Pennsylvania Medicaid ABA Reimbursement Rates (2026)

From official Pennsylvania Medicaid sources. Updated July 2026.

These are the published Pennsylvania 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.

Pennsylvania ABA Fee Schedule

How Pennsylvania Compares

Market Context

Pennsylvania has had an autism insurance mandate since 2008. About 1,418,667 children in Pennsylvania are enrolled in Medicaid. Autism prevalence is 3.4% (2022 data). ProviderSpark lists 262 verified ABA provider locations in Pennsylvania.

Getting Paneled with Pennsylvania Medicaid (Behavioral HealthChoices / IBHS)

Pennsylvania’s Medicaid program is called Medical Assistance. Behavioral health runs under a separate carve-out, “Behavioral HealthChoices” (BH-HC), and ABA itself is billed as part of “Intensive Behavioral Health Services” (IBHS). Getting paneled here means more than an enrollment form — the state requires ABA to be delivered through a licensed agency, not an individually enrolled BCBA. The core steps:

• Obtain OMHSAS IBHS agency licensure from the applicable regional field office. Individual BCBAs generally cannot bill solo; ABA must run through a licensed IBHS agency.
• Enroll the agency as a PA Medical Assistance provider through the PROMISe Online Provider Enrollment portal.
• Contact and credential with the Behavioral Health MCO(s) that serve the counties you’ll operate in. Statewide Medicaid enrollment doesn’t guarantee network access, and some MCO networks are closed.
• Confirm staff meet IBHS ABA role qualifications (Clinical Director, Behavior Consultant-ABA, Assistant Behavior Consultant-ABA, BHT-ABA) before billing under that role.
• For the residual fee-for-service population, submit prior authorization using the MA 97 form per the OMHSAS-20-07 handbook; most cases instead route through the assigned county’s Behavioral Health MCO.

How Pennsylvania Delivers ABA

PA’s behavioral health Medicaid is a mandatory, county-based MCO carve-out — it is not integrated with physical-health HealthChoices MCOs. The Behavioral Health MCOs include Community Care Behavioral Health (CCBH), PerformCare, Magellan Behavioral Health of PA (MBH), Community Behavioral Health (CBH, serving Philadelphia), and Carelon Behavioral Health. Which one (or ones) you need to credential with depends entirely on the counties you serve, since coverage is regional rather than statewide. In practice, the rate you’re actually paid runs through whichever MCO holds the contract for that county, not a single statewide fee schedule.

Billing Notes

IBHS/ABA services require prior authorization. For the fee-for-service residual population, a completed MA 97 form must be submitted within 30 days of completing the Individual Treatment Plan (ITP). Most counties instead route prior authorization through their contracted Behavioral Health MCO rather than fee-for-service.

Telehealth coverage is conditional, not a blanket yes. Under Bulletin OMHSAS-22-02, certain IBHS/ABA administrative steps — written orders and ITP creation and signing — can be completed via telehealth, though audio-only doesn’t satisfy the face-to-face requirement. OMHSAS classifies IBHS as a “High Intensity Service,” so providers must evaluate telehealth appropriateness case by case; some components may be delivered primarily via telehealth while others require in-person delivery.

The biggest structural quirk to plan around: Pennsylvania requires ABA to be delivered by a state-licensed IBHS agency, not an individually Medicaid-enrolled BCBA. That’s unusual nationally, and it adds real administrative overhead — agency policies, staffing qualifications, a QA program, and an annual OMHSAS compliance review — before you can bill a single unit.

Common Questions

What does Pennsylvania Medicaid pay for CPT 97153?

Pennsylvania Medicaid pays $12.73 per 15 minutes for 97153 (direct treatment by a technician). That is about $50.92 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 Pennsylvania 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: New York · New Jersey · Ohio · Maryland · West Virginia