Utah Medicaid ABA Reimbursement Rates (2026)
From official Utah Medicaid sources. Updated July 2026.
These are the published Utah 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.
Utah ABA Fee Schedule
| Code | Service | Rate | Unit | Effective | Source |
|---|---|---|---|---|---|
| 97151 | Behavior identification assessment by professional Was 31.00 estimated; PRISM PAC-166 shows $37.51 effective 07/01/2026 (updated 06/12/2026). No PA required, ages 1+. | $37.51 | per 15 min | 2026-07-01 | source |
| 97153 | Adaptive behavior treatment by protocol (technician) Was 17.00 estimated; PRISM shows $19.67 effective 07/01/2026. PA required. | $19.67 | per 15 min | 2026-07-01 | source |
| 97154 | Group adaptive behavior treatment by technician (per participant) Covered at $13.91 effective 07/01/2026; PA required. | $13.91 | per 15 min | 2026-07-01 | source |
| 97155 | Adaptive behavior treatment w/ protocol modification (professional; single rate, credential modifier required) Was 31.00 estimated; now $37.51 effective 07/01/2026. Utah requires credential modifiers on 97155/H0032 — HP=psychologist/BCBA-D, HO=BCBA, HN=BCaBA/trainee — but the modifier does not change the rate. 97155 = direct case supervision; indirect supervision billed as H0032 at same $37.51. | $37.51 | per 15 min | 2026-07-01 | source |
| 97156 | Family adaptive behavior treatment guidance (professional) Was 22.00 estimated; now $37.51 effective 07/01/2026. PA required. | $37.51 | per 15 min | 2026-07-01 | source |
| H0032 | Indirect case supervision (mental health service plan development by non-physician) Utah bills indirect ABA case supervision as H0032 with HP/HO/HN credential modifier; direct supervision uses 97155. $37.51/15 min effective 07/01/2026. | $37.51 | per 15 min | 2026-07-01 | source |
How Utah Compares
| Code | Utah | National median | Difference |
|---|---|---|---|
| 97151 | $37.51 | $29.14 | 29% above national median |
| 97153 | $19.67 | $15.00 | 31% above national median |
| 97155 | $37.51 | $24.18 | 55% above national median |
| 97156 | $37.51 | $22.50 | 67% above national median |
Market Context
Utah has had an autism insurance mandate since 2014. About 169,369 children in Utah are enrolled in Medicaid. Autism prevalence is 4.0% (2022 data). ProviderSpark lists 112 verified ABA provider locations in Utah.
Getting Paneled with Utah Medicaid — Autism Spectrum Disorder (ASD) Related Services, under Traditional Medicaid/EPSDT
Utah runs ABA coverage through Traditional Medicaid/EPSDT rather than a managed-care carve-in, so enrollment goes straight through the state’s own portal, not through a health plan.
- Create or log in to a Utah-ID account, then start the New Enrollment Application through the Become a Medicaid Provider page.
- Complete provider enrollment in PRISM (Provider Reimbursement Information System for Medicaid), which requires multi-factor authentication; unsubmitted online applications are purged after 90 days.
- If you’re new to the system, review the PRISM eLearning course on enrolling as a new Medicaid provider.
- Submit the required forms listed on the Provider Enrollment Forms page, including the PRISM Access Agreement and Health Care Provider Access Agreement.
- Read the Autism Spectrum Disorder Services provider manual before billing, it covers ABA-specific coding, technician certification, and prior-authorization documentation.
How Utah Delivers ABA
Utah pays for ABA fee-for-service, direct from Medicaid, with no managed care organization in between, even for members who are otherwise enrolled in an Accountable Care Organization like Health Choice Utah, Healthy U, Molina Healthcare, or SelectHealth Community Care. That’s different from how Utah handles physical therapy, occupational therapy, and speech therapy, which do route through the ACO. For a BCBA, this means one billing relationship: you bill Medicaid directly for ABA, and you don’t need a separate contract with each ACO just to see their members for ABA services.
Billing Notes
Prior authorization is required for ABA services. For initial services, providers get a 10-business-day grace period from the start of services to submit the PA request, with ASD diagnosis documentation and a prescription for ABA; miss that window and authorization starts on the day the request is actually completed. Treatment plans are generally reassessed every six months, and re-authorization requests, including updated progress data, must be submitted within 10 business days of the start of the new certification period.
Telehealth is allowed, but only for specific pieces of the service: behavior identification assessments, supervision of an assistant behavior analyst or technician, and parent/caregiver training can be delivered via synchronous two-way video/audio. Direct technician-delivered 1:1 or group adaptive behavior treatment, and QHP-led group treatment with protocol modification, are explicitly not covered via telehealth. Plan your service delivery model around that split, hands-on treatment stays in person, assessment and supervision can go virtual.
A few billing quirks worth knowing: mental health evaluations and psychological testing used to diagnose developmental disorders are carved out of MCE services and billed fee-for-service with a UC modifier. And technicians must hold full NCCA-accredited certification (RBT, QABA, or BICC) before they perform any billable service, there’s no grace period for uncertified staff, so certification has to be complete before hours go on a claim.
Common Questions
What does Utah Medicaid pay for CPT 97153?
Utah Medicaid pays $19.67 per 15 minutes for 97153 (direct treatment by a technician). That is about $78.68 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 Utah 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.
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