Indiana Medicaid ABA Reimbursement Rates (2026)

From official Indiana Medicaid sources. Updated July 2026.

These are the published Indiana 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.

Indiana ABA Fee Schedule

How Indiana Compares

Market Context

Indiana has had an autism insurance mandate since 2001. About 749,606 children in Indiana are enrolled in Medicaid. Autism prevalence is 3.6% (2022 data). ProviderSpark lists 211 verified ABA provider locations in Indiana.

Getting Paneled with Indiana Health Coverage Programs (IHCP)

IHCP is Indiana’s Medicaid program, delivered through four plans: Healthy Indiana Plan (HIP), Hoosier Healthwise, Hoosier Care Connect, and Indiana PathWays for Aging. A moratorium on new ABA group enrollments and ownership changes began June 6, 2026 for six months — confirm current status before an agency-level application (individual provider enrollment is unaffected).

• Confirm your provider type and specialty: Provider Type 11 with Specialty 615 (Masters/Doctoral or HSPP), 624 (Bachelors), or 625 (RBT).
• Review requirements on the Become an IHCP Provider page.
• Apply through the IHCP Provider Healthcare Portal (run by Gainwell).
• Pay the application fee per service location, for initial enrollment, revalidation, or ownership changes.
• For managed-care members, credential separately with the relevant plan — MCE claims go to the plan, not fee-for-service. See IHCP bulletins.

How Indiana Delivers ABA

Indiana runs a hybrid model: some ABA is fee-for-service, and some runs through managed care — Anthem Blue Cross Blue Shield of Indiana (all four programs), CareSource Indiana (HIP and Hoosier Healthwise), Managed Health Services/MHS (HIP, Hoosier Healthwise, Hoosier Care Connect), UnitedHealthcare Community Plan (Hoosier Care Connect and PathWays for Aging), and Humana Healthy Horizons (PathWays for Aging only). Because coverage splits across five payers, the rate you collect depends on which plan your client is enrolled in — IHCP enrollment alone doesn’t guarantee access to every member; you also need to be credentialed with the specific MCO.

Billing Notes

All ABA requires prior authorization under 405 IAC 5-3 (a BCBA can submit it directly). You’ll need a comprehensive diagnostic evaluation, a standardized behavior assessment, an individualized treatment plan, and a physician referral. Initial authorization runs up to six months; continuing care needs a new PA with documented progress. Requests above 40 hours/week need extra justification.

Telehealth is only partly reimbursable. Just CPT 97155 and 97156 qualify, and only when performed or supervised by an HSPP, BCBA, or BCBA-D — RBTs and BCaBAs cannot deliver ABA by telehealth themselves. In practice, 97155 gets billed via telehealth when a supervisor remotely guides an RBT delivering 97153 in person. All telehealth must be synchronous audiovisual with modifier 95; audio-only doesn’t qualify.

Claims need modifier U1 (RBT), U2 (BCaBA), or U3 (physician, BCBA-D, BCBA, or HSPP) for dates of service on or after January 1, 2024, and since July 1, 2025 your enrolled specialty must match the billed modifier. The biggest change lands April 1, 2026: IHCP restricts ABA coverage to EPSDT (under 21) only, with members 21+ losing coverage after a transition window ending September 30, 2026. A 4,000-hour lifetime cap applies to comprehensive ABA, and rates get cut 6% on non-group ABA services starting April 1, 2026, with another 4% cut to all ABA codes effective April 1, 2027.

Common Questions

What does Indiana Medicaid pay for CPT 97153?

See the rate table above for the codes Indiana 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 Indiana 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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