Colorado Medicaid ABA Reimbursement Rates (2026)
From official Colorado Medicaid sources. Updated July 2026.
These are the published Colorado 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.
Colorado ABA Fee Schedule
| Code | Service | Rate | Unit | Effective | Source |
|---|---|---|---|---|---|
| 97151 | Behavior identification assessment (flat per-assessment, 1 unit per 365 days) Stored $882.78 (eff 7/1/2025) verified as the prior rate; reduced to $866.88 effective 10/1/2025 and unchanged in the Jan 2026, Apr 2026, and current July 2026 (FY26-27) schedules. Flat-rate structure in place since 2/11/2024. | $866.88 | per assessment | 2025-10-01 | source |
| 97151 (TJ) | Behavior identification assessment, supplemental units (97151-TJ) Rate confirmed in July 2026 fee schedule XLSX. Per HCPF guidance, 97151-TJ is limited to 2 units per 365 days alongside the flat base 97151. Unit is the standard CPT 15-min unit (fee schedule does not restate units); was $40.24 in July 2025 schedule. | $39.61 | per 15 min | 2025-10-01 | source |
| 97153 | Adaptive behavior treatment by protocol (RBT-delivered) Stored $18.17 was the July 2025 rate; reduced to $17.20 effective 10/1/2025, carried through the current July 2026 (FY26-27) schedule. Per HCPF PM 25-005 (2025), only RBTs may deliver 97153. Single rate, no practitioner tiering. | $17.20 | per 15 min | 2025-10-01 | source |
| 97154 | Group adaptive behavior treatment by protocol (technician) Stored $11.51 was the July 2025 rate; cut sharply to $8.81 effective 10/1/2025, unchanged in current July 2026 schedule. | $8.81 | per 15 min | 2025-10-01 | source |
| 97155 | Adaptive behavior treatment with protocol modification Stored $26.62 was the July 2025 rate; reduced to $25.80 effective 10/1/2025, unchanged in current July 2026 schedule. | $25.80 | per 15 min | 2025-10-01 | source |
| 97158 | Group adaptive behavior treatment with protocol modification Stored $17.83 was the July 2025 rate; cut sharply to $9.34 effective 10/1/2025, unchanged in current July 2026 schedule. | $9.34 | per 15 min | 2025-10-01 | source |
How Colorado Compares
| Code | Colorado | National median | Difference |
|---|---|---|---|
| 97151 (TJ) | $39.61 | $29.14 | 36% above national median |
| 97153 | $17.20 | $15.00 | 15% above national median |
| 97155 | $25.80 | $24.18 | 7% above national median |
Market Context
Colorado has had an autism insurance mandate since 1992. About 522,907 children in Colorado are enrolled in Medicaid. Autism prevalence is 3.5% (2022 data). ProviderSpark lists 574 verified ABA provider locations in Colorado.
Getting Paneled with Health First Colorado
ABA is delivered under Health First Colorado’s “Pediatric Behavioral Therapies” (PBT) benefit, and enrollment order matters — group enrollment has to happen before any individual clinician can be added.
- Enroll the practice or clinic first as Provider Type 83 (Behavioral Therapy Group). This has to be submitted before any individual can enroll. See HCPF’s PBT provider page.
- Each clinician then submits a separate Provider Type 84 (Behavioral Therapy Individual) application through the Online Provider Enrollment tool, listing an affiliation with the PT83 group — applications without that affiliation won’t be approved.
- Complete “Next Steps”: submit required documents to Gainwell Technologies, the fee-for-service fiscal agent, for Provider Web Portal claims access and provider training.
- Before starting services, submit a Prior Authorization Request (PAR) — with a standardized assessment, a referral, and the member’s plan of care — through Acentra’s (formerly Kepro) Atrezzo portal.
- For onboarding help or the public provider list, contact HCPF’s EPSDT team.
How Colorado Delivers ABA
Colorado runs PBT as straight fee-for-service — no managed care organization sits between you and reimbursement. The rate HCPF publishes is the rate you’re paid; there’s no plan-by-plan negotiation to shop for a better contract. That also means recent cuts hit every provider the same way: CPT 97153 (RBT-delivered direct service) pays $17.20 per 15-minute unit and CPT 97155 (BCBA-level service) pays $25.80, both effective October 1, 2025 — down from $18.17 and $26.62, part of a statewide budget-shortfall rollback.
Billing Notes
Prior authorization is required for every PBT/ABA service before treatment starts, submitted via Acentra’s Atrezzo portal and reviewed by Acentra’s clinical reviewers. An approved PAR is good for up to six months before you resubmit. If denied, you have four paths: reconsideration, a new PAR with more information, a peer-to-peer review, or a formal appeal to the Office of Administrative Courts.
Telehealth is allowed more broadly for PBT than for other outpatient therapies. HCPF’s Telemedicine and eConsult Billing Manual states “Pediatric Behavioral Treatment may be provided via any telemedicine modality” — wider than the audio/visual-only rule for outpatient PT/OT/speech.
Two details to watch: 97153 requires an active RBT credential, and 97155 requires a BCBA or equivalent — claims can be denied if the credential doesn’t match the code. CPT 97151 (assessment) is billable once per 365 days. All providers had to migrate from legacy Provider Type 24/25 to Provider Type 83/84 by September 1, 2025; unclosed old enrollments were closed automatically, causing claims delays for stragglers. Home and community visits also require Electronic Visit Verification, and clinic-setting PBT is capped below 40 hours a week when a child has school access, unless the district can show it can’t serve that child in a classroom.
Common Questions
What does Colorado Medicaid pay for CPT 97153?
Colorado Medicaid pays $17.20 per 15 minutes for 97153 (direct treatment by a technician). That is about $68.80 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 Colorado 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: Utah · New Mexico · Arizona · Kansas · Nebraska