Nebraska Medicaid ABA Reimbursement Rates (2026)
From official Nebraska Medicaid sources. Updated July 2026.
These are the published Nebraska 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.
Nebraska ABA Fee Schedule
| Code | Service | Rate | Unit | Effective | Source |
|---|---|---|---|---|---|
| 97151 | Behavior identification assessment (ABA assessment) PB 25-14 table omits the unit text, but SFY27 fee schedule states ‘per 15 minutes’ explicitly. Billable by MD/DO/PhD/Licensed Psychologist/BCBA; not BCaBA/RBT. Same rate for all eligible types. Confirmed unchanged in SFY27 schedule (eff 2026-07-01). | $38.16 | per 15 min | 2025-08-01 | source |
| 97152 | Supporting assessment administered by technician Billable by Provisionally Licensed PhD/Licensed Psychologist/BCaBA/RBT columns. Confirmed in PB 25-14 and SFY27 fee schedule. | $25.88 | per 15 min | 2025-08-01 | source |
| 97153 | Adaptive behavior treatment by protocol, administered by technician Verified in PB 25-14 and re-confirmed in SFY27 MHSUD fee schedule (eff 2026-07-01, no change). Result of ~48% cut effective 8/1/2025. | $18.70 | per 15 min | 2025-08-01 | source |
| 97154 | Group adaptive behavior treatment by protocol, administered by technician Group code; fee schedule does not state per-participant explicitly but rate is per 15 min. Confirmed in PB 25-14 and SFY27 schedule. | $7.49 | per 15 min | 2025-08-01 | source |
| 97155 | Adaptive behavior treatment with protocol modification, by QHP Verified in PB 25-14 and re-confirmed in SFY27 MHSUD fee schedule (eff 2026-07-01, no change). Telehealth allowed (mod 95, POS 02/10). | $22.72 | per 15 min | 2025-08-01 | source |
| 97156 | Family adaptive behavior treatment guidance, by QHP Confirmed in PB 25-14 and SFY27 fee schedule. Telehealth allowed (mod 95, POS 02/10). This code took a ~51% cut in Aug 2025. | $26.06 | per 15 min | 2025-08-01 | source |
| 97158 | Adaptive behavior treatment social skills group, by QHP Confirmed in PB 25-14 and SFY27 fee schedule. | $12.05 | per 15 min | 2025-08-01 | source |
How Nebraska Compares
| Code | Nebraska | National median | Difference |
|---|---|---|---|
| 97151 | $38.16 | $29.14 | 31% above national median |
| 97153 | $18.70 | $15.00 | 25% above national median |
| 97155 | $22.72 | $24.18 | 6% below national median |
| 97156 | $26.06 | $22.50 | 16% above national median |
Market Context
Nebraska has had an autism insurance mandate since 2014. About 171,952 children in Nebraska are enrolled in Medicaid. Autism prevalence is 2.6% (2022 data). ProviderSpark lists 59 verified ABA provider locations in Nebraska.
Getting Paneled with Nebraska Medicaid, delivered through the Heritage Health managed care program
Nebraska Medicaid stopped accepting paper enrollment applications as of June 1, 2025. Getting paneled is now a two-layer process: state enrollment first, then separate credentialing with each managed care plan you want to bill.
- Enroll as a Nebraska Medicaid provider through Maximus’ Provider Data Management System (PDMS). You’ll need an NPI to get reimbursed.
- Your application is screened by Maximus, then reviewed and approved by DHHS Provider Relations before your Medicaid enrollment is finalized.
- Separately, apply for credentialing with each Heritage Health plan you want to bill — state enrollment alone doesn’t let you bill a plan’s members. Since January 1, 2025, Verisys runs primary-source verification once for all three plans, but each plan’s committee still reviews your application separately. Re-credentialing runs every 3 years.
- Revalidate your PDMS enrollment every 5 years. Maximus sends notices up to 180 days ahead, and you can start revalidation up to 120 days before your date.
How Nebraska Delivers ABA
Nebraska Medicaid runs ABA through managed care, not fee-for-service. The program is called Heritage Health, split across three plans: Nebraska Total Care (Centene), Molina Healthcare of Nebraska, and UnitedHealthcare Community Plan of Nebraska, whose behavioral health and ABA benefits are handled by Optum/Provider Express. The rate you get paid depends on which plan a client is enrolled in and the contract you’ve negotiated — and all three plans are working from a rate environment that just got tighter. Effective August 1, 2025, DHHS cut ABA reimbursement across the board following a market-alignment study: technician code 97153 dropped to $18.70 per 15 minutes, group code 97154 to $7.49, and clinician codes fell too, with 97155 at $22.72, 97156 at $26.06, and 97158 at $12.05.
Billing Notes
Prior authorization is required before ABA services start. The initial request needs a completed Initial Diagnostic Interview from within the past 12 months, the ABA Behavior Identification Assessment, and an Individualized Treatment, Rehabilitation, and Recovery Plan. That plan must be reviewed and updated at least every 90 days, and continued authorization depends on documented progress and at least 2-4 hours of caregiver participation per month.
Telehealth is only partly reimbursable. Clinician-delivered codes 97155 and 97156 can go by audiovisual telehealth if conditions are met, like 1:1 support, secure internet, and real-time supervisor interaction. Technician codes 97153, 97154, and 97158 cannot be delivered via telehealth.
The billing quirk to know: only RBT- or LaBA-credentialed technicians can bill the technician-level codes, so an uncertified staff member can’t generate revenue on a Medicaid case. Nonbehavioral activities like naps, extended breaks, and unstructured meals or recreation are explicitly non-reimbursable and must still be documented — naps are never billable, full stop.
Common Questions
What does Nebraska Medicaid pay for CPT 97153?
Nebraska Medicaid pays $18.70 per 15 minutes for 97153 (direct treatment by a technician). That is about $74.80 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 Nebraska 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: Iowa · Kansas · Colorado · Missouri · South Dakota