Florida Medicaid ABA Reimbursement Rates (2026)
From official Florida Medicaid sources. Updated July 2026.
These are the published Florida 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.
Florida ABA Fee Schedule
| Code | Service | Rate | Unit | Effective | Source |
|---|---|---|---|---|---|
| 97151 | Behavior identification assessment | $19.05 | per 15 min | 2026-01-01 | source |
| 97152 | Behavior identification supporting assessment | $12.19 | per 15 min | 2026-01-01 | source |
| 97153 | Adaptive behavior treatment by protocol Same rate for RBT, BCaBA, and BCBA | $12.26 | per 15 min | 2026-01-01 | source |
| 97154 (UN) | Group adaptive behavior treatment (2 clients) UN modifier = 2 patients | $7.58 | per 15 min | 2026-01-01 | source |
| 97155 | Adaptive behavior treatment w/ protocol modification (Lead Analyst) Lead Analyst (BCBA) rate | $19.17 | per 15 min | 2026-01-01 | source |
| 97155 (HN) | Adaptive behavior treatment w/ protocol modification (BCaBA) HN = BCaBA credential level | $15.37 | per 15 min | 2026-01-01 | source |
| 97156 | Family adaptive behavior treatment guidance (Lead Analyst) Lead Analyst (BCBA) rate | $19.05 | per 15 min | 2026-01-01 | source |
| 97156 (HN) | Family adaptive behavior treatment guidance (BCaBA) HN = BCaBA credential level | $15.24 | per 15 min | 2026-01-01 | source |
How Florida Compares
| Code | Florida | National median | Difference |
|---|---|---|---|
| 97151 | $19.05 | $29.14 | 35% below national median |
| 97153 | $12.26 | $15.00 | 18% below national median |
| 97155 | $19.17 | $24.18 | 21% below national median |
| 97156 | $19.05 | $22.50 | 15% below national median |
Market Context
Florida has had an autism insurance mandate since 2008. About 2,355,956 children in Florida are enrolled in Medicaid. Autism prevalence is 4.1% (2022 data). ProviderSpark lists 2185 verified ABA provider locations in Florida.
Getting Paneled with Florida Medicaid
Florida bills ABA under Medicaid as “Provider Type 39.” Since February 1, 2025, most of that billing runs through Statewide Medicaid Managed Care (SMMC 3.0) rather than a single fee-for-service system — so enrolling with Medicaid is only step one. Here’s the path:
- Check required documents and background-screening level with AHCA’s Enrollment Readiness Tool before applying.
- Start your application from AHCA’s Provider Enrollment page.
- Complete the FLMMIS Enrollment Wizard with an active NPI, your BCBA/BCaBA/RBT documentation, a W-9, and disclosure of any owners with a 5%+ stake.
- Track your application with your assigned ATN on the FLMMIS Enrollment Status page and fix any deficiencies within the stated window.
- Once approved, credential and contract separately with each SMMC managed care plan you want to bill — Medicaid enrollment alone doesn’t put you in-network with a plan.
How Florida Delivers ABA
Florida runs a hybrid system. Recipients enrolled in a managed care plan get BA services reimbursed only through that plan; recipients not enrolled stay on traditional fee-for-service. Plans carrying BA benefits include Sunshine Health, Aetna Better Health of Florida, Humana Medical Plan, Molina Healthcare of Florida, Simply Healthcare Plans, Community Care Plan, and UnitedHealthcare Community Plan of Florida (managed through Optum Behavioral Health).
Medicaid enrollment gets you paid for fee-for-service recipients, but for the managed-care population you only get paid once you’ve separately credentialed and contracted with that recipient’s specific plan. Skip that step and you’re a fully enrolled Medicaid provider who still can’t bill for most of your caseload.
Billing Notes
Prior authorization is required for all BA services under Rule 59G-4.125, F.A.C. Submit requests to the recipient’s SMMC plan (or to AHCA/its FFS fiscal agent for non-managed-care recipients) with a comprehensive diagnostic evaluation, measurable target behaviors, and treatment goals; approvals can run up to six months. Sunshine Health’s manual reports 5-day turnaround for MMA/CW/SMI/LTC/HIV programs and 7 days for CMS (per the plan, not AHCA’s own policy).
Telehealth is only partly reimbursable: BCBA/BCBA-D can bill telehealth for caregiver training (CPT 97156), but since May 11, 2023, BCaBAs can no longer bill caregiver training via telemedicine, and RBT supervision of behavior-plan implementation can’t happen by telemedicine either.
A few quirks worth knowing, per Sunshine Health’s ABA billing manual: duplicate-claim denials (EX18) happen when the same RBT bills an identical member, procedure code, and date as separate lines — combine into one claim instead. XP-modifier codes (97153XP, 97155XP) reportedly need a minimum $0.01 charge to be accepted. Third-party-liability recipients need the primary payer’s EOB/EOP attached before Medicaid pays secondary. Starting March 27, 2026, an active NPI is required for Direct Data Entry claims for Provider Type 39.
Common Questions
What does Florida Medicaid pay for CPT 97153?
Florida Medicaid pays $12.26 per 15 minutes for 97153 (direct treatment by a technician). That is about $49.04 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 Florida 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: Georgia · Alabama