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Applied Behavior Analysis (ABA) therapy plays a vital role in improving the lives of individuals with Autism Spectrum Disorder (ASD), developmental disabilities, and behavioral health challenges. However, as the demand for ABA therapy grows nationwide, so do the challenges of managing ABA therapy billing efficiently and compliantly. Unlike general mental or behavioral health billing, ABA billing services require specialized expertise, precise documentation, prior authorizations, and correct use of time-based CPT codes such as 97151, 97153, 97154, and 97155. Providers must also maintain compliance with both commercial insurance and Medicaid requirements to ensure proper reimbursement. That is where MedStates, a trusted ABA billing company, steps in to simplify the process. Our team specializes in autism therapy billing and comprehensive ABA revenue cycle management, helping practices reduce denials and improve cash flow. Whether you’re a solo BCBA or manage a growing clinic, our team streamlines the complex world of ABA insurance billing across multiple payers and states
At MedStates, we offer complete, end-to-end ABA billing services designed for:
Board Certified Behavior Analysts (BCBAs)
Registered Behavior Technicians (RBTs)
ABA therapy practices and clinics
Multi-state behavioral health organizations
Our experienced billing specialists ensure every claim meets payer-specific ABA billing requirements. We help ABA providers:
Conduct eligibility and benefits verification before therapy sessions.
Manage prior authorizations to prevent costly denials.
Accurately code and bill claims using ABA billing CPT codes, ICD-10 codes, and modifiers.
Stay compliant with Medicaid, TRICARE, and commercial payer policies.
Maximize reimbursements through clean claim submission, denial management, and transparent patient billing support
At MedStates, we believe ABA billing is not just a service — it’s a partnership. Our specialized approach creates a win-win scenario for providers and families alike. As a trusted autism billing company, MedStates empowers ABA therapy providers across the U.S. — from New York to California — to focus on patient outcomes while we handle the billing complexities.
Billing for ABA therapy services is far more complex than standard behavioral health or medical billing. While both fall under the healthcare revenue cycle, ABA billing services follow distinct rules, documentation guidelines, and payer requirements that make them one of the most detailed specialties in the industry. This complexity is what makes understanding ABA billing is crucial for every provider. Here’s what sets ABA therapy billing apart from general medical billing
Applied Behavior Analysis (ABA) therapy uses time-based CPT and HCPCS codes to represent each stage of assessment, treatment, and supervision. Common ABA billing codes include 97151 – 97158, and Category III codes 0362T and 0373T, covering assessments, technician services, and BCBA-led supervision.
Unlike standard psychotherapy codes, these ABA billing and coding procedures differ based on whether services are provided by a Board Certified Behavior Analyst (BCBA), a Registered Behavior Technician (RBT), or under supervision. Using the correct ABA billing CPT codes and corresponding modifiers is essential for accurate, on-time reimbursement
ABA therapy relies on 15-minute time-based billing units, which adds another layer of complexity to the ABA billing cycle. For example, CPT 97153 (adaptive behavior treatment by RBT) is often paired with CPT 97155 (supervision by BCBA).
Precise documentation, proper time tracking, and correct ABA billing modifiers are necessary to prevent payer rejections and maintain clean claims.
This structured approach is what separates billing for ABA therapy from broader behavioral health billing, where session-based codes are common
Most major payers — including Blue Cross Blue Shield (BCBS), UnitedHealthcare (Optum), Aetna, Cigna, Anthem, Humana, Kaiser Permanente, Magellan, and TRICARE — require prior authorization before ABA therapy begins. Providers must submit supporting documentation, such as:
A confirmed autism diagnosis (DSM-5 F84.0)
BCBA-authored treatment plans with measurable goals
Updated progress reports for re-authorization
Failure to manage prior authorizations or renewals in time is one of the most common causes of ABA billing rejections and claim denials. Partnering with an experienced ABA billing company like MedStates helps reduce these errors and streamline approvals
Because ABA therapy can involve intensive, ongoing treatment, payers closely monitor medical necessity. To remain compliant, providers must:
Use accurate DSM-5 diagnosis codes
Document measurable goals and skill development progress
Maintain BCBA supervision notes and family training logs
Following ABA billing guidelines ensures that every claim meets payer standards and audit requirements. A professional ABA insurance billing team validates these details before submission to safeguard reimbursement
Medicaid coverage for ABA therapy is not uniform across the U.S. Each state has its own rules and limitations.
In California, Medi-Cal funds ABA services under 21 through managed care plans like LA Care and Blue Shield Promise. Strict documentation and progress reports are required every six months.
In Florida, SMMC (Sunshine Health, Humana Healthy Horizons, etc.) mandates frequent re-authorizations and proof of caregiver participation.
In Texas, the Medicaid Comprehensive Care Program (CCP) enforces specific BCBA and physician signature requirements.
Because rules differ by region, ABA billing companies offering multi-state support — like MedStates — help ABA providers stay current with BCBS ABA billing guidelines, state-specific Medicaid rules, and payer audit requirements. This localized expertise ensures compliance and consistent reimbursement for providers delivering services across different states
Due to the high cost and frequency of ABA sessions, payers often conduct pre-payment and post-payment audits. Insurers may request copies of treatment plans, session notes, and measurable outcomes to verify compliance.
Even minor errors — such as incomplete time logs or unsigned supervision notes — can delay payment or cause recoupments. Moreover, payer credentialing and re-credentialing add another administrative layer, especially for ABA providers working with Medicaid and TRICARE.
MedStates’ ABA billing specialists manage these processes end-to-end — keeping practices audit-ready, compliant, and aligned with commercial payer requirements. Our experience helps minimize disruptions, maintain consistent cash flow, and support providers through every stage of the ABA billing cycle
Managing ABA therapy billing requires far more than just submitting claims — it requires a trusted partner who understands autism therapy billing codes, Medicaid compliance, payer-specific policies, and documentation requirements. At MedStates, we deliver comprehensive, end-to-end ABA billing services designed for Board Certified Behavior Analysts (BCBAs), Registered Behavior Technicians (RBTs), ABA therapy clinics, and multi-state behavioral health organizations. Our approach combines human expertise with advanced ABA therapy billing software, ensuring accuracy, transparency, and faster payments across every payer. When providers search for leading ABA billing companies near me, MedStates appears on the top as best ABA therapy billing company to support your entire ABA revenue cycle management — from eligibility verification to denial prevention
Before any ABA session begins, our team conducts full ABA eligibility and benefits verification to confirm patient coverage limits, deductibles, copays, and CPT codes allowed for ABA services. This proactive step helps ABA billing providers avoid reimbursement issues and treatment interruptions.
We manage every step of the ABA insurance billing prior authorization process. Our billing specialists handle treatment plans, updated progress reports, and required autism documentation for major payers, ensuring uninterrupted care and timely approvals for ABA billing for clinics and group practices
Our certified ABA billing coders apply all relevant CPT codes (97151 – 97158, 0362T, 0373T) and ICD-10 codes (e.g., F84.0, F84.5, F88). We ensure each claim uses the correct modifiers, time units, and staff-based billing codes to achieve maximum accuracy and faster reimbursements.
Our certified ABA billing coders apply all relevant CPT codes (97151 – 97158, 0362T, 0373T) and ICD-10 codes (F84.0, F84.5, F88) accurately. Using billing software with ABA coding support, we ensure every claim includes correct modifiers, time units, and staff-based billing identifiers.
Given the strict scrutiny of ABA claims, compliance is non-negotiable. MedStates maintains accurate session notes, supervision logs, and progress reports to keep your practice audit-ready. Our autism revenue cycle management services include payer audit support, helping clinics remain compliant payer guidelines.
We provide monthly reports. These insights empower ABA practices to optimize their operations and improve financial predictability. Whether you are an independent BCBA or managing multiple clinics, our ABA reimbursement services and full RCM support help you grow sustainably.
By outsourcing ABA therapy billing to us, you save time, energy, claim denials, and expect a more predictable cash flow
Accurate medical coding is at the core of successful ABA therapy billing. Because ABA services involve time-based sessions and multiple provider roles (BCBA, RBT, BCaBA), proper use of CPT codes, ICD-10 codes, Place of Service (POS) codes, and modifiers ensures clean claim submission and faster reimbursements. Below is a detailed ABA billing codes reference guide for medical billers, behavioral health providers, and autism therapy clinics
These ABA billing CPT codes are used to describe different stages of assessment and treatment. Using the right code improves claim accuracy and prevents underpayment or denials.
| CPT Code | Description | When to Use |
|---|---|---|
| CPT 97151 | Behavior identification assessment | Initial assessment by BCBA |
| CPT 97152 | Behavior identification – administered by technician | Data collection under BCBA supervision |
| CPT 97153 | Adaptive behavior treatment, by technician (per 15 min) | Direct one-on-one therapy |
| CPT 97154 | Group adaptive behavior treatment, by technician (per 15 min) | Group ABA therapy sessions |
| CPT 97155 | Adaptive behavior treatment with protocol modification, by BCBA (per 15 min) | Treatment plan adjustments |
| CPT 97156 | Family adaptive behavior treatment guidance (per 15 min) | Parent/caregiver training |
| CPT 97157 | Multiple-family group adaptive behavior guidance (per 15 min) | Group parent training |
| CPT 97158 | Group adaptive behavior treatment with protocol modification, by BCBA (per 15 min) | BCBA-led group session |
| CPT 0362T | Behavior identification supporting assessment (per 15 min, 2+ techs) | Complex assessments |
| CPT 0373T | Adaptive behavior treatment (per 15 min, 2+ techs) | Intensive interventions |
Correct diagnosis coding ensures payers recognize medical necessity for ABA services. These ICD-10 codes are most frequently used for autism and developmental disorders
| ICD-10 Code | Description |
|---|---|
| ICD F84.0 | Autistic disorder |
| ICD F84.5 | Asperger’s syndrome |
| ICD F84.9 | Pervasive developmental disorder, unspecified |
| ICD F88 | Other disorders of psychological development |
| ICD F89 | Unspecified disorder of psychological development |
| ICD R62.50 | Unspecified developmental disorder of childhood |
| ICD F90.2 | Attention deficit disorder with hyperactivity, combined type |
Accurate Place of Service (POS) coding is essential for clean claim submission in ABA therapy billing. Most ABA sessions occur in clinical, home, or telehealth settings — each requiring the correct POS code to ensure compliance and full reimbursement. For a detailed explanation of each POS code, including POS 02, POS 10, and how they apply to tele ABA sessions, visit our complete guide on Place of Service (POS) Codes in Mental Health Billing.
Accurate use of modifiers is vital for clean claim submission in ABA therapy billing — especially since billing often depends on the clinician’s role (BCBA, BCaBA, or RBT) and service type (in-person or telehealth). Modifiers clarify the provider level and service method to payers, ensuring proper reimbursement and compliance with Medicaid and commercial payer guidelines. To learn more about the full list of behavioral health and telehealth billing modifiers, including HO, HN, HM, and 95, refer to our detailed guide Modifiers in Mental Health Billing
Compliance is the foundation of successful ABA therapy billing. Even the smallest documentation error can lead to claim denials, payer audits, overpayment recoveries, or fraud investigations. For ABA providers, maintaining compliance means following payer-specific documentation, credentialing, and coding standards across all states and payers. Below are the key ABA billing compliance requirements and why they matter
| 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. |
At MedStates, we build compliance into every stage of the ABA billing process, ensuring accuracy, transparency, and full regulatory alignment for every ABA billing provider. Our approach combines automation, expert review, and payer-specific policy tracking to prevent errors and improve ABA therapy reimbursement outcomes.
✅ Authorization Management: We manage ABA insurance billing authorizations for major payers including Medicaid and TRICARE. Our specialists track approvals, handle renewals, and prevent coverage gaps. With expertise in ABA billing Medicaid rules and TRICARE ABA billing requirements, we help providers stay compliant across multiple payer types.
✅ Documentation Support: We provide structured templates and compliance guidelines for SOAP notes, session documentation, and BCBA supervision logs. These records help prevent ABA billing rejections due to missing details or incomplete progress notes.
✅ Coding and Modifier Accuracy:
Our team ensures every claim includes proper ABA billing codes and modifiers, combining CPT, ICD-10, POS, and ABA billing modifiers based on payer-specific criteria. Correct coding eliminates underpayment risk and supports successful audits.
✅ Audit-Ready Records:
Every claim we submit is backed by a complete documentation trail — session notes, treatment plans, and authorization approvals — ensuring readiness for payer audits or recertifications. Our ABA denial management specialists also review historical denials to identify and correct root causes.
✅ Real-Time Compliance Updates:
We continuously monitor changes in Medicaid, TRICARE, and commercial payer regulations. This allows our ABA billing companies to keep every client fully aligned with updated coding and documentation requirements, reducing denials and maintaining audit readiness.
Compliance is not optional — it’s a safeguard for your ABA practice. Partnering with a specialized ABA billing company like MedStates helps ensure that your claims meet every documentation, credentialing, and payer-specific requirement — protecting your revenue and reputation. We handle the administrative complexity so you can stay focused on patient outcomes and therapy quality.
Insurance coverage and payer rules for ABA therapy differ widely across states. Each Medicaid program and commercial insurance plan enforces unique authorization, documentation, and reimbursement policies. At MedStates, we stay current with every state’s evolving ABA billing regulations to help providers stay compliant, minimize denials, and secure timely payments. Below is a summary of major state-specific payer variations affecting ABA therapy reimbursement:
| 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. |
When it comes to ABA therapy billing, you need more than a vendor — you need a trusted ABA billing company that understands the complexities of ABA reimbursement. At MedStates, our team of certified specialists brings together payer-specific expertise, accurate coding, and compliance precision to help ABA providers reduce denials, resolve ABA billing rejections, and accelerate ABA therapy reimbursement while staying aligned with Medicaid and commercial payer regulations.
Nationwide Coverage with Local Expertise
MedStates delivers ABA billing services for providers in all 50 states. From Florida Medicaid ABA coverage rules to California ABA billing documentation requirements and BCBS ABA billing guidelines, our experts stay current on every payer’s protocols. We also assist with regional programs such as ABA billing NY, ensuring accurate submission, modifier compliance, and first-pass claim approvals across state lines.
Beyond Claim Submission — Full ABA Revenue Cycle Management
Our solutions go beyond simple claim submission. MedStates offers complete ABA revenue cycle management — including eligibility and benefits verification, prior authorization management, claim scrubbing, payment posting, and ABA denial management. We also support ABA billing outsourcing for clinics that prefer to delegate their full ABA billing cycle to an experienced partner. Whether you are a solo BCBA, a small practice, or a multi-site organization, our flexible model ensures scalability and transparency. We may not be offering cheap ABA therapy billing services, but we do offer best ABA therapy billing.
Practice Management and Credentialing Support
As part of our ABA practice management billing solutions, we handle provider credentialing and payer enrollment for both Medicaid and commercial insurance plans. Our team’s knowledge of authorization workflows and payer database maintenance helps minimize administrative burden and maximize claim acceptance rates.
Transparent Reporting and Reliable Results
Every MedStates client receives customized monthly financial reports that detail turnaround times, denial trends, and payer patterns. These insights give ABA clinics predictable cash flow and full financial visibility. Clear pricing — no hidden fees, no long-term contracts — makes MedStates one of the most trusted ABA billing companies and ABA billing services near me for ABA health practices.
Technology, Integrity, and Experience
Our billing experts are trained in the nuances of CPT and ICD-10 coding, state Medicaid rules, and commercial payer requirements. We operate under strict HIPAA compliance and maintain audit-ready workflows. Most importantly, our technology-driven processes shorten payment timelines and improve reimbursement consistency nationwide.
Partner with MedStates Today
When you partner with MedStates, you gain a team focused on your practice’s long-term success. We handle every administrative and payer challenge so you can focus on client care.
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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