Vermont Medicaid ABA Reimbursement Rates (2026)
From official Vermont Medicaid sources. Updated July 2026.
These are the published Vermont 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.
Vermont ABA Fee Schedule
| Code | Service | Rate | Unit | Effective | Source |
|---|---|---|---|---|---|
| 0362T | Behavior identification supporting assessment, complex No PA; counted as one member hour despite 2+ techs; capped 4 hrs per 6 months | $52.00 | per 15 min | 2019-01-01 | source |
| 0373T | Adaptive behavior treatment w/ protocol modification, complex PA required; 2:1 staffing counted as one member hour | $26.00 | per 15 min | 2019-01-01 | source |
| 97151 | Behavior identification assessment (BCBA) No PA; capped 4 hrs per 6 months | $65.80 | per 15 min | 2019-01-01 | source |
| 97152 | Behavior identification supporting assessment (technician) No PA | $30.00 | per 15 min | 2019-01-01 | source |
| 97153 | Adaptive behavior treatment by protocol (technician rate) PA required; BCBAs billing 97153 receive the technician rate | $15.00 | per 15 min | 2019-01-01 | source |
| 97154 | Group adaptive behavior treatment by technician PA required | $7.50 | per 15 min | 2019-06-01 | source |
| 97155 | Adaptive behavior treatment w/ protocol modification (BCBA only) PA required; BCaBA row end-dated 12/31/2025 | $49.35 | per 15 min | 2019-01-01 | source |
| 97156 | Family adaptive behavior treatment guidance (BCBA) PA required; telehealth allowed | $21.39 | per 15 min | 2019-01-01 | source |
| 97157 | Multiple-family group adaptive behavior treatment guidance PA required; telehealth allowed | $21.39 | per 15 min | 2019-01-01 | source |
| 97158 | Group adaptive behavior treatment w/ protocol modification PA required | $16.45 | per 15 min | 2019-06-01 | source |
How Vermont Compares
| Code | Vermont | National median | Difference |
|---|---|---|---|
| 97151 | $65.80 | $29.14 | 126% above national median |
| 97153 | $15.00 | $15.00 | 0% above national median |
| 97155 | $49.35 | $24.18 | 104% above national median |
| 97156 | $21.39 | $22.50 | 5% below national median |
Market Context
Vermont has had an autism insurance mandate since 2009. About 57,787 children in Vermont are enrolled in Medicaid. Autism prevalence is 4.5% (2022 data). ProviderSpark lists 13 verified ABA provider locations in Vermont.
Getting Paneled with Vermont Medicaid
Vermont Medicaid runs under Green Mountain Care, the umbrella brand for the state’s public coverage programs. It’s administered by the Department of Vermont Health Access (DVHA) within the Agency of Human Services, with Gainwell Technologies handling claims as fiscal agent. Enrollment runs through Gainwell’s Provider Management Module (PMM), not DVHA directly.
- Confirm a current Vermont OPR license as an Applied Behavior Analyst or Assistant Behavior Analyst — a BCBA or BCaBA credential alone doesn’t qualify you for reimbursement. See OPR’s ABA program page.
- Request a PMM account and complete the online New Provider Enrollment application, submitting a signed General Provider Agreement and a copy of your license (one service location and provider type per application).
- Document background checks (VCIC or FBI, plus Child and Adult Abuse Registry checks) and, for Behavior Technicians, the required 40-hour training package, before staff deliver billable services — see the ABA Supplement.
- Review the General Provider Manual for enrollment and billing rules; direct ABA benefit questions to AHS.DVHAABABenefit@vermont.gov.
- Wait for DVHA/Gainwell to review your application before submitting claims. Once enrolled, ongoing transactions run through the provider portal.
How Vermont Delivers ABA
Vermont Medicaid pays for ABA fee-for-service (FFS) — no managed care organizations administer the ABA benefit here. You bill DVHA/Gainwell directly rather than negotiating with a separate MCO, and the fee schedule rate is the rate you get, with no plan-to-plan variation to shop between.
Billing Notes
Three codes skip prior authorization but cap at 4 hours per 6 months: 97151 (assessment, BCBA), 97152 (caregiver/adaptive-behavior guidance, BT/BCaBA/BCBA), and 0362T (BCBA). Everything else — 97153, 97154 (BT/BCaBA/BCBA), 97155, 97156, 97157, 97158 (BCBA-level), and 0373T (BCBA) — requires prior authorization, subject to Medicaid’s MUE limits. Authorization needs the state PA form, a referral from a qualifying prescriber (board-certified/eligible psychiatrist, doctorate-level psychologist, board-certified/eligible neurologist, or developmental-behavioral pediatrician), a current diagnostic assessment, and a BCBA-authored treatment plan (PEAK, VB-MAPP, or ESDM, or documented clinical rationale) updated at least every 6 months.
Telehealth covers only 97155, 97156, and 97157. For 97155, the BCBA must still be in-person for any 2:1 group codes. All other codes are not billable via telehealth.
One quirk to plan around: if a BCBA personally delivers services billed under 97152, 97153, or 97154, Medicaid reimburses at the lower BT rate, not the BCBA rate — bill a comparable BCBA-only code instead where one exists. Also, Vermont Medicaid is payor of last resort: when it’s secondary and a service is denied by the primary insurer, you must exhaust that insurer’s appeals — and for costs over $100, get a Vermont Department of Financial Regulation review of the denial — before DVHA will pay the claim.
Common Questions
What does Vermont Medicaid pay for CPT 97153?
Vermont Medicaid pays $15.00 per 15 minutes for 97153 (direct treatment by a technician). That is about $60.00 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 Vermont 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 Hampshire · New York · Massachusetts