Wyoming Medicaid ABA Reimbursement Rates (2026)
From official Wyoming Medicaid sources. Updated July 2026.
These are the published Wyoming 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.
Wyoming ABA Fee Schedule
| Code | Service | Rate | Unit | Effective | Source |
|---|---|---|---|---|---|
| 97151 | Behavior identification assessment by physician/QHP (BCBA) Stored $19.15 (2023 benchmarking PDF) outdated; current FFS rate $24.60/15min effective 2026-07-01, same for ages 0-20 and 21+. | $24.60 | per 15 min | 2026-07-01 | source |
| 97151 (HCBS waiver benefit plans) | Behavior identification assessment — Comprehensive/Supports (Adult & Child) waiver rate State distinguishes by BENEFIT_PLAN field, not a billing modifier; same $32.27 across all four DD waivers. | $32.27 | per 15 min | 2026-07-01 | source |
| 97152 | Behavior identification supporting assessment by technician $12.30/15min base FFS; DD waiver benefit plans pay $20.56. | $12.30 | per 15 min | 2026-07-01 | source |
| 97153 | Adaptive behavior treatment by protocol, by technician Stored $20.50 outdated; current base FFS rate $12.30/15min effective 2026-07-01. DD waiver benefit plans pay $19.23 (see separate row). | $12.30 | per 15 min | 2026-07-01 | source |
| 97153 (HCBS waiver benefit plans) | Adaptive behavior treatment by technician — Comprehensive/Supports (Adult & Child) waiver rate State distinguishes by BENEFIT_PLAN field, not a billing modifier; same $19.23 across all four DD waivers. | $19.23 | per 15 min | 2026-07-01 | source |
| 97154 | Group adaptive behavior treatment by technician Priced per participant per 15 min. | $4.04 | per 15 min | 2026-07-01 | source |
| 97155 | Adaptive behavior treatment with protocol modification by physician/QHP (BCBA) Stored $20.50 outdated; current FFS rate $24.60/15min effective 2026-07-01. | $24.60 | per 15 min | 2026-07-01 | source |
| 97156 | Family adaptive behavior treatment guidance by physician/QHP Core code we lacked; $24.60/15min effective 2026-07-01. | $24.60 | per 15 min | 2026-07-01 | source |
| 97157 | Multiple-family group adaptive behavior treatment guidance by physician/QHP Per family per 15 min. | $8.20 | per 15 min | 2026-07-01 | source |
| 97158 | Group adaptive behavior treatment with protocol modification by physician/QHP Priced per participant per 15 min. | $9.31 | per 15 min | 2026-07-01 | source |
How Wyoming Compares
| Code | Wyoming | National median | Difference |
|---|---|---|---|
| 97151 | $24.60 | $29.14 | 16% below national median |
| 97153 | $12.30 | $15.00 | 18% below national median |
| 97155 | $24.60 | $24.18 | 2% above national median |
| 97156 | $24.60 | $22.50 | 9% above national median |
Market Context
About 40,672 children in Wyoming are enrolled in Medicaid. Autism prevalence is 2.6% (2022 data). ProviderSpark lists 12 verified ABA provider locations in Wyoming.
Getting Paneled with Wyoming Medicaid
Wyoming Medicaid doesn’t run a separately branded ABA or behavioral-health program — ABA is covered through the regular Medicaid enrollment and prior-authorization process. Here’s the enrollment path:
- Register an account on the Discover Your Provider (DyP) portal and complete the application, Provider Agreement, and W-9 after email confirmation.
- Select the correct provider/taxonomy type — behavior analyst, assistant behavior analyst, or registered behavior technician — within the DyP application.
- Complete any additional screening required, such as a fingerprint-based criminal history check, and wait for review by a Provider Enrollment specialist. Questions go to Provider Enrollment Customer Service at 1-877-399-0121 or WYEnrollmentSvcs@HHSTechGroup.com — see Wyoming Medicaid’s provider page.
- Once enrolled, register separately for Telligen’s Qualitrac portal to submit prior authorization requests for ABA and behavioral health services.
How Wyoming Delivers ABA
Wyoming Medicaid pays for ABA fee-for-service — there are no managed care organizations administering ABA benefits here. That means one set of enrollment rules and one payer to bill, rather than juggling different MCO contracts, credentialing timelines, or rate schedules. You enroll once with the state and bill Medicaid directly for covered services.
Billing Notes
ABA is covered for Medicaid members ages 0-20 with an Autism Spectrum Disorder diagnosis, reviewed through Wyoming Medicaid’s behavioral-health prior-authorization process administered by Telligen via its Qualitrac portal. Requests need a treatment plan built on a comprehensive assessment with measurable goals, updated at least every 90 days, plus 3-5 of the most recent progress notes per requested procedure code. The authorization date range has to match the treatment-plan period, and treatment plans shouldn’t overlap.
Telehealth is billable: Board Certified Behavior Analysts are listed as eligible telehealth providers in Wyoming Medicaid’s CMS-1500 Provider Manual. Telehealth means real-time, interactive audio-and-video only — phone calls, email, fax, and store-and-forward aren’t reimbursed. Claims use the GT or 95 modifier and pay at the same rate as the in-person code. A dedicated telehealth consent form is no longer required, but you still need to keep documented patient consent on file.
One billing quirk worth knowing: Acentra Health (formerly CNSI) is Wyoming Medicaid’s fiscal agent and processes claims and payments through its Benefits Management System — separate from Telligen, which only handles prior authorization and utilization review for behavioral health. Claims or payment issues go to Acentra Health/BMS Provider Services (1-888-996-6223); prior-authorization and documentation issues go to Telligen. Telligen’s own training flags a mismatch between what was authorized (modifiers, units) and what’s actually billed as a common cause of denials, since Telligen doesn’t calculate or verify units for you.
Common Questions
What does Wyoming Medicaid pay for CPT 97153?
Wyoming Medicaid pays $12.30 per 15 minutes for 97153 (direct treatment by a technician). That is about $49.20 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 Wyoming 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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