Virginia Medicaid ABA Reimbursement Rates (2026)
From official Virginia Medicaid sources. Updated July 2026.
These are the published Virginia 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.
Virginia ABA Fee Schedule
| Code | Service | Rate | Unit | Effective | Source |
|---|---|---|---|---|---|
| 97151 (HN) | Behavior identification assessment (LABA) Rate/unit/modifier verified in current DMAS Project BRAVO rates file. Effective date corrected: rate unchanged since 12.5% increase eff 7/1/2022; no ABA change on 1/1/2024. | $23.48 | per 15 min | 2022-07-01 | source |
| 97151 (HO) | Behavior identification assessment (LBA) Verified in current DMAS file. Desc tightened to state term LBA (Licensed Behavior Analyst); effective date corrected to 7/1/2022. | $46.63 | per 15 min | 2022-07-01 | source |
| 97151 (TF) | Behavior identification assessment (LMHP) Missing tier added from current DMAS Project BRAVO rates file. TF = Licensed Mental Health Professional. | $39.40 | per 15 min | 2022-07-01 | source |
| 97153 | Adaptive behavior treatment by protocol (technician) Verified in current DMAS file (no-modifier = technician level incl. RBTs). Effective date corrected to 7/1/2022. | $15.00 | per 15 min | 2022-07-01 | source |
| 97153 (HN) | Adaptive behavior treatment by protocol (LABA) Verified in current DMAS file. Effective date corrected to 7/1/2022. | $23.48 | per 15 min | 2022-07-01 | source |
| 97153 (HO) | Adaptive behavior treatment by protocol (LBA) Verified in current DMAS file. Effective date corrected to 7/1/2022. | $46.63 | per 15 min | 2022-07-01 | source |
| 97153 (TF) | Adaptive behavior treatment by protocol (LMHP) Missing tier added from current DMAS Project BRAVO rates file. | $39.40 | per 15 min | 2022-07-01 | source |
| 97154 | Group adaptive behavior treatment by protocol (technician) Added from current DMAS file; group code priced per 15 min per participant-facing staff tier. Higher tiers: HN 15.60, TF 13.13, HO 15.55. | $12.77 | per 15 min | 2022-07-01 | source |
| 97155 (HN) | Adaptive behavior treatment w/ protocol modification (LABA) Verified in current DMAS file. Effective date corrected to 7/1/2022. | $23.48 | per 15 min | 2022-07-01 | source |
| 97155 (HO) | Adaptive behavior treatment w/ protocol modification (LBA) Verified in current DMAS file. Effective date corrected to 7/1/2022. | $46.63 | per 15 min | 2022-07-01 | source |
| 97155 (TF) | Adaptive behavior treatment w/ protocol modification (LMHP) Missing tier added from current DMAS Project BRAVO rates file. | $39.40 | per 15 min | 2022-07-01 | source |
| 97156 (HN) | Family adaptive behavior treatment guidance (LABA) Verified in current DMAS file. Effective date corrected to 7/1/2022. | $23.48 | per 15 min | 2022-07-01 | source |
| 97156 (HO) | Family adaptive behavior treatment guidance (LBA) Verified in current DMAS file. Effective date corrected to 7/1/2022. | $46.63 | per 15 min | 2022-07-01 | source |
| 97156 (TF) | Family adaptive behavior treatment guidance (LMHP) Missing tier added from current DMAS Project BRAVO rates file. | $39.40 | per 15 min | 2022-07-01 | source |
| 97158 (HO) | Group adaptive behavior treatment w/ protocol modification (LBA, additional staff with child) Added from current DMAS file. Other tiers: TF 28.13, HN 22.83. | $30.54 | per 15 min | 2022-07-01 | source |
How Virginia Compares
| Code | Virginia | National median | Difference |
|---|---|---|---|
| 97151 (HO) | $46.63 | $29.14 | 60% above national median |
| 97153 | $15.00 | $15.00 | 0% above national median |
| 97155 (HO) | $46.63 | $24.18 | 93% above national median |
| 97156 (HO) | $46.63 | $22.50 | 107% above national median |
Market Context
Virginia has had an autism insurance mandate since 2011. About 805,438 children in Virginia are enrolled in Medicaid. Autism prevalence is 3.3% (2022 data). ProviderSpark lists 332 verified ABA provider locations in Virginia.
Getting Paneled with Virginia Medicaid, delivered under the “Cardinal Care” program name
Virginia rebranded its Medicaid program to Cardinal Care in January 2023 and finished folding Medallion 4.0 and CCC Plus into Cardinal Care Managed Care on October 1, 2023. If you’re enrolling now, you’re enrolling into the consolidated program. Enrollment steps:
- Register as a Virginia Medicaid provider through the Medicaid Enterprise System (MES) Provider Services Solution (PRSS) portal.
- Submit your new-enrollment application through the DMAS Provider Enrollment wizard, using your NPI and Tax ID; applications go through risk-based screening before you get an Application Tracking Number and approval.
- Check the provider enrollment and revalidation page if you’re setting up an organizational NPI to bill for supervised technicians or LABAs; revalidation is required roughly every 5 years.
- Separately credential and contract with each Cardinal Care managed care plan you want to serve members through. State enrollment via PRSS does not get you into any MCO’s network automatically.
- Enroll for Electronic Funds Transfer (EFT), the only payment method Virginia Medicaid uses, via a paper form (fax or mail), not the online portal.
How Virginia Delivers ABA
Cardinal Care is a hybrid program: some ABA claims run through fee-for-service, some through managed care. The five MCOs are Aetna Better Health of Virginia, Anthem HealthKeepers Plus, Humana Healthy Horizons of Virginia (replaced Molina on July 1, 2025), Sentara Health Plans, and UnitedHealthcare Community Plan of the Mid-Atlantic. Because DMAS requires separate credentialing with each plan, the rate you actually get paid depends on which MCOs you’ve contracted with, not just your state enrollment status.
Billing Notes
Service authorization is required for ABA. As of October 15, 2025, DMAS moved to unit-specific authorization by CPT code (97153, 97154, 97155, 97156, 97157, 97158, 0373T), so no more bundled requests covering all codes under 97155. Each code needs its own unit count, for both fee-for-service and Cardinal Care Managed Care claims. Assessment codes (97151, 97152, 0362T) don’t require authorization. Requests over 20 hours (80 units) a week need the schedule of activities used to structure sessions, tied to individualized treatment goals.
ABA telehealth is reimbursable under DMAS’s Telehealth Services Supplement. The Individual Service Plan must specify when telehealth versus in-person delivery is used, and you need to document that the youth and caregiver can participate safely and that telehealth is clinically appropriate for that case.
Two billing quirks to know before you submit claims: non-covered activities include childcare, respite care, housing supports, transportation time, and snacks, meals, or napping unless clinically tied to treatment goals. And delegation authority to supervise unlicensed ABA technicians is limited to LBAs, LABAs, and Licensed Clinical Psychologists, plus LMHP-R/RP/S. LCSWs and LPCs cannot supervise ABA technicians under this bulletin.
Common Questions
What does Virginia Medicaid pay for CPT 97153?
Virginia 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 Virginia 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: Maryland · North Carolina · District of Columbia · West Virginia · Tennessee