District of Columbia Medicaid ABA Reimbursement Rates (2026)
From official District of Columbia Medicaid sources. Updated July 2026.
These are the published District of Columbia 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.
District of Columbia ABA Fee Schedule
| Code | Service | Rate | Unit | Effective | Source |
|---|---|---|---|---|---|
| 97153 (TL) | Adaptive behavior treatment by protocol, by technician Verified exactly in DHCF Medical Fee Schedule Report as-of 07/06/2026. Begin date 01/01/2019, no end date. Max 32 units/day. Telehealth (GT+TL, eff 2020-03-18) and audio-only (TL+93, eff 2023-03-21) variants pay the same $27.50. Base 97153 without TL is non-covered. | $27.50 | per 15 min | 2019-01-01 | source |
| 97154 (TL) | Group adaptive behavior treatment by protocol, by technician Priced per 15-min unit (not per participant in the schedule). Max 18 units. GT+TL and TL+93 telehealth variants pay the same rate. | $18.43 | per 15 min | 2021-01-01 | source |
| 97155 (TL) | Adaptive behavior treatment with protocol modification, by QHP/BCBA Verified exactly in DHCF Medical Fee Schedule Report as-of 07/06/2026. Max 24 units. GT+TL telehealth and TL+93 audio-only variants pay the same $31.25. | $31.25 | per 15 min | 2019-01-01 | source |
How District of Columbia Compares
| Code | District of Columbia | National median | Difference |
|---|---|---|---|
| 97153 (TL) | $27.50 | $15.00 | 83% above national median |
| 97155 (TL) | $31.25 | $24.18 | 29% above national median |
Market Context
District of Columbia has had an autism insurance mandate since 2007. About 94,918 children in District of Columbia are enrolled in Medicaid. Autism prevalence is 3.9% (2022 data). ProviderSpark lists 18 verified ABA provider locations in District of Columbia.
Getting Paneled with DC Medicaid (administered by the Department of Health Care Finance, DHCF)
DC Medicaid retired its old provider portal — dc-medicaid.com no longer resolves — and enrollment now runs through a system called PDMS. Here’s the current path:
- Confirm your NPI and gather your licensure documentation (BCBA/behavior-analyst license), background check, and liability insurance — see the PDMS application user guides.
- Create a provider account in the DC Provider Data Management System (PDMS) at dcpdms.com, the current DC Medicaid enrollment portal.
- Complete a Streamlined enrollment application (no fee) using the PDMS How-To-Enroll guide for section-by-section instructions.
- Screening is handled by Maximus on DHCF’s behalf (1-844-218-9700).
- Separately credential with each Medicaid managed care plan you want to bill through — PDMS/FFS enrollment doesn’t automatically get you into an MCO network.
How District of Columbia Delivers ABA
DC Medicaid is a hybrid program: some ABA is billed fee-for-service, and some runs through managed care organizations. The MCOs are AmeriHealth Caritas DC, MedStar Family Choice DC, and Wellpoint DC (formerly Amerigroup DC) — plus Health Services for Children with Special Needs (HSCSN), a specialty plan for the Child and Adolescent Supplemental Security Income Program. One change to plan around: DHCF announced on July 2, 2026 that Wellpoint DC is exiting the DC Medicaid market effective August 1, 2026. Its members are being auto-reassigned to AmeriHealth Caritas DC, with the option to switch to MedStar Family Choice DC through January 31, 2027. If you’re credentialing now, don’t build a network strategy around Wellpoint — treat AmeriHealth Caritas DC and MedStar Family Choice DC as the two general MCOs going forward, plus HSCSN for CASSIP-eligible kids.
Billing Notes
ABA generally requires prior authorization with a treatment plan and medical-necessity documentation from a supervising BCBA, but the exact PA thresholds and renewal cadence are set by each MCO individually — DC doesn’t publish a standalone ABA provider manual the way neighboring Virginia and Maryland do, so confirm current PA rules directly with whichever MCO you’re billing.
On telehealth: DC Medicaid’s general telemedicine guidance reimburses telehealth at the same rate as in-person for covered services, and ABA isn’t on the excluded-services list. But that guidance predates the 2024 behavior-analyst licensure law and doesn’t name behavior analysts or BCBAs specifically among its example provider types, so confirm ABA-specific telehealth billing with DHCF or your MCO before relying on it.
One billing quirk worth knowing: DC Medicaid’s fiscal agent and web portal changed recently. The old dc-medicaid.com portal is offline; claims and eligibility now run through medicaid.dc.gov under fiscal agent Gainwell Technologies, while provider enrollment runs through the separate Maximus-operated dcpdms.com. Pull current billing guidance from those two sites directly rather than older bookmarked DC Medicaid links.
Common Questions
What does District of Columbia Medicaid pay for CPT 97153?
See the rate table above for the codes District of Columbia publishes.
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 District of Columbia 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 · Virginia