Alabama Medicaid ABA Reimbursement Rates (2026)
From official Alabama Medicaid sources. Updated July 2026.
These are the published Alabama 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.
Alabama ABA Fee Schedule
| Code | Service | Rate | Unit | Effective | Source |
|---|---|---|---|---|---|
| 0362T | Behavior identification supporting assessment, complex (physician/QHP directed) PA required. | $30.00 | per 15 min | 2026-02-05 | source |
| 0373T | Adaptive behavior treatment with protocol modification, complex (destructive behavior) PA required. | $20.00 | per 15 min | 2026-02-05 | source |
| 97151 | Behavior identification assessment Stored $31.97 was wrong. Official rate $25.00/15min. Only ABA code NOT requiring prior authorization. | $25.00 | per 15 min | 2026-02-05 | source |
| 97152 | Behavior identification supporting assessment (observation follow-up) PA required. | $12.50 | per 15 min | 2026-02-05 | source |
| 97153 | Adaptive behavior treatment by protocol Stored $31.25 was wrong. Official rate $10.00/15min. PA required. | $10.00 | per 15 min | 2026-02-05 | source |
| 97154 | Group adaptive behavior treatment by protocol Group code, priced per participant per 15 min. PA required. | $4.00 | per 15 min | 2026-02-05 | source |
| 97155 | Adaptive behavior treatment with protocol modification Stored $31.25 was wrong. Official rate $15.00/15min. PA required. | $15.00 | per 15 min | 2026-02-05 | source |
| 97156 | Family adaptive behavior treatment guidance Stored $31.25 was wrong. Official rate $30.00/15min. PA required. | $30.00 | per 15 min | 2026-02-05 | source |
| 97157 | Multiple-family group adaptive behavior treatment guidance Group code, priced per family/participant per 15 min. PA required. | $2.50 | per 15 min | 2026-02-05 | source |
| 97158 | Group adaptive behavior treatment with protocol modification (social skills group) Group code, per participant per 15 min. PA required. | $5.00 | per 15 min | 2026-02-05 | source |
How Alabama Compares
| Code | Alabama | National median | Difference |
|---|---|---|---|
| 97151 | $25.00 | $29.14 | 14% below national median |
| 97153 | $10.00 | $15.00 | 33% below national median |
| 97155 | $15.00 | $24.18 | 38% below national median |
| 97156 | $30.00 | $22.50 | 33% above national median |
Market Context
Alabama has had an autism insurance mandate since 2012. About 672,491 children in Alabama are enrolled in Medicaid. Autism prevalence is 2.8% (2022 data). ProviderSpark lists 60 verified ABA provider locations in Alabama.
Getting Paneled with Alabama Medicaid
Alabama doesn’t have a separate “autism” or “ABA” Medicaid brand. Instead, ABA gets billed one of two ways: through the general Alabama Medicaid Provider Manual Chapter 37 (“Therapy”), under Provider Type 17 / Specialty 175 (Applied Behavior Analysis Therapy), for standard BCBA-run private practices; or through the Department of Mental Health’s own Autism Services / Intensive Home-Based Services program (Chapter 110), for ADMH-contracted rehab providers. Most private-practice BCBAs will enroll under Chapter 37.
- Register your business with the Alabama Secretary of State and get an NPI through NPPES. Business entity registration
- Enroll as an Alabama Medicaid provider through the AMMIS/HCP Provider Enrollment Web Portal (run by Gainwell Technologies), requesting Provider Type 17 with Specialty 175, and proving BCBA licensure. As of February 24, 2026, your service location must be a physical facility with visible signage — home addresses and shared/leased space inside another business no longer qualify. Provider Enrollment Portal
- Reference the AMMIS Provider Enrollment Web Portal User Manual and forms library for general steps. Provider enrollment guidance
- To deliver ADMH’s contracted Autism Services (Chapter 110) instead of, or alongside, standalone private-practice ABA, apply separately to become an ADMH-contracted provider (Medicaid application, background check, Relias/Therap training, site visit). Autism Services enrollment
- To bill telehealth, also enroll with Specialty Type 931 (Telemedicine Service) and submit the Telemedicine Service Agreement/Certification. Telemedicine policy
How Alabama Delivers ABA
Alabama Medicaid pays for ABA on a fee-for-service basis — there are no managed care organizations sitting between you and the state for this benefit. That means the rate the state publishes is the rate you’re paid, without an MCO negotiating a different number or adding its own prior-authorization layer on top of the state’s.
Billing Notes
Under Chapter 37, every ABA procedure code requires prior authorization except 97151, the initial behavior identification assessment, which needs an “ABA Therapy Behavior Assessment Form” instead. Under the Chapter 110 Autism Services program, rehab procedure codes generally don’t require prior authorization — the exception is when a provider needs to request additional hours beyond standard limits for an EPSDT-eligible recipient under 21. Those requests must go in at least 10 days ahead and clear ICC review, TCM supervisor approval, and Regional Autism Coordinator sign-off; not every case qualifies as the required “extraordinary circumstance.”
Telehealth is billable under Chapter 37 once you’re enrolled with Specialty 931 and append the GT modifier. It’s limited to interactive audio-plus-video (no audio-only visits), requires recipient consent, and is reimbursed at parity with in-person services. Telehealth service locations are limited to Office or Home.
One billing quirk to build into your workflow: Alabama Medicaid does not allow span-billing on standard therapy codes. Each date of service needs its own claim line, with documentation to support the exact units billed. Standard timely-filing rules apply — claims must be filed within one year of the date of service.
Common Questions
What does Alabama Medicaid pay for CPT 97153?
Alabama Medicaid pays $10.00 per 15 minutes for 97153 (direct treatment by a technician). That is about $40.00 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 Alabama 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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