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
-
What is Task Analysis in Aba for Self-care Routines?
Read More »: What is Task Analysis in Aba for Self-care Routines?In Applied Behavior Analysis (ABA), task analysis is a systematic method used to teach self-care and functional life skills by breaking down complex routines into small, manageable, and teachable steps. This approach deconstructs sequential actions—such as dressing, grooming, or meal…
-
How does Aba Therapy Teach Daily Living Skills like Dressing?
Read More »: How does Aba Therapy Teach Daily Living Skills like Dressing?ABA therapy teaches daily living skills, such as dressing, by utilizing a systematic approach called task analysis. This method involves deconstructing complex routines into small, sequential, and manageable steps that act as a clear roadmap for both the therapist and…
-
What are the Most Important Life Skills Taught in Aba Therapy?
Read More »: What are the Most Important Life Skills Taught in Aba Therapy?Applied Behavior Analysis (ABA) therapy focuses on teaching essential life skills—referred to as adaptive behavior activities—that help children with autism achieve long-term self-sufficiency. These skills are often broken down into specific categories tailored to a child’s age and abilities. According…
-
Can Aba Therapy Help with Mealtime and Sleep Issues?
Read More »: Can Aba Therapy Help with Mealtime and Sleep Issues?Yes, ABA therapy can effectively address mealtime and sleep issues by integrating daily living skills into a child’s natural routines. Through family-centered care, therapists work directly in the home to address these specific challenges. How ABA Supports Mealtime Therapists use…
-
How do State Rate Cuts Affect In-home Aba Provider Availability?
Read More »: How do State Rate Cuts Affect In-home Aba Provider Availability?State rate cuts, particularly within Medicaid programs, can significantly impact the availability of in-home ABA therapy. Because Medicaid rates are established directly by state legislation and budget cycles, reductions can create several challenges for service access: Related FAQs
