Hawaii Medicaid ABA Reimbursement Rates (2026)
From official Hawaii Medicaid sources. Updated July 2026.
These are the published Hawaii 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.
Hawaii ABA Fee Schedule
| Code | Service | Rate | Unit | Effective | Source |
|---|---|---|---|---|---|
| 0362T (HO) | Behavior ID supporting assessment, destructive behavior (LBA + 2 team members) Confirmed in QI-2431 and matching $54.71 on the 06/01/2026 statewide schedule. | $54.71 | per 15 min | 2025-01-01 | source |
| 0373T (HO) | Adaptive behavior treatment w/ protocol modification, severe destructive behavior (LBA) Tiered: HO (LBA) $35.94, HN (BCaBA) $20.24, HM (RBT) $17.66. Confirmed at $35.94 on the 06/01/2026 statewide schedule. | $35.94 | per 15 min | 2025-01-01 | source |
| 97151 (HO) | Behavior identification assessment (LBA: BCBA/BCBA-D) QI-2431/FFS 24-13 Attachment C (rates eff 2025-01-01) listed $28.52; the statewide FFS schedule as of 06/01/2026 lists 97151 at $32.13 (without-modifiers table), so $32.13 is current. Assessment must be performed by an LBA (billed HO); cannot be done by BCaBA/RBT. | $32.13 | per 15 min | 2026-06-01 | source |
| 97152 (HN) | Behavior identification supporting assessment (BCaBA) Rate identical in QI-2431 Attachment C and the 06/01/2026 statewide schedule. Delivered by BCaBA under LBA supervision. | $20.24 | per 15 min | 2025-01-01 | source |
| 97153 (HM) | Adaptive behavior treatment by protocol (RBT; HN/HO bill same rate) Single rate for all practitioner levels: RBT (HM), BCaBA (HN), and LBA (HO) all reimbursed $17.66 per QI-2431. +41.3% increase from the Milliman rate study Scenario 1. Confirmed unchanged on 06/01/2026 statewide schedule. | $17.66 | per 15 min | 2025-01-01 | source |
| 97154 (HM) | Group adaptive behavior treatment by protocol, RBT, 2 members (UN) Priced per participant by group size: 2 (UN) $12.58, 3 (UP) $8.83, 4 (UQ) $6.95, 5 (UR) $5.83, 6-8 (US) $4.35 per member per 15 min. | $12.58 | per 15 min | 2025-01-01 | source |
| 97155 (HN) | Adaptive behavior treatment w/ protocol modification (BCaBA) BCaBA tier per QI-2431 Attachment C. | $20.24 | per 15 min | 2025-01-01 | source |
| 97155 (HO) | Adaptive behavior treatment w/ protocol modification (LBA: BCBA/BCBA-D) Confirmed in QI-2431 and matching $35.94 on the 06/01/2026 statewide schedule. May be billed concurrently with 97153 when criteria for both are met. | $35.94 | per 15 min | 2025-01-01 | source |
| 97156 (HN) | Family adaptive behavior treatment guidance (BCaBA) BCaBA tier per QI-2431 Attachment C. | $25.01 | per 15 min | 2025-01-01 | source |
| 97156 (HO) | Family adaptive behavior treatment guidance (LBA: BCBA/BCBA-D) Per QI-2431 Attachment C (+39.0% from rate study). Note: the 06/01/2026 without-modifiers statewide schedule shows an anomalous $8.61 base value for 97156; the ABA policy memo modifier rates (HO $46.20 / HN $25.01) are the operative ABA rates. | $46.20 | per 15 min | 2025-01-01 | source |
| 97157 (HO) | Multi-family group guidance, 2 families (UN) Per family per 15 min by group size: 2 (UN) $24.86, 3 (UP) $17.45, 4 (UQ) $13.74, 5 (UR) $11.51, >5 (US) $8.60. Also billable HN (BCaBA). | $24.86 | per 15 min | 2025-01-01 | source |
| 97158 (HO) | Group adaptive behavior treatment w/ protocol modification (LBA), 2 members (UN) Per member per 15 min by group size: 2 (UN) $24.86, 3 (UP) $17.45, 4 (UQ) $13.74, 5 (UR) $11.51, >5 (US) $8.60. | $24.86 | per 15 min | 2025-01-01 | source |
How Hawaii Compares
| Code | Hawaii | National median | Difference |
|---|---|---|---|
| 97151 (HO) | $32.13 | $29.14 | 10% above national median |
| 97153 (HM) | $17.66 | $15.00 | 18% above national median |
| 97155 (HO) | $35.94 | $24.18 | 49% above national median |
| 97156 (HO) | $46.20 | $22.50 | 105% above national median |
Market Context
About 152,533 children in Hawaii are enrolled in Medicaid. Autism prevalence is 2.5% (2022 data). ProviderSpark lists 49 verified ABA provider locations in Hawaii.
Getting Paneled with QUEST Integration (QI)
QUEST Integration is Hawaii’s Medicaid managed-care program, run by the Med-QUEST Division of the Dept. of Human Services. ABA is also referenced under a parallel Fee-For-Service track used for rate-setting and populations served outside QI managed care. To get paneled:
- Register for a HOKU (Hawaii’s Online Kahu Utility) account, the state’s online provider enrollment system.
- Log into HOKU to submit an online application (recommended for priority processing), or download the paper Provider Enrollment Application (DHS Form 1139) from the Med-QUEST provider enrollment page.
- Gather your required credentials: Hawaii Behavior Analyst (LBA) license, RBT or BCaBA certification as applicable, W-9, and NPI.
- Submit the application through HOKU, or by email, fax (808-692-8087), or mail to Med-QUEST Division, Health Care Services Branch, 601 Kamokila Blvd., Room 506A, Kapolei, HI 96707.
- Once enrolled as a Hawaii Medicaid provider, credential and contract separately with each QI health plan you plan to bill, since QI is delivered through managed care.
How Hawaii Delivers ABA
Hawaii runs a hybrid model: most ABA is delivered and paid through QI managed-care plans, with an FFS track alongside it for rate-setting and non-QI populations. The QI plans are AlohaCare, HMSA, Kaiser Permanente, ‘Ohana Health Plan, and UnitedHealthcare Community Plan. Since coverage runs through managed care, the rate you’re actually paid depends on your contract with each plan, not one statewide fee schedule — budget time to negotiate with each MCO you intend to bill. Medicaid is always secondary to any other insurance the client has.
Billing Notes
No prior authorization is needed for ASD screening or the initial diagnostic evaluation, though a QI plan may require a PCP referral. Prior authorization is required before ABA treatment begins, once the QI plan determines it’s medically necessary and recommended by the rendering LBA. A pre-diagnosis trial period of up to 26 weeks can be authorized while diagnosis is pending. Ongoing authorization runs in hours per week for up to 26 weeks at a time, with re-authorization requiring an interim progress assessment (e.g., VB-MAPP or ABLLS-R) showing documented progress.
Telehealth is covered: Hawaii’s Medicaid telehealth parity law (HRS §346-59.1, amended by 2023 Act 107) requires QI plans and FFS to cover any service via telehealth that would be covered in person, with claims flagged using modifier 95, GT, or GQ instead of a place-of-service code.
One billing quirk: normally only one rendering provider can bill for a member at a time, but codes 97153 (RBT under LBA supervision) and 97155 (LBA alone, or a BCaBA under LBA supervision) can be billed concurrently for the same member, each with its own modifier (HM, HO, HN). Code 97151, the initial behavior identification assessment, can only be billed by the LBA — never by a BCaBA or RBT.
Common Questions
What does Hawaii Medicaid pay for CPT 97153?
See the rate table above for the codes Hawaii 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 Hawaii 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: California · Washington · Alaska