Arizona Medicaid ABA Reimbursement Rates (2026)
From official Arizona Medicaid sources. Updated July 2026.
These are the published Arizona 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.
Arizona ABA Fee Schedule
| Code | Service | Rate | Unit | Effective | Source |
|---|---|---|---|---|---|
| 97151 | Behavior identification assessment (base rate) Verified exactly in FY26 xlsx; row-level effective date shows 2024-10-01 (rate unchanged from FY25). Home (POS 12) rate is 33.27. | $30.06 | per 15 min | 2025-10-01 | source |
| 97151 (HO) | Behavior identification assessment (HO master’s/BCBA) Verified exactly in FY26 xlsx. Home (POS 12) rate is 39.60. | $35.78 | per 15 min | 2025-10-01 | source |
| 97151 (HP) | Behavior identification assessment (HP doctoral) From FY26 xlsx; home (POS 12) rate 49.50. | $44.73 | per 15 min | 2025-10-01 | source |
| 97152 | Behavior identification supporting assessment by technician (base; HM same rate) From FY26 xlsx; home (POS 12) rate 23.95. | $21.49 | per 15 min | 2025-10-01 | source |
| 97152 (HN) | Behavior identification supporting assessment by technician (HN bachelor’s) HO and HP both pay 28.43 on this code. | $25.58 | per 15 min | 2025-10-01 | source |
| 97152 (HO) | Behavior identification supporting assessment by technician (HO master’s; HP same rate) Home (POS 12) rate 31.71. | $28.43 | per 15 min | 2025-10-01 | source |
| 97153 | Adaptive behavior treatment by protocol, technician (base rate) Verified exactly; HM modifier pays the same 17.91. Home (POS 12) rate is 19.96. | $17.91 | per 15 min | 2025-10-01 | source |
| 97153 (HN) | Adaptive behavior treatment by protocol (HN bachelor’s/BCaBA) Home (POS 12) rate 23.79. | $21.32 | per 15 min | 2025-10-01 | source |
| 97153 (HO) | Adaptive behavior treatment by protocol (HO master’s/BCBA) Verified exactly; HP pays the same 23.69 on this code. Home (POS 12) rate is 26.43. | $23.69 | per 15 min | 2025-10-01 | source |
| 97154 | Group adaptive behavior treatment by technician (base; HM same rate) Priced per participant per 15 min. HN 5.33; HO/HP 5.92. Home (POS 12) base 4.99. | $4.48 | per 15 min | 2025-10-01 | source |
| 97154 (TJ) | Group adaptive behavior treatment by technician (TJ program group modifier) Only new FY26 rate; footnote ‘Last Updated on 6/30/2026 added rate for TJ modifier’. Effective 10/01/2025 per row. | $14.93 | per 15 min | 2025-10-01 | source |
| 97155 | Adaptive behavior treatment w/ protocol modification (base rate) Verified exactly; HN pays the same 25.05. Home (POS 12) rate is 27.72. | $25.05 | per 15 min | 2025-10-01 | source |
| 97155 (HO) | Adaptive behavior treatment w/ protocol modification (HO master’s/BCBA) Verified exactly. Home (POS 12) rate is 33.00. | $29.82 | per 15 min | 2025-10-01 | source |
| 97155 (HP) | Adaptive behavior treatment w/ protocol modification (HP doctoral) Home (POS 12) rate 41.25. | $37.28 | per 15 min | 2025-10-01 | source |
| 97158 | Group adaptive behavior treatment by professional (base rate) Verified exactly; HN pays the same 6.26. Home (POS 12) rate is 6.93. | $6.26 | per 15 min | 2025-10-01 | source |
| 97158 (HO) | Group adaptive behavior treatment by professional (HO master’s/BCBA) HP pays 9.32. Home (POS 12) HO rate 8.25. | $7.46 | per 15 min | 2025-10-01 | source |
How Arizona Compares
| Code | Arizona | National median | Difference |
|---|---|---|---|
| 97151 | $30.06 | $29.14 | 3% above national median |
| 97153 | $17.91 | $15.00 | 19% above national median |
| 97155 | $25.05 | $24.18 | 4% above national median |
Market Context
Arizona has had an autism insurance mandate since 2008. About 751,998 children in Arizona are enrolled in Medicaid. Autism prevalence is 3.5% (2022 data). ProviderSpark lists 182 verified ABA provider locations in Arizona.
Getting Paneled with AHCCCS (Arizona Health Care Cost Containment System) — Arizona’s Medicaid program
Arizona’s enrollment runs through an online portal rather than paper forms. The steps, in order:
- Get an NPI (National Provider Identifier) via NPPES before applying.
- Review AHCCCS’s “Getting Ready to Enroll” prerequisite steps and have your W-9, licenses/certifications, and TIN ready.
- Create an account and complete the Provider Enrollment Application and Provider Participation Agreement in the AHCCCS Provider Enrollment Portal (APEP), which replaced the manual paper process.
- Upload your required licenses/certifications and pay the provider enrollment fee in APEP.
- Once AHCCCS-enrolled, separately credential and contract with each relevant MCO (for example Mercy Care or UnitedHealthcare Community Plan) or with DES/DDD to bill for members assigned to that plan.
How Arizona Delivers ABA
Arizona runs a hybrid delivery model. Most members are assigned to one of six Arizona Complete Care (ACC) managed care organizations — Arizona Complete Health – Complete Care Plan, Banner-University Family Care, Molina Healthcare, Mercy Care, Blue Cross Blue Shield of Arizona Health Choice, or UnitedHealthcare Community Plan — while DES/DDD (Division of Developmental Disabilities) is the primary payer for most autism-diagnosed members receiving ABA. A separate fee-for-service option, the American Indian Health Program (AIHP), covers AI/AN members through IHS, tribal, and urban Indian facilities.
Because ABA routes through either DDD or one of six ACC MCOs depending on the member, you generally need separate credentialing and contracting with each relevant plan plus DDD to avoid network gaps. Whichever plan you bill, the rate itself is set by AHCCCS’s statewide fee schedule and tiered by credential, not negotiated plan-by-plan.
Billing Notes
Prior authorization: AMPM 320-S requires ABA services to follow an individualized treatment plan, developed by the Licensed Behavior Analyst, that specifies dosage, frequency, intensity, and duration, with progress reports at minimum every six months. The policy itself doesn’t set a fixed prior-authorization duration. Adaptive behavior treatment codes (97153-97158) commonly require prior auth from the member’s assigned plan, and at least one plan, Mercy Care, documents issuing authorizations in roughly 6-month increments tied to that progress-report cadence — confirm the exact PA code list and cycle length with the member’s plan.
Telehealth: AMPM 320-S explicitly requires the treatment plan to identify whether services are delivered in person or via telehealth, individually or in group. It’s a recognized, reimbursable modality as long as the treatment plan justifies it.
Billing quirk: reimbursement is tiered by credential using HCPCS modifiers layered on top of the standard ABA CPT code family (97151-97158) — HM for technician/RBT-level, HN for BCaBA-level, HO for BCBA-level, and HP for doctoral-level. For example, CPT 97153 pays $17.91 at HM versus $23.69 at HO/HP per 15-minute unit. Know which modifier applies to each biller on your team before you submit claims.
Common Questions
What does Arizona Medicaid pay for CPT 97153?
Arizona Medicaid pays $17.91 per 15 minutes for 97153 (direct treatment by a technician). That is about $71.64 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 Arizona 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.
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