapy?
Read More »: How do State-regulated Insurance Plans Cover Autism Therapy?State-regulated insurance plans cover autism therapy through autism insurance mandates. These are state laws that require health insurance companies to provide coverage for the diagnosis and treatment of autism spectrum disorder, specifically including evidence-based treatments like Applied Behavior Analysis (ABA)…
-
What are the Age Limits for the Autism Insurance Mandate in Maryland?
Read More »: What are the Age Limits for the Autism Insurance Mandate in Maryland?In Maryland, the autism insurance mandate provides broader protections compared to many other states. According to the state’s regulations: It is important to note that these state-level requirements generally apply to state-regulated (fully insured) plans. If you are covered by…
-
What is the Difference between a State Mandate and an Erisa Plan for Aba Therapy?
Read More »: What is the Difference between a State Mandate and an Erisa Plan for Aba Therapy?The difference between a state mandate and an ERISA plan primarily involves which laws regulate the insurance coverage and whether the insurer is legally required to provide autism-related benefits. State Mandates An autism insurance mandate is a state-level law that…
-
Does Every State have an Autism Insurance Mandate?
Read More »: Does Every State have an Autism Insurance Mandate?No, not every state or insurance plan follows a universal autism insurance mandate. While a majority of states have enacted some form of mandate requiring health plans to cover autism diagnosis and treatment, the regulations and their reach vary significantly.…