Illinois Medicaid ABA Reimbursement Rates (2026)
From official Illinois Medicaid sources. Updated July 2026.
These are the published Illinois 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.
Illinois ABA Fee Schedule
| Code | Service | Rate | Unit | Effective | Source |
|---|---|---|---|---|---|
| 97151 | Behavior identification assessment (professional) GT modifier. Professional (BCBA/QHP) only. Max 8 units/day. | $20.39 | per 15 min | 2022-01-15 | source |
| 97153 | Adaptive behavior treatment by protocol (tech) Technician/RBT rate. Max 32 units/day. | $13.00 | per 15 min | 2022-01-15 | source |
| 97155 | Adaptive behavior treatment w/ protocol modification GT modifier. Professional (BCBA/QHP) only. Max 24 units/day. | $20.39 | per 15 min | 2022-01-15 | source |
| 97156 | Family adaptive behavior treatment guidance GT modifier. Professional (BCBA/QHP) only. Max 16 units/day. | $20.39 | per 15 min | 2022-01-15 | source |
How Illinois Compares
| Code | Illinois | National median | Difference |
|---|---|---|---|
| 97151 | $20.39 | $29.14 | 30% below national median |
| 97153 | $13.00 | $15.00 | 13% below national median |
| 97155 | $20.39 | $24.18 | 16% below national median |
| 97156 | $20.39 | $22.50 | 9% below national median |
Market Context
About 1,365,759 children in Illinois are enrolled in Medicaid. Autism prevalence is 3.5% (2022 data). ProviderSpark lists 274 verified ABA provider locations in Illinois.
Getting Paneled with Illinois Medicaid for ABA (Adaptive Behavior Support)
Illinois Medicaid, officially the HFS Medical Assistance Program, pays for ABA under the name Adaptive Behavior Support (ABS) services. Note the naming shift if you’re reading older documentation: the October 2020 launch notice called this “Applied Behavioral Analysis (ABA) services,” but current HFS notices and the Administrative Code both use Adaptive Behavior Support, or ABS.
Enrollment runs through the state’s IMPACT system:
- Create a Single Sign-On (SSO) ID via the IMPACT login page.
- Once your SSO ID is approved, log back into IMPACT Provider Enrollment and click NEW ENROLLMENT.
- On the Basic Information page, select your Applicant Type: Independent Sole Proprietor or Rendering/Servicing Provider.
- Select the correct Provider Type/Specialty for your credential, for example RBTs select “Adaptive Behavior Supports / ABS Registered Behavior Technician,” on the ABS provider page, then submit for HFS review.
- For enrollment help, contact the IMPACT Help Desk at 877-782-5565 or IMPACT.Help@illinois.gov. For behavioral-health policy questions, contact HFS.BBH@illinois.gov.
How Illinois Delivers ABA
Illinois runs ABS through a hybrid of fee-for-service and managed care. Five MCOs currently carry ABS: Aetna Better Health of Illinois, Blue Cross Community Health Plan (BCBSIL), CountyCare Health Plan (Cook County only), Meridian Health Plan of Illinois (which also administers the YouthCare program for DCFS youth in care, not a separate plan), and Molina Healthcare of Illinois. Your actual reimbursement depends on which MCO a client is enrolled in as much as the state’s FFS fee schedule, so paneling with the MCOs active in your area matters as much as your HFS enrollment itself.
Billing Notes
Prior authorization applies across ABS. Behavioral Assessment and Treatment Planning (BATP) needs PA only once you request more than 6 hours (24 units) in a 180-day period; past that threshold, submit a clinical narrative justifying the extra time. All Behavioral Analytic Intervention (BAI) services require PA, and every BAI request must include the recipient’s BATP, completed within 30 days of the request date.
ABS covers clients age 0 through 20 (under 21) with an autism spectrum disorder diagnosis, per Public Act 101-10. You cannot seek reimbursement until your IMPACT enrollment is fully approved.
Supervision rules changed in 2022: effective February 1 (PA 103-0102), HFS dropped the requirement that unlicensed ABS Clinicians and Technicians be supervised by a licensed healing-arts practitioner, and dropped the mandatory written collaborative agreement between enrolled ABS providers. RBTs still need ongoing supervision from a BCBA: at least 5% of monthly service hours, including two face-to-face contacts. HFS policy has shifted more than once since 2020, so confirm current requirements before you bill.
Common Questions
What does Illinois Medicaid pay for CPT 97153?
Illinois Medicaid pays $13.00 per 15 minutes for 97153 (direct treatment by a technician). That is about $52.00 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 Illinois 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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