What is the Cpt Code 97153 Reimbursement Rate for 2026?
The reimbursement rates for CPT code 97153 in 2026 vary by state and are projected to see modest decreases in several Medicaid programs. CPT code 97153 is the primary billing code used for direct, face-to-face adaptive behavior treatment provided by a technician under the supervision of a Board Certified Behavior Analyst (BCBA).
According to projected 2026 Medicaid fee schedule data, the average rates are as follows:
- Utah: The projected rate is $12.25 per unit, reflecting a 2% decrease from the 2025 average rate of $12.50.
- Arizona: The projected rate is $13.50 per unit, reflecting a 3.6% decrease from the 2025 average rate of $14.00.
- Maryland: The projected rate is $13.50 per unit, reflecting a 1.8% decrease from the 2025 average rate of $13.75.
These figures represent industry-wide projections for public payers. Actual reimbursement amounts for private insurance are negotiated between provider networks and employer health plans, meaning they may differ from Medicaid benchmarks. Families are encouraged to verify their specific plan’s deductibles and out-of-pocket maximums to determine their final costs.
Related FAQs
-
How can Parents Create a Sensory-friendly Calm-down Space at Home?
Read More »: How can Parents Create a Sensory-friendly Calm-down Space at Home?Creating a sensory-friendly calm-down space is a wonderful way to support your child’s natural self-regulation. We believe in The Power of Small Steps, and setting up a dedicated area for self-soothing can yield big results for your child’s emotional well-being.…
-
What are some Common Self-soothing Techniques Used by Children with Autism?
Read More »: What are some Common Self-soothing Techniques Used by Children with Autism?Common self-soothing techniques for children with autism often involve repetitive movements, sounds, or actions known as stimming. These behaviors are natural and healthy ways for children to regulate their nervous systems, manage sensory input, and cope with overstimulation or anxiety.…
-
What is the Difference between a Bcba and an Rbt in Home-based Therapy?
Read More »: What is the Difference between a Bcba and an Rbt in Home-based Therapy?In our In-Home ABA Therapy model, the difference between a BCBA and an RBT lies in their specific responsibilities and level of oversight. These two roles work in a close, collaborative partnership to ensure your child receives high-quality, evidence-based care.…
-
How Many Hours of Bcba Supervision are Required for Rbt Sessions?
Read More »: How Many Hours of Bcba Supervision are Required for Rbt Sessions?At our practice, we follow the Behavior Analyst Certification Board (BACB) supervision standards without exception to ensure the highest quality of care. These standards require that all Registered Behavior Technicians (RBTs) practice under the close and ongoing supervision of a…
-
What is the Difference between Traditional Aba and Naturalistic Teaching (ndbi)?
Read More »: What is the Difference between Traditional Aba and Naturalistic Teaching (ndbi)?The primary difference lies in the environment and the structure of the sessions. While both approaches utilize evidence-based strategies, naturalistic teaching — often referred to as Naturalistic Developmental Behavioral Intervention (NDBI) — moves away from rigid table-top structures in favor…
