ABA Therapy Billing for Autism and Behavioral Health Providers

Applied Behavior Analysis (ABA) therapy plays a critical role in supporting children and adults with Autism Spectrum Disorder (ASD), developmental disabilities, and behavioral challenges. As demand for ABA services grows across the United States, providers face an equally growing challenge: navigating the complex world of ABA therapy billing services. Unlike general mental health billing, ABA billing is uniquely complicated. Providers must use time-based CPT codes such as 97151, 97153, and 97155; secure prior authorizations; document every session for medical necessity; and remain compliant with both commercial insurance and state Medicaid programs. Without the expertise of a trusted ABA billing company, these requirements often result in high denial rates and long reimbursement cycles.

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At Medstates, we specialize in ABA Therapy Billing Services designed for:

Board Certified Behavior Analysts (BCBAs)
Registered Behavior Technicians (RBTs)
ABA therapy practices and clinics
Multi-state behavioral health organizations

Our team helps ABA providers:

Verify patient eligibility and benefits before sessions.
Manage prior authorizations to prevent costly denials.
Accurately code and bill claims with ABA-specific CPT, ICD-10, and modifiers.
Stay compliant with Medicaid and insurance regulations.
Maximize collections with clean claim submission, denial management, and patient billing.

For MedStates, medical billing is not just providing services, we offer solutions to create a win-win situation for providers as well as our billing company. When you partner with us, you gain more than just a billing company, you gain a revenue cycle management partner that understands the specific payer requirements, compliance rules, and state regulations for ABA therapy.

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How ABA Therapy Billing Is different from Standard Medical Billing

Billing for ABA therapy is not the same as billing for general mental health services. While both fall under the behavioral health umbrella, ABA therapy comes with slightly different billing documentation, and compliance requirements that make it one of the most complex specialties in healthcare revenue cycle management. Here is what sets ABA therapy billing apart:

1. Specialized CPT and HCPCS Codes in ABA Billing

ABA therapy relies on a specific set of time-based codes ranging from CPT 97151 to CPT 97158 and Category III codes (0362T, 0373T) that reflect assessments, treatment planning, direct services, and group therapy. Unlike traditional psychotherapy, these codes vary based on whether the service is provided by a BCBA, RBT, or under supervision. Using the right code in line with the ABA services is the key to accurate and timely reimbursement.

2. Time-Based and Staff-Based Billing

Unlike most mental health CPT codes, ABA codes are billed in 15-minute increments and depends on whether is service is provided by BCBA or RBT. For example, CPT 97153, used for adaptive behavior treatment, billed by an RBT often be paired with a supervision code CPT 97155. This requires precise medical coding and appropriate use of modifiers and supporting codes.

3. Prior Authorization (PA) Requirements in ABA therapy

Most major commercial insurers require pre-authorization for ABA therapy before treatment begins, and many mandate periodic re-authorizations supported by updated treatment plans. Payers such as Blue Cross Blue Shield, UnitedHealthcare (Optum), Aetna, Cigna, Anthem, Humana, Kaiser Permanente, Magellan, and TRICARE all typically require prior approval for ABA services. While the process varies by plan and state, providers are usually asked to submit a confirmed autism diagnosis, a comprehensive treatment plan from a BCBA, and documentation of medical necessity. Failure to secure or renew authorizations on time is one of the most common causes of claim denials for ABA therapy providers.

4. Medical Necessity Scrutiny in ABA Services

ABA therapy involves high-cost, therefore, payers closely monitor whether services meet medical necessity criteria. In order to address this concern, providers must ensure inclusion of following details while submitting claims:

DSM-5 diagnosis codes (e.g., F84.0 for autism)
Documentation of skill deficits and behavior challenges
Individualized treatment plans with measurable goals

5. Medicaid and State-Specific Rules

Medicaid coverage for Applied Behavior Analysis (ABA) therapy is not standardized nationwide, and each state enforces unique rules that providers must follow to remain compliant. In California, Medi-Cal funds ABA services for children under 21 with autism spectrum disorder (ASD), but with limitations on session, use of billing modifiers, and prior authorization, which differs from county-to-country and managed care organization (MCO). Providers must stay updated with local Medi-Cal manuals to ensure medical necessity and documentation requirements are met. In Florida, ABA services are managed under the Statewide Medicaid Managed Care (SMMC) program, where prior authorization is required through either the managed care plan or Acentra, the state’s utilization review contractor. Authorizations are typically valid for six months and demand comprehensive treatment plans, measurable goals, and progress monitoring reports. Though EPSDT rules protect against strict hour caps, failure to follow plan-specific protocols often leads to claim denials. In Texas, the Medicaid program updated autism services policy in 2025, requiring physician signatures only on initial 180-day plans, while 90-day extensions rely on streamlined Comprehensive Care Program (CCP) forms. These differences in authorization forms, session caps, and billing guidelines highlight why ABA providers working across multiple states need expert revenue cycle management and compliance support to secure exact reimbursement and reduce denials.

6. Frequent Payer Audits and Re-certifications

ABA therapy insurance claims face greater payer scrutiny than general behavioral health because of the high cost and frequency of services. Insurers often conduct pre-payment and post-payment audits, requiring providers to submit session notes, treatment plans, progress reports, and standardized assessments to verify medical necessity. Even minor documentation errors—such as vague goals or missing signatures—can delay reimbursement or trigger denials. Beyond audits, credentialing and re-credentialing with commercial insurers and Medicaid plans is more complex for ABA providers. Payers typically require supervising Board Certified Behavior Analysts (BCBAs) and technicians to meet strict licensing and supervision standards, with periodic re-credentialing to maintain network status. This contrasts with broader behavioral health, where credentialing is less specialized. Combined with prior authorization and re-authorization rules, these requirements create a heavier compliance burden for ABA practices. Without strong billing workflows and audit-readiness processes, providers risk payment delays, and contract complications.

Our ABA Therapy Billing Services

Managing ABA therapy billing requires more than just claim submission, it requires a partner who understands autism therapy codes, Medicaid compliance, prior authorizations, and insurance-specific rules. At MedStates, we offer end-to-end ABA billing solutions tailored to the unique needs of BCBAs, RBTs, ABA therapy clinics, and multi-state behavioral health practices. Here is how we support your revenue cycle:

Eligibility and Benefits Verification

Before sessions begin, we verify each patient’s insurance coverage, plan benefits, deductibles, and copays for ABA therapy services.

Prior Authorizations and Re-Authorizations

We manage pre-authorization process from start to end, including submission of treatment plans, progress reports, and required forms. Our team also handles ongoing re-authorization requests, ensuring uninterrupted therapy and continued payments.

Accurate CPT, HCPCS and ICD-10 Coding

Our ABA billing specialists apply ABA therapy CPT codes (97151–97158, 0362T, 0373T) and ICD-10 autism-related diagnoses (F84.0, F84.5, F88, etc.). We ensure every claim is coded properly with the right modifiers and time units, for accurate reimbursement.

Clean Claim Submission and Denial Management

We submit clean claims electronically to reduce errors and speed up processing. In case of claim denial, the denial trends and reasons are investigated before filing appeals and the claim is re-submited with supporting documentation to recover lost revenue.

Patient Billing and Collections

ABA therapy often involves family cost-sharing, deductibles, or co-pays. We manage patient statements, set up payment plans, and provide clear communication so families understand their balances.

Compliance and Audit Support

ABA billing is under frequent payer audit due to high costs. We prepare and maintain accurate treatment documentation, session notes, and supervision logs to keep your practice audit-ready. Our compliance support reduces risks and protects your revenue.

Reporting and Full Revenue Cycle Management (RCM)

We provide monthly financial reports with insights into collections, denial trends, and revenue performance. With transparent reporting, you know exactly where your practice stands financially and can make informed growth decisions.

By outsourcing ABA therapy billing to us, you save time, energy, claim denials, and create a more predictable cash flow

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Medical Coding Guide for ABA Therapy Billing

ABA therapy billing requires precise use of different coding systems. Below are the most common CPT, ICD-10, POS, and Modifiers used by ABA providers and medical billers.

1. CPT Codes for ABA Therapy

CPT Code	Description	When to Use
97151	Behavior identification assessment	Initial assessment by BCBA
97152	Behavior identification – administered by technician	Data collection under BCBA supervision
97153	Adaptive behavior treatment, by technician (per 15 min)	Direct one-on-one therapy
97154	Group adaptive behavior treatment, by technician (per 15 min)	Group ABA therapy sessions
97155	Adaptive behavior treatment with protocol modification, by BCBA (per 15 min)	Treatment plan adjustments
97156	Family adaptive behavior treatment guidance (per 15 min)	Parent/caregiver training
97157	Multiple-family group adaptive behavior guidance (per 15 min)	Group parent training
97158	Group adaptive behavior treatment with protocol modification, by BCBA (per 15 min)	BCBA-led group session
0362T	Behavior identification supporting assessment (per 15 min, 2+ techs)	Complex assessments
0373T	Adaptive behavior treatment (per 15 min, 2+ techs)	Intensive interventions

2. ICD-10 Codes Used in ABA Therapy Billing

ICD-10 Code	Description
F84.0	Autistic disorder
F84.5	Asperger’s syndrome
F84.9	Pervasive developmental disorder, unspecified
F88	Other disorders of psychological development
F89	Unspecified disorder of psychological development
R62.50	Unspecified developmental disorder of childhood
F90.2	Attention deficit disorder with hyperactivity, combined type

3. Place of Service (POS) Codes for ABA Therapy

POS Code	Location	Notes
11	Office	ABA clinic sessions
12	Home	Home-based ABA therapy
02	Telehealth (synchronous)	Live ABA telehealth sessions
10	Telehealth (patient’s home)	Client’s home-based telehealth
99	Other	Non-traditional settings, as payer allows

4. Modifiers Used in ABA Billing

Modifier	Meaning	Use Case
HO	Master’s level clinician	BCBA-led sessions
HM	Less than bachelor’s level	RBT sessions
HN	Bachelor’s level clinician	BCaBA services
U1–U9	State-specific Medicaid modifiers	Varies by state payer
95	Telehealth services	Synchronous video sessions
GT	Telehealth via interactive audio/video	Legacy telehealth usage

State-Specific Payer Variations in ABA Therapy Billing

Insurance coverage and payer rules for ABA therapy vary significantly from state to state. Below is a table summarizing Medicaid, top commercial payers, and key details across different states.

State	Key Medicaid Program	Top Commercial Payers Covering ABA	Special Notes
California (CA)	Medi-Cal (through MCOs like LA Care, Blue Shield Promise)	Anthem Blue Cross, Blue Shield of CA, Kaiser, Aetna	Medi-Cal requires treatment authorization requests (TARs). Strict documentation of goals, progress reports every 6 months. POS 12 (home), POS 02 (telehealth) rules apply.
Florida (FL)	Florida Medicaid (Sunshine Health, Simply Healthcare, Humana Healthy Horizons)	Florida Blue, Cigna, Aetna, UnitedHealthcare	PAs required for almost all ABA codes. Denials common for RBT direct service if not linked to BCBA plan. Medicaid requires specific behavior reduction vs skill acquisition goals.
Texas (TX)	Texas Medicaid (TMHP, Superior Health, Amerigroup, UnitedHealthcare Community Plan)	BCBS TX, UnitedHealthcare, Aetna, Humana	PA required every 6 months with updated treatment plan. Medicaid enforces RBT billing under supervising BCBA NPI. Telehealth coverage limited.
New York (NY)	NY Medicaid (Fidelis, Healthfirst, Emblem)	EmblemHealth, Empire BCBS, UnitedHealthcare, Aetna	Must use ICD-10 F84.0 (Autism). Progress reports required every 90 days. Medicaid does not cover school-based ABA unless through IEP contracts.
Illinois (IL)	Illinois Medicaid (Meridian, Blue Cross Medicaid)	BCBS IL, Molina, Aetna Better Health	BCBS IL requires detailed time logs with start/stop times. Medicaid requires prior diagnosis by licensed psychologist or physician.
Massachusetts (MA)	MassHealth	Harvard Pilgrim, Tufts Health, BCBS MA	One of the most ABA-friendly states. Telehealth ABA covered. Requires Board Certified providers. Claims often denied for missing session notes.
New Jersey (NJ)	NJ FamilyCare	Horizon BCBS, AmeriHealth, Aetna	Requires treatment plan signed by BCBA + physician. Medicaid covers ABA only for ASD diagnosis. Telehealth ABA partially covered.
Arizona (AZ)	AHCCCS Medicaid	UnitedHealthcare, Mercy Care, BCBS AZ	Strict progress reporting. PA required for RBT billing over 20 hrs/week. Home-based ABA has extra documentation requirements.
Pennsylvania (PA)	PA Medical Assistance (HealthChoices)	UPMC, Highmark, Aetna, Keystone First	Intensive Behavioral Health Services (IBHS) rules apply. Claims denied if not linked to formal written order by psychologist/physician.
Michigan (MI)	Michigan Medicaid (MHP, Meridian, Molina)	Priority Health, BCBS MI, Aetna	Medicaid requires a physician order. Strict limits on service hours unless medical necessity is proven.
Georgia (GA)	GA Medicaid (Peach State, Amerigroup)	Anthem, Cigna, UHC, Aetna	Medicaid requires Comprehensive Diagnostic Evaluation by licensed psychologist. Annual reauthorization mandatory.

Compliance & Documentation in ABA Therapy Billing

Compliance is the cornerstone of successful ABA therapy billing. Failure to maintain compliance can lead to claim denials, audits, overpayments, recoupments, or even fraud investigations. That is why ABA practices need to comply with strict documentation, coding precision, and adherence to payer regulations.

Requirement	What It Means	Why It Matters
Prior Authorization	Approval from payers before therapy sessions can begin.	Without it, claims are denied regardless of clinical necessity.
Treatment Plans	Written and updated every 6 months (or per payer rules) by a BCBA.	Demonstrates ongoing medical necessity.
Progress Notes	RBTs and BCBAs must document goals, interventions, and outcomes after every session.	Supports time-based CPT codes and prevents denials.
Supervision Documentation	Payers often require proof of BCBA supervision of RBTs.	Ensures compliance with payer and state licensure rules.
Telehealth Rules	Some states/payers allow telehealth ABA, others restrict it.	Incorrect POS/Modifier leads to rejected claims.
Session Limits	Medicaid and commercial payers may limit daily/weekly ABA hours.	Overbilling triggers red flags and audits.
Provider Credentials	Must be credentialed and enrolled with payers (including Medicaid).	Non-credentialed claims are automatically denied.
HIPAA Compliance	Secure handling of PHI in notes, claims, and communication.	Protects providers from penalties and lawsuits.

How We Help Providers Stay Compliant

✅ Authorization Management – We track authorizations, submit renewals timely and prevent coverage gaps.
✅ Documentation Support – Templates and training for SOAP notes, treatment plans, and BCBA supervision logs.
✅ Coding & Modifier Accuracy – We apply correct CPT, POS, and modifier combinations across all payers and states.
✅ Audit-Ready Records – Our billing system maintains detailed documentation for every claim to withstand payer audits.
✅ State & Payer Updates – We monitor regulatory changes and payer policy updates regularly to maintain accuracy and compliance.

State & Payer Variations in ABA Therapy Billing Compliance

Compliance Challenge	State / Payer Specific	How MedStates Resolves It
Prior Authorizations (PAs)	California Medi-Cal requires new PA every 6 months, even if treatment is ongoing.	We track PA expiration dates, submit renewals in advance, and prevent service interruptions.
Treatment Plan Signatures	Texas Medicaid mandates treatment plans to be signed by a licensed BCBA and a supervising physician in some MCOs.	We ensure all plans include proper signatures and meet both BCBA and physician attestation requirements.
Parent/Caregiver Participation	Florida Medicaid requires documentation that parents are present in training and generalization sessions.	We guide providers on including caregiver participation notes in progress documentation.
Supervision Requirements	TRICARE requires RBT sessions to have ongoing BCBA supervision notes logged in the medical record.	We help maintain compliant supervision logs, attach them to claims when needed, and prevent denials.
Time-Based CPT Coding	New York Medicaid demands session notes clearly reflect start/stop times for each 15-min unit billed.	Our billing process enforces time tracking documentation, cross-checking against CPT increments before claim submission.
Service Limits	Illinois Medicaid caps ABA hours per week unless a medical necessity exception is filed.	We submit exception requests with supporting clinical documentation when higher service levels are justified.
Telehealth Restrictions	Georgia Medicaid allows telehealth for ABA, but not for initial evaluations (97151).	We configure telehealth billing rules to block codes not payable via telehealth in Georgia.
Audit Triggers	Commercial insurers (Aetna, BCBS) often audit ABA claims for duplicate billing across multiple children in group settings.	We run claim scrubs to detect overlaps and maintain audit-ready notes for group services (97154).
Documentation Retention	Arizona Medicaid (AHCCCS) requires progress notes and treatment plans be kept for 7 years for compliance.	We help practices archive and organize ABA records, ensuring full retention compliance.

Benefits of Outsourcing to ABA Therapy Billing Agency

1. Faster Claim Approvals

Our ABA billing specialists use claim scrubbing tools and payer-specific knowledge to submit clean claims the first time, cutting down approval delays.
Faster reimbursements mean consistent cash flow for your practice.

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2. Lower Denial Rates

ABA claims often face denials for documentation errors, modifier misuse, or incorrect POS codes.
We implement payer-specific denial prevention strategies and conduct audits to reduce rejections by up to 40%.

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3. Expert Navigation of Payer Rules

Every state and payer (Medicaid, Blue Cross, UnitedHealthcare, etc.) has unique ABA coverage rules.
Our billing team tracks state Medicaid manuals, prior authorization requirements, and commercial payer guidelines, ensuring your claims comply.

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4. Scalable Support for Practices of All Sizes

Whether you are a solo BCBA, mid-size group, or multi-state ABA therapy center, our billing solutions are customized to meet your practice requirements.
Flexible support for in-house billing staff or fully outsourced revenue cycle management (RCM).

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5. Clear Reporting & Predictable Cash Flow

Detailed financial dashboards with denial trends, collection rates, and reimbursement timelines.
Providers gain visibility into net collection ratios, payer mix analysis, and aging reports for informed decision-making.

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Why Choose Medstates ABA Therapy Billing Company

When it comes to ABA therapy billing, you need more than just a billing vendor, you need a company who understands the unique complexities of behavioral health billing. Our ABA-specific billing specialties are trained with variations of CPT codes, modifiers, payer rules, and prior authorization requirements. Moreover, we provide nationwide coverage with state-specific expertise across the U.S. from Florida Medicaid to California commercial plans, and comply with industry regulations for accurate ABA therapy reimbursement. We maintain up-to-date payer lists, authorization protocols, and compliance requirements for all 50 states, ensuring you never miss a claim due to state-specific differences. Our ABA therapy billing is not limited to submission of claims, we specialize in revenue cycle management from eligibility & benefits verification for ABA coverage, prior authorization management to avoid delays, claim scrubbing to reduce rejections, payment posting & denial management, provider credentialing & enrollment with Medicaid and commercial plans. Whether you are a solo BCBA, a small ABA therapy practice, or a large multi-site ABA therapy center, our solutions are customized with your needs. We adjust services based on your needs so you only pay for what you use. Lastly, we believe in clear, honest pricing—no hidden fees, no surprises. Plus, you will receive customized financial reports monthly that show claim turnaround, denial trends, and revenue performance.

Ready to maximize your ABA billing revenue? Schedule a Free consultation today to discuss how we can add value to your ABA therapy practice.

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Frequently Asked Questions

Which CPT codes are used in ABA billing?

CPT codes include CPT 97151 for assessment, CPT 97153 for direct therapy, CPT 97155 for supervision, CPT 97156 for family training, and CPT 97158 for group therapy.

Do all states cover ABA therapy under Medicaid?

No. While many states mandate ABA coverage under Medicaid and commercial plans, however, coverage rules, age limits, and authorization requirements vary by state.

What documentation is required for ABA claims?

Typically required documentation includes treatment plans, progress notes, session notes, supervisor reports, and parent/caregiver involvement records.

Can telehealth ABA sessions be billed?

Yes, many payers cover telehealth ABA sessions, but rules differ by state and payer. Proper POS codes, modifiers and authorization must be applied for reimbursement.

How long does it take to get reimbursed for ABA services?

On average, 14–30 days depending on payer and claim accuracy.

Why are ABA therapy claims often denied?

Common denial reasons include incorrect CPT coding, missing modifier, insufficient documentation, lack of prior authorization and payer-specific coverage rules