Idaho Medicaid ABA Reimbursement Rates (2026)
From official Idaho Medicaid sources. Updated July 2026.
These are the published Idaho 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.
Idaho ABA Fee Schedule
| Code | Service | Rate | Unit | Effective | Source |
|---|---|---|---|---|---|
| H0004 | Behavioral Intervention, Individual — EBM Intervention Paraprofessional No modifier on this tier per the state schedule. | $14.34 | per 15 min | 2025-09-01 | source |
| H0004 (HA) | Behavioral Intervention, Individual — Intervention Technician CHIS analog of 97153 (technician-delivered 1:1 treatment). | $13.54 | per 15 min | 2025-09-01 | source |
| H0004 (HN) | Behavioral Intervention, Individual — Intervention Specialist | $15.48 | per 15 min | 2025-09-01 | source |
| H0004 (HO) | Behavioral Intervention, Individual — Intervention Professional | $21.34 | per 15 min | 2025-09-01 | source |
| H0004 (TF) | Behavioral Intervention, Individual — EBM Intervention Specialist EBM tier ~ RBT/BCaBA-analog under ABA model. | $18.51 | per 15 min | 2025-09-01 | source |
| H0004 (TG) | Behavioral Intervention, Individual — EBM Intervention Professional Top individual-treatment rate; BCBA-analog EBM tier (closest analog of 97155). | $24.68 | per 15 min | 2025-09-01 | source |
| H0005 (HA) | Behavioral Intervention, Group — Intervention Technician CHIS analog of 97154. Priced per participant per 15 min. | $5.41 | per 15 min | 2025-09-01 | source |
| H0005 (HO) | Behavioral Intervention, Group — Intervention Professional CHIS analog of 97158. Other group tiers: HN $6.18, no-mod EBM para $5.73, TF $7.41, TG $9.88. | $8.53 | per 15 min | 2025-09-01 | source |
| H0024 | Family Education — Individual (support service) Children’s DD support service deducted from the child’s independent budget; group (HQ) pays $4.13. | $12.39 | per 15 min | 2025-09-01 | source |
| H0032 (HN) | Assessment and Clinical Treatment Plan — Intervention Specialist CHIS analog of 97151 assessment. DDA fee schedule, last reviewed 1/1/2026. | $15.48 | per 15 min | 2025-09-01 | source |
| H0032 (HO) | Assessment and Clinical Treatment Plan — Intervention Professional | $21.34 | per 15 min | 2025-09-01 | source |
| H0032 (TF) | Assessment and Clinical Treatment — EBM Intervention Specialist EBM = evidence-based model tier (ABA pathway). | $17.63 | per 15 min | 2025-09-01 | source |
| H0032 (TG) | Assessment and Clinical Treatment — EBM Intervention Professional Highest assessment tier; BCBA-level EBM professional. | $21.82 | per 15 min | 2025-09-01 | source |
| H2014 | Habilitative Skill Building — Individual Core CHIS skill-building service delivered by DD agencies. Group (HQ) pays $5.41. | $13.54 | per 15 min | 2025-09-01 | source |
| H2019 (HT) | Interdisciplinary Training Caregiver/team training component of CHIS (nearest analog of 97156 family guidance). | $15.48 | per 15 min | 2025-09-01 | source |
Market Context
About 152,556 children in Idaho are enrolled in Medicaid. Autism prevalence is 2.8% (2022 data). ProviderSpark lists 31 verified ABA provider locations in Idaho.
Getting Paneled with Idaho Medicaid
Idaho Medicaid (Basic Alternative Benefit Plan) now bills ABA-type services as Children’s Habilitation Intervention Services (CHIS), under the “Behavioral Intervention” (BI) benefit — replacing the old “Behavior Modification and Consultation” (BMC) benefit as of 12/1/2025. Enrollment requires three separate approvals — Children’s Developmental Disabilities qualification review, Gainwell provider enrollment, and Telligen prior authorization — all in hand before you can bill.
- Complete an Idaho Background Check through the Idaho Background Check Unit (Pay Code QTKBYM, “HCBS – Children”), required before the Provider Enrollment Application.
- Get CPR/First-Aid certification, general liability insurance, and an NPI via NPPES (taxonomy 222Q00000X, 106S00000X, or 103K00000X depending on tier).
- Register a Trading Partner Account, then submit the Provider Enrollment Application through the Gainwell portal with your Provider Agreement, W9, EFT Agreement, background-check clearance, and liability proof.
- Submit degree/transcript, supervised-hours logs, and 40-hour ABA training or competency checklist to the Children’s Developmental Disabilities program for qualification review.
- Register with Telligen, the prior-authorization vendor, via its Qualitrac portal, before delivering billable services.
How Idaho Delivers ABA
CHIS/Behavioral Intervention is fee-for-service, not managed care. Magellan Healthcare still runs Idaho’s broader behavioral-health managed-care contract, but as of 12/1/2025 ABA/CHIS billing and prior authorization were carved out of it — claims now go through Gainwell, and prior authorization goes through Telligen’s Qualitrac portal, so you enroll directly with the state for ABA, not with an MCO. Idaho’s 2025 legislature passed HB 345, directing a future shift to comprehensive managed care, but that isn’t expected until roughly 2029.
Billing Notes
Prior authorization is required for essentially all CHIS/Behavioral Intervention services, submitted through Telligen’s Qualitrac portal. Initial requests need the Assessment and Clinical Treatment Plan (ACTP) and requested hours by provider tier; up to 24 hours over 30 days can be delivered while the initial PA is pending. Ongoing PA reviews happen at least every 6 months. Crisis Intervention alone can be authorized retroactively, within 72 hours.
Telehealth is limited within CHIS. Only Crisis Intervention is named as an eligible virtual care service — Habilitative Skill Building and Behavioral Intervention are defined as direct, participant-present services, so treat those as not currently telehealth-reimbursable unless confirmed otherwise with the state.
Idaho’s transition was disruptive: on 10/31/2025 the state told BMC providers that Magellan billing would end 12/1/2025 (Medicaid Information Release MA25-21). In-force Magellan authorizations were honored through their original expiration or 90 days after 12/1/2025, whichever came later. Group services require 2-3 participants per staff for both Habilitative Skill Building (H2014) and Behavioral Intervention (H0004 individual / H0005 group). Behavioral Intervention modifiers are tier-specific (HA Technician, HN Specialist, HO Professional, TF/TG EBM), so claims need the right modifier for the rendering provider’s tier or risk denial. Exact post-transition reimbursement rates weren’t in a published fee schedule at research time — verify current rates directly.
Common Questions
What does Idaho Medicaid pay for CPT 97153?
See the rate table above for the codes Idaho publishes.
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 Idaho 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: Washington · Oregon · Montana · Utah · Nevada