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.
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