Which States have the Highest Autism Therapy Reimbursement in 2026?
Among the states analyzed for 2026, Arizona is projected to have the highest average Medicaid reimbursement rate for CPT code 97153 (adaptive behavior treatment), followed closely by Maryland.
According to the 2026 projections for Medicaid fee schedules, the rates per unit are:
- Arizona: Projected average rate of $13.50 per unit (despite a 3.6% reduction from 2025).
- Maryland: Projected average rate of $13.50 per unit (reflecting a 1.8% decrease from 2025).
- Utah: Projected average rate of $12.25 per unit (reflecting a 2% decrease from 2025).
While Arizona and Maryland are projected at the same average rate, Arizona historically started from a higher 2025 baseline ($14.00) compared to Maryland ($13.75).
It is important to note that these figures apply specifically to Medicaid. Private insurance reimbursement rates are negotiated between employer health plans and provider networks and typically offer different, often more flexible, rate structures compared to state-legislated Medicaid budgets.
Related FAQs
-
How do I Determine if my Insurance is Subject to State Autism Mandates?
Read More »: How do I Determine if my Insurance is Subject to State Autism Mandates?To determine if your insurance is subject to state autism mandates, you must first identify your health plan type and the state laws governing it. While many states have mandates requiring coverage for Applied Behavior Analysis (ABA) therapy, these laws…
-
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…
