Delaware Medicaid ABA Reimbursement Rates (2026)
From official Delaware Medicaid sources. Updated July 2026.
These are the published Delaware 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.
Delaware ABA Fee Schedule
| Code | Service | Rate | Unit | Effective | Source |
|---|---|---|---|---|---|
| 97151 (HN) | Behavior identification assessment — bachelor’s level Same rate as HP/HO tiers. | $43.76 | per 15 min | 2022-11-01 | source |
| 97151 (HO) | Behavior identification assessment — master’s level (BCBA) Stored row had no modifier, $26.00, eff 2022-01-01 — wrong. DE prices 97151 only with HP/HO/HN modifiers; all tiers $43.76/15 min on the official 11/1/2022 ABA fee schedule. | $43.76 | per 15 min | 2022-11-01 | source |
| 97151 (HP) | Behavior identification assessment — doctoral level Same rate as HO/HN tiers. | $43.76 | per 15 min | 2022-11-01 | source |
| 97152 (HN) | Behavior identification supporting assessment by technician — bachelor’s level | $43.76 | per 15 min | 2022-11-01 | source |
| 97152 (HO) | Behavior identification supporting assessment by technician — master’s level | $43.76 | per 15 min | 2022-11-01 | source |
| 97152 (HP) | Behavior identification supporting assessment by technician — doctoral level All three tiers priced identically. | $43.76 | per 15 min | 2022-11-01 | source |
| 97153 | Adaptive behavior treatment by protocol (technician) — base/no modifier Stored $13.50 eff 2022-01-01 was wrong. $15.68 on 11/1/2022 ABA schedule; identical rate repeated on Jan 1, 2026 Physician Fee Schedule. | $15.68 | per 15 min | 2022-11-01 | source |
| 97153 (HN) | Adaptive behavior treatment by protocol — bachelor’s level (BCaBA) | $21.34 | per 15 min | 2022-11-01 | source |
| 97153 (HO) | Adaptive behavior treatment by protocol — master’s level (BCBA) | $31.25 | per 15 min | 2022-11-01 | source |
| 97153 (HP) | Adaptive behavior treatment by protocol — doctoral level | $31.82 | per 15 min | 2022-11-01 | source |
| 97155 | Adaptive behavior treatment with protocol modification — base/no modifier Stored $21.50 eff 2022-01-01 was wrong. $17.66 on 11/1/2022 ABA schedule; identical rate repeated on Jan 1, 2026 Physician Fee Schedule. | $17.66 | per 15 min | 2022-11-01 | source |
| 97155 (HN) | Adaptive behavior treatment with protocol modification — bachelor’s level (BCaBA) | $26.31 | per 15 min | 2022-11-01 | source |
| 97155 (HO) | Adaptive behavior treatment with protocol modification — master’s level (BCBA) | $35.19 | per 15 min | 2022-11-01 | source |
| 97155 (HP) | Adaptive behavior treatment with protocol modification — doctoral level | $36.55 | per 15 min | 2022-11-01 | source |
| 97156 | Family adaptive behavior treatment guidance — base/no modifier HP, HO, and HN modifier rows also published, all at the same $31.25; base row kept as canonical since rate does not vary by tier. Rate reconfirmed on Jan 1, 2026 Physician Fee Schedule. | $31.25 | per 15 min | 2022-11-01 | source |
How Delaware Compares
| Code | Delaware | National median | Difference |
|---|---|---|---|
| 97151 (HO) | $43.76 | $29.14 | 50% above national median |
| 97153 | $15.68 | $15.00 | 5% above national median |
| 97155 | $17.66 | $24.18 | 27% below national median |
| 97156 | $31.25 | $22.50 | 39% above national median |
Market Context
Delaware has had an autism insurance mandate since 2011. About 107,720 children in Delaware are enrolled in Medicaid. Autism prevalence is 3.5% (2022 data). ProviderSpark lists 22 verified ABA provider locations in Delaware.
Getting Paneled with Delaware Medical Assistance Program (DMAP), delivered through the Diamond State Health Plan (DSHP), a Section 1115 managed-care demonstration extended by CMS through 12/31/2028
Enrollment runs through Delaware’s Gainwell Technologies portal before you can contract with any individual MCO:
- Gather your Provider Name, NPI, Taxonomy, Tax ID (individuals use SSN, not a business FEIN), license(s), addresses, disclosure information, DOB, Tax ID letter, and CMS/PECOS approval letter — see the How-To Enrollment Guide for Fee-For-Service Providers.
- Go to the Delaware Medical Assistance Portal and open the Provider Portal.
- Click Provider Enrollment.
- Select Enrollment Application to start a new FFS application (a separate “MCO-Only Registration” enrollment type exists if you’re only enrolling with an MCO). Complete provider screening, the taxonomy/NPI search, addresses, disclosures, and EFT/ERA setup, then save your Application Tracking Number (ATN) and password.
- Once DMAP enrollment and screening are complete, credential and contract separately with each MCO you want to bill — AmeriHealth Caritas Delaware, Highmark Health Options, or Delaware First Health.
How Delaware Delivers ABA
Delaware runs a hybrid model. DMAP enrollment is the base layer, but most members are assigned to one of three managed-care organizations: AmeriHealth Caritas Delaware, Highmark Health Options, and Delaware First Health. Because each MCO credentials and contracts separately, the rate you’re actually paid depends on which MCO the client is enrolled with — DMAP enrollment alone doesn’t guarantee you’re in-network with all three. Budget for three separate credentialing processes if you want to see the full Medicaid-eligible population in Delaware.
Billing Notes
ABA services require prior authorization. This is confirmed for AmeriHealth Caritas Delaware, which caps pediatric (under-18) ABA at 30 units per calendar year. Once a member exhausts that cap, further prior authorization and payment shifts away from the MCO to the state’s Division of Developmental Disabilities Services (DDDS) directly — a two-track billing relationship you need to track mid-year. Whether Highmark Health Options and Delaware First Health apply the same 30-unit cap and DDDS overflow process hasn’t been independently confirmed, so don’t assume it carries over; verify each MCO’s threshold separately.
On telehealth, Delaware Medicaid broadly reimburses telemedicine at parity with in-person care, provided both the originating and distant-site providers are DMAP-enrolled and the distant practitioner is located in the continental US. An ABA-specific telehealth policy or modifier document was not confirmed, so confirm coverage for telehealth ABA directly with the MCO before billing it.
Common Questions
What does Delaware Medicaid pay for CPT 97153?
Delaware Medicaid pays $15.68 per 15 minutes for 97153 (direct treatment by a technician). That is about $62.72 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 Delaware 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: Maryland · Pennsylvania · New Jersey