California Medicaid ABA Reimbursement Rates (2026)
From official California Medicaid sources. Updated July 2026.
These are the published California Medicaid rates for applied behavior analysis (ABA) services. Rates are shown as published. For per-15-minute rows, multiply by 4 for the hourly rate; rows priced per hour, per session, or per assessment are labeled in the table.
California ABA Fee Schedule
| Code | Service | Rate | Unit | Effective | Source |
|---|---|---|---|---|---|
| 97151 | Behavior identification assessment — QAS Provider (BCBA/licensed) | $40.81 | per 15 min | 2025-07-01 | source |
| 97153 | Adaptive behavior treatment by protocol — QAS Paraprofessional (technician) | $19.39 | per 15 min | 2025-07-01 | source |
| 97155 | Adaptive behavior treatment w/ protocol modification — QAS Provider | $40.81 | per 15 min | 2025-07-01 | source |
| 97156 | Family adaptive behavior treatment guidance — QAS Provider | $40.81 | per 15 min | 2025-07-01 | source |
How California Compares
| Code | California | National median | Difference |
|---|---|---|---|
| 97151 | $40.81 | $29.14 | 40% above national median |
| 97153 | $19.39 | $15.00 | 29% above national median |
| 97155 | $40.81 | $24.18 | 69% above national median |
| 97156 | $40.81 | $22.50 | 81% above national median |
Market Context
California has had an autism insurance mandate since 2017. About 4,835,377 children in California are enrolled in Medicaid. Autism prevalence is 4.4% (2022 data). ProviderSpark lists 801 verified ABA provider locations in California.
Getting Paneled with Medi-Cal
Medi-Cal enrollment for ABA runs through a program called QAS (Qualified Autism Service), with one quirk that trips up new applicants: even a solo BCBA has to apply as an organization, not an individual.
- Confirm you qualify as a QAS Provider — a BCBA, or a licensed practitioner with 12 semester units in ABA plus 2 years of experience. Only QAS Providers formally enroll; staff under them aren’t individually enrolled.
- Get an NPI through NPPES — Type 1 for sole proprietors, Type 2 for a corporation or LLC.
- Apply in DHCS’s PAVE portal. Don’t select “Individual” or “Group” — per DHCS’s guidance, every applicant, including solo practices, must select “I’m a healthcare business.”
- Attest that every staff member you’ll bill under meets the state’s qualification and supervision rules, subject to audit.
- Submit and wait. State law gives DHCS up to 180 days to act; miss it and you may get provisional status. Approval arrives as a letter in PAVE.
How California Delivers ABA
Medi-Cal pays for BHT/ABA through two tracks, and which one your client is on affects who cuts the check. Members in managed care go through a plan that varies by county under the 2-Plan, GMC, or COHS models — Anthem Blue Cross, Health Net, Molina, Kaiser, L.A. Care, Blue Shield of CA Promise, and County Organized Health System plans all appear, but DHCS doesn’t publish one master list by county, so check the Managed Care Health Plan Directory directly. Members outside managed care go through fee-for-service, via their local Regional Center or, since July 1, 2025, directly through an enrolled FFS QAS Provider. Your rate depends on which track and plan your client is assigned to.
Billing Notes
No prior authorization is needed for the initial BHT assessment or treatment plan. Authorization kicks in only when you continue or modify services after the QAS Provider’s periodic review, required at least every 6 months. Under managed care, All Plan Letter 23-010 requires MCPs to disclose denial criteria, bans blanket hour caps, and forbids limiting BHT just because a child is in school — every denial is a case-by-case call.
Telehealth is reimbursable under Medi-Cal’s general policy, including synchronous video and audio-only, and the BHT manual allows delivery on-site at school or during remote school sessions. No document spells out a BHT-specific telehealth rule for CPT codes 97151-97158, so confirm current-year rules against DHCS’s Telehealth Modifier Reference Sheet.
One quirk: S5110 (home care training, per 15 minutes) and S5111 (per session) can’t both be billed for the same member on the same date. QAS Providers don’t individually enroll their staff, but must keep an internal, audit-ready roster of everyone billing under their number — a common compliance gap DHCS flags providers on.
Common Questions
What does California Medicaid pay for CPT 97153?
California Medicaid pays $19.39 per 15 minutes for 97153 (direct treatment by a technician). That is about $77.56 per hour.
What are the main ABA CPT codes?
97151 is the assessment. 97153 is direct treatment by a technician. 97155 is treatment with protocol modification by the BCBA. 97156 is family guidance.
Are these California rates current?
Rates come from the state fee schedule and were last checked July 2026. Each row links to its source. Always confirm against the current fee schedule before billing.
Compare neighboring states: Nevada · Arizona · Oregon